the importance of nutrition for brain health and during...

The Importance of Nutrition for

Brain Health and during Brain

Disease

Diewerke de Zwarte

Let’s Talk About Brain Health & Brain Disease

27/8/2018

Outline

• Nutrition to maintain brain health

– Cardiovascular health

– Lifestyle factors

• Nutrition during brain disease

– How may Parkinson’s Disease and Dementia

affect eating and drinking?

– Tips which may help

– Useful resources

Nutrition for Brain Health

• Ongoing Research

• No Magic bullet –Lifestyle

approach

• Sufficient evidence to support a

link between some modifiable

risk factors and a reduced risk

for cognitive decline, dementia

and Parkinson’s disease.

Cardiovascular health

• Diabetes

– Prevention: Type 2 diabetes = healthy weight

and diet

– Management: diet, exercise and medication

• Mid-life obesity – not later life

– Healthy balanced diet and exercise

• Mid-life high blood pressure

– Moderate salt intake and healthy weight

• Cholesterol

– Reduce saturated fat, more unsaturated fats.

Lifestyle

• Physical activity

– Related to nutrition as helps to maintain healthy weight

• Diet

– Whole dietary pattern approach

– Mediterranean diet (focus on wholegrains, fruits and vegetables,

fish, nuts, healthy oils - relatively little red meat).

– DASH Diet (dietary approaches to stop hypertension): No

added salt, Lots of vegetables and fruit, wholegrains, low fat

dairy, less meat/poultry/fish, some nuts/seeds/legumes

• Alcohol

– Small to moderate alcohol consumption

How may Parkinson’s Disease and

Dementia affect your eating and drinking?

Many will not experience difficulties with eating and

drinking!

Healthy eating advice as for the rest of our population!

- Food pyramid

- Maintain healthy weight

- Regular exercise

Nutrition difficulties you might face with Parkinson’s Disease

Slowness of movement

Motor fluctuations

“on” and “off” periods

Swallowing difficulties

Medication interactions

Difficulties preparing

meals

Loss of smell

Loss of Appetite

Constipation

Nutrition difficulties you might face with

Dementia

Poor hand-mouth co-ordination

Taste and smell

changes Loss of interest in

food

Paranoia/ Depression

Swallowing Difficulties

Difficulty understanding

the meal process Walking

about during meals

Agitation Shaking/ tremor

Loss of appetite

Constipation

Suspicious of food

Undernutrition

“ Food, however good, is of no nutritional value

unless it is eaten”

Dept. of Health, 1995.

• Weight loss is common, and increases with disease

progression and severity.

• 25% of people coming into hospital are malnourished.

• Malnutrition increases risk of infection, disability and

death.

Parkinson’s Disease Specific

• Motor fluctuations

• Medication Interactions

Dementia Specific

• Walking about during meals

• Difficulty understanding the meal process

• Agitation/ suspicion of food

Both

• Difficulty preparing meals

• Difficulty getting food from plate to mouth

• Taste changes

• Swallowing difficulties

• Constipation

• Loss of appetite

Nutrition difficulties:

Parkinson’s Disease specific

• Motor Fluctuations

– Eat when you feel most comfortable, Snacks can be helpful

• Medication Interactions – Levodopa can cause nausea and vomiting

– Dopamine agonists (pergolide, apomorphine) can cause nausea and vomiting and psychiatric problems

– MAO-B inhibitors (selegiline) can cause insomnia and induce daytime sleeping

– Anticholergenics (benzhexol) can cause dry mouth, constipation and nausea

– Amantidine can cause confusion, hallucinations, insomnia and dry mouth

Protein and Levodopa

• Protein interferes with the absorption of levodopa

• Recommend taking levodopa 45 minutes before a meal

• If nausea is an issue take levodopa with a low protein snack e.g. cracker, biscuit.

• Some studies show dietary protein redistribution can help improve medication efficacy. This is an experimental technique and is NOT standard practice.


Dementia specific

• Walking around during meals

– Finger foods

– Lunch boxes

– Encouragement

• Difficulty understanding the meal process

– Mealtime environment

– Colours

– Assistance

– Finger foods

– Encourage to engage in preparing for the meal


Dementia specific

• Agitation (refusing to eat, “No”)

– Meal time environment

– Take away meal and serve again

5-10 minutes later

– Reason for refusing?

• Suspicious of food

– Avoid mixing tablets into meals

– Is there a problem with the food?

Spicy, hot, cold?

– Consider “liked” and familiar foods

Nutrition Difficulties

• Difficulty Preparing

Meals

– Encourage independence

– Help grocery shopping

– Ready meals

– Meals on wheels

– Frozen foods and long

shelf-life foods

– Easy access foods:

Grated cheese, chopped

carrots, sliced bread.


• Difficulty getting food from plate to

mouth

– Adaptive cutlery from Occupational

Therapist

– Use a non slip mat or damp cloth

underneath the plate or bowl

– Large handled cutlery

– Two handled cups to reduce spillage

– A “stay-warm” plate to keep food hot or

microwave midway through the meal

– Use energy dense finger foods


• Taste changes

– Enjoyed foods

– Food combinations

– Strongly flavoured

foods: salt, sweet,

sour, spicy.

– Cold v’s hot foods


• Swallowing difficulties

– Common in Parkinson’s disease and

later-stage Dementia

– May require a modified consistency

diet e.g. smooth puree diet

– May require modified consistency

fluids

– Need speech and language

therapist involvement

– Need to be referred to the dietitian

as modified consistency diets may

be nutritionally inadequate


• Loss of appetite – Eat little and often – aim for 3 meals and 2-3 snacks

– Aim to use at least 1 x pint full fat milk/day – as drink,

in cereal, sauces, soup, puddings etc.

– Avoid “low fat” and “diet” food and drinks

– Food can be made more nourishing by adding extra

butter, margarine, cream or cheese to savoury foods

or extra honey, jam or cream to sweet foods


• Oral nutritional supplements may be used to

supplement your diet

• Enteral nutrition may be used to prevent or

reverse nutritional deficits during periods of poor

intake or swallowing difficulties.

• As the disease progresses, quality of life and

comfort should be our priority.

• May come a time when someone will completely

refuse food and drinks. Part of natural process

and does not cause distress or discomfort.

Summary

• Nutrition-related modifiable risk factors

• Most do not experience nutritional difficulties.

• Some nutritional difficulties specific to Parkinson’s Disease

and Dementia.

• Seek the help from your dietitian - GP can refer, also in

hospital

• OT and SLT can help reduce nutrition difficulties also.

Thank you for your time!

Gladly welcome any questions

Useful Links

• Nutrition and Dementia: A practical guide

when caring for a person with dementia

(https://www.indi.ie/images/Dementia_Book

let__.pdf)

• Eating well with Parkinson’s Disease

(https://www.indi.ie/resources/fact-

sheets/515-eating-well-with-parkinson-s-

disease.html)

Useful References

• Baumgarta M, Snyderb HM et al, Summary of the evidence on

modifiable risk factors for cognitive decline and dementia: A

population-based perspective, Alzheimer’s & Dementia 11 (2015)

718-726

• Dauncey MJ, Symposium on ‘Early nutrition and later disease:

current concepts, research and implications’ New insights into

nutrition and cognitive neuroscience, Proceedings of the Nutrition

Society (2009), 68, 408–415

• Miller DB, O’Callaghan JP. Do early-life insults contribute to the late-

life development of Parkinson and Alzheimer diseases? Metabolism

(2008)5,2, 44-49

• Volkert D, Chourdakis M et al, ESPEN guidelines on nutrition in

dementia, Clinical Nutrition 34 (2015) 1052e1073

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