Neurological Problems Affecting Nutrition in Older Adults

Chapter 13

Central Nervous System

• “Control by committee”

Both photos Courtesy of the Alzheimer's Disease Education and Referral Center, a service of the National Institute on Aging.

Introduction

• Some neurological disorders are caused by nutritional deficiencies.

• Brain’s role in eating– Hypothalamus

• Regulates hunger and satiety• Regulates respiration, body temperature, and

water balance• Important emotion center

– Parietal lobes of the brain• Taste, aroma, texture, and visual

Introduction

• The brain’s role in eating– Parietal lobes of the brain

• Frontal – temperature, taste, and touch– Occipital lobes

• Visual information– Cerebral cortex

• The processing of all information for eating• Injury can affect the desire or interest to eat

Appetite and Anorexia

• Physical Causes of Anorexia– Anorexia of aging

• A result of diminished metabolic rate and decreased energy output

• Compromised socioeconomic situations, depression, and/or dementia

• Endocrine changes with aging• Other anorexins• Diminution of the senses of smell and taste• Parageusia

Appetite and Anorexia

• Physical Causes of Anorexia (cont.)– Assess appetite

• Simplified Nutritional Appetite Questionnaire• Council on Nutrition Appetite Questionnaire• Mini Nutritional Assessment

– Chronic mental health problems

Appetite and Anorexia• Strategies

– Social support– Manage medications– Assess teeth– Avoid alcohol and tobacco, spicy food, and dry

mouth– Adequate water– Meals on Wheels and/or family and neighbor

support– Nutritional snacks– Keep living and eating area clean– Provide companionship during meals

Appetite and Anorexia

• Cancer Cachexia and Anorexia– Complex metabolic wasting syndrome associated

with anorexia – Progressive unintentional weight loss– Depletion of host reserves of adipose tissue,

skeletal muscle, and essential amino acids– Cause: unknown– Therapies

• Various medications and/or supplementation

Appetite and Anorexia

• Depression in Older Adults– Common in older adults– Common in hospital and institutional settings– Malnutrition is prevalent in hospitalized older

adults– Depression sometimes untreated in assisted living

facilities– Geriatric Depression Scale

Appetite and Anorexia

• Depression in Older Adults (cont.)– Systemic and metabolic disorders may have a

depression component– Deficiencies of HUFA, folate– Medications – Anxiety– Pain

Appetite and Anorexia

• Treatment– Medication

• Selective serotonin-reuptakeinhibitors (SSRIs)– Psychotherapy– Medication plus psychotherapy– Frequent monitoring and promotion of good

nutrition, elimination, sleep and rest, and physical comfort

– Assess internal and external influences on hunger and appetite

Appetite and Anorexia

• Isolation– Living alone– Limited access to stores and shopping– Health problems– Lack of social support

• Long-term Care– Often served “restricted” meals

Alzheimer’s Disease and Other Dementias and Nutrition

Alzheimer’s Disease Shown in PET scans

From An Introduction to Human Disease, 7th ed.

Photo courtesy of Leonard V. Crowley, M.D., Century College.

Alzheimer’s Disease and Other Dementias and Nutrition

• The specific cause of AD and most dementias remain unknown

• Neurotransmitter defects in AD patients– Combination of medications for treatment

• Vascular dementia

Alzheimer’s Disease and Other Dementias and Nutrition

• Management– Refer to Box 13-4: Management of Alzheimer’s

Disease and Other Dementias– Establish a routine– Use memory aids– Make mealtime a pleasurable experience– Follow the Mediterranean diet– Take a simple walk every day

Parkinson’s Disease and Dietary Problems

• One of the most common neurological disorders

• Parkinson’s Disease and Eating– Swallowing becomes more difficult– Aspiration becomes common– Risk for pneumonia increases

Parkinson’s Disease and Dietary Problems

• Strategies for Eating– Sit upright when eating or drinking– Tilt head downward when swallowing– Remain seated for 20–30 minutes after snacks and

meals– Eat 4-6 small meals/snacks throughout the day – Limit meal time to <25 minutes– Pause between bites– Small bites of food– Use a straw– Avoid food that are difficult to eat– Thicken foods as needed

Parkinson’s Disease and Dietary Problems

• Medications for Treatment of Parkinson’s Disease– Levodopa

• Effectiveness decreases with extended use and as the disease worsens

– Carbidopa-levodopa– Other commonly used drugs

Parkinson’s Disease and Dietary Problems

• Nutrition Management for Drug Side Effects– Avoid alcoholic beverages– Avoid high protein diets– Avoid foods with high amounts of Vitamin B6– Avoid high amounts of pyroxidine– Nonprotein snack to minimize nausea– Use ginger to treat nausea and vomiting– Limit high-fat or high-fiber meals

The Older Patient with Stroke

• Third most common cause of death in the U.S.• Stroke has many different signs and symptoms• Caused by loss of blood flow to brain and cell

death• Often causes paralysis and neurological

changes

The Older Patient with Stroke

• Stroke Prevention– Multiple risk factors

• Managed with diet, exercise, and medical interventions

– Reduce risk• Tight management of blood glucose• Management of hypertension• Lower homocysteine level• Prevent atrial fibrillation

The Older patient with Stroke

• Stroke Sequelae– High percentage of patients live with deficits

Vitamin B12 Deficiency Dementia

• Bioavailability diminishes with age• Decline of serum B12 to low normal levels• Clinical signs of B12 deficiency• Pernicious anemia

– Result of chronic atrophic autoimmune gastritis, type A

– Multiple signs and symptoms– Diagnosis– Treatment

Postpolio Syndrome

• Viral disease eradicated in the U.S.• Management

– Conservation of energy – Frequent rest periods throughout the day– Planned exercise to prevent further decline in

muscle strength– Nutrition counseling

• Softer foods• Scheduled meals

Conclusion

• Early diagnosis of neurological disorders may help outcomes, as treatment and prevention of further disability may allow the older adult to live with a greater quality of life

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