Many people in hospital after a stroke are at risk of reduced food intake, leading to less effective post-stroke recovery. Finger foods (foods that can be easily transferred from the plate to the mouth without cutlery) have the potential to increase food intake and enable mealtime independence. However, the components of a well-designed trial evaluating a finger food menu in a hospital are unclear, with little published evaluation of how to implement a finger food menu in hospitals. This study aimed to implement a finger food menu and to evaluate the feasibility of using it in a stroke rehabilitation ward.

The feasibility study was a prospective, before-and-after intervention study. Thirty-one hospital inpatients from a stroke ward in a National Health Service hospital in the United Kingdom were included. A finger food menu was offered over two lunchtime meals and compared with the standard lunchtime menu. Feasibility was assessed by evaluating recruitment and retention of patients to the study, feasibility of data collection methods, interrater reliability of plate waste estimations using digital photography and assessing change in food intake. Intervention costs were assessed to support a cost-consequence analysis. Barriers and facilitators to implementation were evaluated through qualitative observations.

Thirty-one participants were recruited (mean age 80, SD 8.5). Retention to the study was low, with 40% of patient participants not completing the study. Attrition was due to participants moving from the study ward. Dietary intake measures were successful via plate waste photography with good interrater reliability κ = 0.709 (95% CI: 0.64-0.77). A cost-consequence analysis identified food costs and staff costs as key to delivering the finger food menu. The ward context and use of an internal facilitator to support the delivery of the intervention are important factors to consider.

Using finger foods in hospitals for older people after stroke is feasible and warrants a future cluster randomised control trial with minor adaptions to the protocol.

As global life expectancy increases, research reveals a critical challenge in aging: the progressive deterioration of immune function, termed immunosenescence. This age-related immune decline is characterized by a complex dysregulation of immune responses, which leaves older adults increasingly vulnerable to infections, chronic inflammatory states, and various degenerative diseases. Without intervention, immunosenescence significantly contributes to morbidity and mortality among the elderly, intensifying healthcare burdens and diminishing quality of life on both individual and societal levels. This review explores the essential role of zinc, a trace element critical for immune health, in mitigating the impact of immunosenescence and slowing the cascade of immunological dysfunctions associated with aging. By modulating the activity of key immune cells and pathways, zinc supplementation emerges as a promising approach to strengthen immunity, reduce oxidative stress, and counteract "inflammaging," a state of chronic, low-grade inflammation that accelerates tissue damage and drives disease progression. Zinc's involvement in cellular defense and repair mechanisms across the immune system highlights its ability to enhance immune cell functionality, resilience, and adaptability, strengthening the body's resistance to infection and its ability to manage stressors that contribute to diseases of aging. Indeed, zinc has demonstrated potential to improve immune responses, decrease inflammation, and mitigate the risk of age-related conditions including diabetes, depression, cardiovascular disease, and vision loss. Given the prevalent barriers to adequate zinc intake among older adults, including dietary limitations, decreased absorption, and interactions with medications, this review underscores the urgent need to address zinc deficiency in aging populations. Recent findings on zinc's cellular and molecular effects on immune health present zinc supplementation as a practical, accessible intervention for supporting healthier aging and improving quality of life. By integrating zinc into targeted strategies, public health efforts may not only sustain immunity in the elderly but also extend healthy longevity, reduce healthcare costs, and potentially mitigate the incidence and impact of chronic diseases that strain healthcare systems worldwide.

Malnutrition is common in dementia patients and can lead to poor outcomes. Also, these patients are often prescribed medications with sedative and anticholinergic effects for various reasons. Thus, we aimed to explore the relationship between drug burden index (DBI), anticholinergic burden (ACB), and nutrition status in community-dwelling older adults with dementia.

A total of 415 outpatients with dementia, evaluated by Mini Nutrition Assessment, and whose drug information is registered are included in study. DBI score was calculated by summing the scores of regularly used anticholinergic and/or sedative drugs taken for at least four weeks prior to admission.

The mean age of participants was 77.4 ± 6.3 years, and the majority were female (64.3%). The most prevalent type of dementia (71.6%) was Alzheimer's dementia. The prevalence of malnutrition is 23.6%. Polypharmacy was present in approximately half of the participants (47.5). In total, 57.0% of the participants were using anticholinergic drugs, and 77% of the participants had drug exposure. In the fully adjusted multivariate models, an increase in DBI score raised the risk of "malnutrition" by 2.12 times (OR, 2.12; 95% CI, 1.15-4.01; P = 0.02), whereas no relationship was determined between ACB score and "malnutrition" (OR, 1.21; 95% CI, 0.98-1.49; P = 0.07).

Older adults with dementia are frequently exposed to drugs with sedative and anticholinergic properties. Considering the relationship between DBI and malnutrition, these drugs and doses should be optimized to prevent malnutrition and its adverse outcomes in this vulnerable population.

For the oldest-old residents around their 90s living in facilities, quality end-of-life care is crucial. While an association between reduced food intake and death is known, specific patterns of intake changes before death are not well-documented.

This study aims to classify food intake changes among residents in Japan's special nursing homes during the 6 months before death, enabling precision care for each group using routinely recorded data.

Sixty-nine deceased older adults from five special nursing homes were studied over 3.5 years (January 2016 to June 2020). Criteria included: at least six months' residency before death, ability to eat orally during the study period, and death within the facility. We created a time-series dataset for 69 participants, documenting their average weekly food intake (on a scale of 0-10). Subsequently, we used cluster analysis to identify clusters of change in the average weekly food intake from the 6 months before death.

Eligible residents' mean age was 89.7 ±  6.7 years, and 79.7% were female. Cluster analysis classified 4 clusters of decline in food intake changes during the last 6 months before death: immediate decrease (n = 14); decrease from 1 month before death (n = 24); decrease from 3 months before death (n = 7); and gradual decrease for 6 months before death (n = 24).

This study identified four groups of food intake prior to death. Recognizing food intake clusters in practical settings can help manage and provide appropriate end-of-life care in facilities with few medical providers but many care providers.

In those with mild cognitive impairment (MCI) and dementia, nutritional intake decreases, increasing nutritional deficiency risk. Dietary supplements (DSs) may be an important source of nutrition, but recent insight into their use in those with normal cognition (NC), MCI or dementia is lacking.

A cross-sectional study design determined prevalence for reported use of 12 DS categories and 19 individual DSs based on co-participant report in 9517 older adult (≥ 55 years) National Alzheimer's Coordinating Center (NACC) participants diagnosed with NC (n = 5361), MCI (n = 1800) or dementia (n = 2347) in 2019. Multivariable binary logistic regression compared reported DS use prevalence between NC, MCI and dementia adjusting for demographics.

Reported use of any DS was highly prevalent (NC: 76.6%, MCI: 73.9% and dementia: 69.6%). For all DS categories and many DSs, reported use was significantly lower in dementia compared to NC. Prevalence of reported use progressively declined from NC, MCI and dementia for 8/12 DS categories, including any vitamin (NC: 71.2%, MCI: 68% and dementia: 62.4%) and any mineral (NC: 34.8% MCI: 28.2% and dementia: 23.5%). This trend was also observed for 4/19 DSs, including vitamin D (NC: 49.2%, MCI: 41.2% and dementia: 36.7%). For vitamin B12 (NC: 15.5%, MCI: 18.2% and dementia: 18.5%) and melatonin (NC: 6.0%, MCI: 7.3% and dementia: 7.9%), prevalence increased from NC to MCI and from NC to dementia.

For many DSs, prevalence was significantly lower in dementia compared to NC. Reported use of any DS was highly prevalent in NACC older adults with NC, MCI or dementia in 2019.

Alzheimer's disease (AD) is a progressive neurodegenerative disorder that primarily affects the elderly, leading to severe cognitive decline and loss of autonomy. The accumulation of amyloid-β peptides and tau proteins in the brain is considered the central pathogenic mechanism, which results in neuronal dysfunction and cell death. Various metabolic disruptions, such as chronic oxidative stress and inflammatory processes, further exacerbate the progression of AD. This review, based on literature from PubMed, SciELO, MDPI, and ScienceDirect, evaluates the role of bioactive compounds and dietary patterns, specifically the Mediterranean and MIND diets, in mitigating the progression of AD. These diets, rich in vitamins, flavonoids, carotenoids, and omega-3 fatty acids, have shown potential in reducing oxidative damage and inflammation in the brain, offering neuroprotective benefits. The findings suggest that bioactive compounds such as vitamin E isomers and polyphenols may delay cognitive decline, presenting a promising avenue for future dietary interventions aimed at optimizing the consumption of these compounds to prevent or slow the onset of AD. Further research is needed to determine the optimal doses and combinations of these bioactive compounds to maximize their protective effects.

Improving supports to enhance wellbeing of people living with dementia is a priority. Engaging people living with dementia, care partners, and other stakeholders in development of interventions increases the likelihood they will be relevant and impactful. We describe the participatory approach used to co-design the Dementia Lifestyle Intervention for Getting Healthy Together (DELIGHT) program, which aims to promote the health and wellbeing of people living with dementia and care partners. The DELIGHT project was guided by a team of researchers, people living with dementia, care partners, and an Alzheimer Society representative. The co-design team included additional people living with dementia, care partners, exercise professionals, dietitians, health care professionals, and community service providers (n = 29). The co-design was planned for in-person but was transitioned to six online, 1.5-h sessions due to COVID-19 related restrictions. We used breakout rooms for discussion, with people living with dementia in each breakout room. Co-design meetings focused on identifying target population and outcomes and developing program components and structure. Two or three guiding questions focused discussion in each meeting. The final co-design session focused on the overall structure of the DELIGHT program. Program resources were iteratively designed with the research team, co-design team, and other external stakeholders. The result of the co-design process was the DELIGHT program, an 8-week, twice weekly program designed to promote living well with dementia for people living with dementia and care partners. Each session includes 50-60 minutes of exercise and 20-30 minutes of facilitated, shared learning with an associated resource. A healthy snack may be offered. Shared learning focuses on healthy eating, sleeping well, mental well-being, social connection, and physical activity. Our vision is that the co-designed DELIGHT program will promote the health and wellbeing of people living with dementia and care partners, increasing the likelihood of living well with dementia.

BackgroundNutrition risk is common in Alzheimer's disease and is associated with symptoms of dementia, cognitive decline, institutionalization, and mortality. Family caregivers who increasingly manage nutrition needs of persons with dementia (PWD) experience high caregiver burden, low health literacy, and nutrition risk. Few interventions for informal caregivers have included nutrition.ObjectiveTo inform design of a future caregiver nutrition intervention.MethodsThis cross-sectional study used a convergent mixed methods approach to 1) assess nutrition status among PWD and caregiver dyads (measures in common included Mini Nutrition Assessment, skin carotenoid, and handgrip strength), and 2) interview caregivers to identify needs and barriers for nutrition intervention. We hypothesized caregiver nutrition literacy is associated with PWD nutrition risk. Data collected in nutrition assessment and interviews were analyzed separately then side-by-side for comparison.ResultsOf 50 dyads, 48% had at least one individual exhibiting nutrition risk, and nutrition status categories (χ2 = 6.25, p = 0.012) between caregivers and PWD were related. Caregiver nutrition literacy was associated with 1) PWD factors including nutrition risk (rho = 0.244), body mass index (BMI) (rho = 0.421), handgrip strength (rho = 0.283), and skin carotenoid (rho = 0.351), and 2) Caregiver factors including nutrition risk (rho = 0.304), diet quality (rho = 0.304), and BMI (rho = 0.333). Interviews with 18 caregivers found caregivers prioritize PWD nutrition, provide more PWD nutrition care since diagnosis, experience social isolation, and would attend nutrition interventions if PWD are included.ConclusionsNutrition risk was more common among caregivers when PWD demonstrated nutrition risk. Factors present in individuals within the dyad were associated with partner nutrition risk. Future research should identify effective approaches for intervening on dyadic nutrition risk.

The triglyceride-cholesterol-body weight index (TCBI), a novel and easily computable nutritional index, incorporates serum triglyceride (TG), total cholesterol (TC), and body weight (BW). This study explored the association between TCBI and cognitive impairment in middle-aged and elderly Chinese populations.

This cross-sectional study employed data from the China Health and Retirement Longitudinal Study (CHARLS) baseline survey, including 7,145 participants. TCBI was calculated as TG (mg/dL) × TC (mg/dL) × BW (kg)/1,000. Cognitive function was assessed based on mental status and episodic memory, with a total score below 11 indicating cognitive impairment. The relationship between TCBI and cognitive impairment was examined using multiple logistic regression, smooth curve fitting, and subgroup analyses.

After full adjustment, each 1-unit increase in log-transformed TCBI (Lg TCBI) was associated with a 29.7% reduction in cognitive impairment risk [odds ratio (OR) = 0.703, 95% confidence interval (CI): 0.529-0.933; p = 0.015]. When Lg TCBI was categorized into quartiles, the Q2, Q3, and Q4 groups exhibited a reduced risk of cognitive impairment by 19.9, 16.3, and 22.9%, respectively (p for trend = 0.043), compared to the Q1 group. Smooth curve fitting revealed a consistent decrease in cognitive impairment risk with higher Lg TCBI levels. Subgroup analysis indicated that the association was stronger among participants aged ≥60 years (OR = 0.655, 95% CI: 0.438-0.979), non-current drinkers (OR = 0.643, 95% CI: 0.451-0.917), and those who engaged in socializing (OR = 0.568, 95% CI: 0.371-0.871).

TCBI was significantly and negatively associated with cognitive impairment in Chinese middle-aged and elderly individuals, with the effect more pronounced in those aged ≥60 years, non-current drinkers, and socially active participants.

Patients enrolling in hospice care are asked their preferences for antibiotic treatment. There is little information regarding which patients are more likely to receive antibiotics. To better inform discussions, we sought to characterize the use of antibiotics in the outpatient hospice setting.

We performed a retrospective review of patients enrolled in outpatient hospice within the Mayo Clinic Health System from 1/1/2017 through 1/1/2023. We calculated what percent of patients received antibiotics based on Hospice Qualifying Condition (HQC), age at enrollment, sex, survival time, and Charlson Comorbidity Index and calculated adjusted odds ratios (aOR). We documented which antibiotics were prescribed based on HQC.

Of 6452 patients identified, 1259 (19.5%) received antibiotic prescriptions. Cephalosporins were the most common class of antibiotics prescribed (22.8% of antibiotics prescribed), followed by fluoroquinolones (20.3%) and penicillin derivatives (14.9%). Patients with Pulmonary HQCs were most likely to receive antibiotics (28.6% aOR 1.85 [1.51-2.25]), those with neurologic HQCs were least likely (14.9% aOR 0.66 [0.53-0.83]). There was no difference of age for those receiving antibiotics (80.7 yr) vs those not receiving (80.3 yr [P = 0.25]), or for sex (male vs female aOR 1.10 [0.96-1.26). 4.6% of those surviving <7d received antibiotics (aOR .22 [0.17-0.29]), compared to 47.7% of those surviving >6mo (aOR 4.46 [3.50-5.69]).

19.5% of patients will receive antibiotics during their hospice course, with more frequent prescriptions in those surviving longer periods and those enrolled for pulmonary conditions. It is important to clarify patient preferences regarding antimicrobial utilization at the time of hospice enrollment.

Alzheimer's disease (AD) is a degenerative disease characterized by progressive cognitive dysfunction. The strong link between nutrition and the occurrence and progression of AD pathology has been well documented. Poor nutritional status accelerates AD progress by potentially aggravating amyloid beta (Aβ) and tau deposition, exacerbating oxidative stress response, modulating the microbiota-gut-brain axis, and disrupting blood-brain barrier function. The advanced stage of AD tends to lead to malnutrition due to cognitive impairments, sensory dysfunctions, brain atrophy, and behavioral and psychological symptoms of dementia (BPSD). This, in turn, produces a vicious cycle between malnutrition and AD. This review discusses how nutritional factors and AD deteriorate each other from the early stage of AD to the terminal stages of AD, focusing on the potential of different levels of nutritional factors, ranging from micronutrients to diet patterns. This review provides novel insights into reducing the risk of AD, delaying its progression, and improving prognosis. HIGHLIGHTS: Two-fifths of Alzheimer's disease (AD) cases worldwide have been attributed to potentially modifiable risk factors. Up to ≈26% of community-dwelling patients with AD are malnourished, compared to 7%∼76% of institutionalized patients. Undernutrition effects the onset, progression, and prognosis of AD through multiple mechanisms. Various levels of nutritional supports were confirmed to be protective factors for AD via specific mechanisms.

Appetite is a strong determinant of nutritional status. As cognitive impairment is usually linked to alterations in eating behaviour, people with dementia might experience changes in appetite with the loss of ability to express their needs, including dietary choices and preferences. The aim of the study was to develop an appetite loss screening tool for older adults, inclusive for those with mild to moderate cognitive impairment. The study questionnaire, consisting of 44 binary items related to appetite, was employed among 127 hospitalized older patients (55.9% women, mean age 79.4 ± 7.1 years) with and without cognitive impairment (31.5% categorized as suspected mild dementia, 26.0% as suspected moderate dementia). An exploratory factor analysis was performed to identify items that constitute the final scale, with a Cronbach's alpha coefficient of 0.81. The final tool consists of seven questions, with a sensitivity of 80% and specificity of 80.6%, using the Council on Nutrition Appetite Questionnaire score as reference. Acceptability post-test was performed in 20 patients (70% women, mean age 79.6 ± 5.3 years) to test the clinical feasibility of the scale. The customized design of the scale, according to the recommendation for written materials for individuals with dementia, empowers older adults, supports diagnosis and encourages their proactivity in the treatment process. The scale was found to perform similarly in older persons with and without cognitive impairment, which renders it a versatile assessment tool.

To explore residents' experiences of the mealtime environment in nursing home.

An exploratory qualitative design was employed to gain in-depth insights.

Twenty semi-structured interviews were conducted with residents at a nursing home. Data were analysed using thematic analysis as outlined by Braun and Clarke. The consolidated criteria for Reporting Qualitative research checklist were used to support the research process.

Four main themes emerged from the analysis: (1) The significance of food, emphasising the centrality of food quality and variety in residents' mealtime experiences. (2) Security through routines, illustrating how established mealtime routines provide comfort and predictability. (3) Variability in staff influence, reflecting residents' perceptions of staff competence and their impact on the dining experience. (4) Limited social interactions, highlighting the varied social dynamics and their effects on residents' sense of community and isolation.

The study underscores the critical importance of food quality, staff compliance and consistent routines in enhancing mealtime experiences in nursing homes. Additionally, it reveals that the ability to choose social interactions plays a significant role in residents' satisfaction and social well-being.

This study provides valuable insights for improving mealtime experiences in nursing homes, suggesting that person-centred care and resident involvement in meal planning can enhance satisfaction and nutritional intake.

The findings offer practical guidance for healthcare management, emphasising the need to prioritise and personalise mealtime environments to better meet residents' needs and preferences.

The aim of this study was to conduct a review of the literature published over the past 18 months and present the latest findings on hydration in individuals with dementia.

A systematic review identified sarcopenia, polypharmacy, delayed oral transit, and poor rinsing ability as markers of eating-drinking-swallowing difficulties in early-stage dementia. A cross-sectional study found a high prevalence of dehydration (57-68%) among dementia patients, associated with hypertension, diabetes, chronic kidney disease, dysphagia, and cognitive decline. An analysis of national dementia care guidelines showed that only the UK and Switzerland addressed assisted nutrition and hydration. "Jelly Drops," a hydrating product for dementia patients, received innovation awards. A study on US Physician Orders for Life Sustaining Treatment forms highlighted inconsistent terminology for end-of-life nutrition and hydration, calling for clearer language to aid decision-making.

The new hydration-related recommendations in the ESPEN 2024 guidelines for dementia reflect a more individualized, proactive, and comprehensive approach to managing hydration. These guidelines emphasize the importance of early detection, personalized interventions, and consistent monitoring to ensure that dehydration is identified and treated promptly. Furthermore, the current literature supports the need for a specific terminology for dementia management using nutrition and hydration to improve patients' health outcomes.

Mild cognitive impairment, dementia and osteoporosis are common diseases of ageing and, with the increasingly ageing global population, are increasing in prevalence. These conditions are closely associated, with shared risk factors, common underlying biological mechanisms and potential direct causal pathways. In this review, the epidemiological and mechanistic links between mild cognitive impairment, dementia and skeletal health are explored. Discussion will focus on how changes in brain and bone signalling can underly associations between these conditions, and will consider the molecular and cellular drivers in the context of inflammation and the gut microbiome. There is a complex interplay between nutritional changes, which may precede or follow the onset of mild cognitive impairment (MCI) or dementia, and bone health. Polypharmacy is common in patients with MCI or dementia, and there are difficult prescribing decisions to be made due to the elevated risk of falls associated with many drugs used for associated problems, which can consequently increase fracture risk. Some medications prescribed for cognitive impairment may directly impact bone health. In addition, patients may have difficulty remembering medication without assistance, meaning that osteoporosis drugs may be prescribed but not taken. Cognitive impairment may be improved or delayed by physical activity and exercise, and there is evidence for the additional benefits of physical activity on falls and fractures. Research gaps and priorities with the aim of reducing the burden of osteoporosis and fractures in people with MCI or dementia will also be discussed.

Community nurses (CNs) play an important role in supporting healthy lifestyles, including healthy eating behaviour of patients. However, many CNs do not incorporate healthy eating support in their daily routines to the fullest extent possible. This study aimed to explore (1) the associations between nurse-related behavioural determinants and self-reported healthy eating support practices of Dutch CNs and (2) CNs' need for additional knowledge.

In this cross-sectional survey design, 244 Dutch CNs completed an online, self-administered questionnaire in October-November 2021. The 60 questionnaire items were related to CNs' characteristics, nurse-related determinants, healthy eating support practices (observing problems, having a conversation about patients' dietary behaviour, motivating patients to eat and drink healthier and supporting patients in goal setting) and the need for additional knowledge. The items on determinants and practices used a 5-point Likert scale. Adjusted prevalence ratios (PRadjusted) with 95% confidence intervals (95%CIs) were obtained for the associations between determinants and practices, using adjusted Poisson regression with robust variance estimations.

More CNs practiced observing problems (75%) and having a conversation (70%) than did motivating patients (45%) and supporting goal setting (28%) at least often. A more positive attitude (PRadjusted 1.8; 95%CI 1.5-2.2), greater self-efficacy (PRadjusted 1.3; 95%CI 1.1-1.5), greater motivation (PRadjusted 1.5; 95%CI 1.3-1.7) and better abilities (PRadjusted 1.4; 95%CI 1.2-1.6) were associated with a greater prevalence of supporting healthy eating at least often (vs. never to sometimes). Barriers were not associated with healthy eating support (PRadjusted 1.1; 95%CI 1.0-1.2). CNs especially desired more knowledge on diet in relation to cancer, gastrointestinal diseases, severe psychiatric diseases and dementia; methods for motivating patients to start and for supporting patients to sustain healthy eating; and dealing with patient autonomy.

This study suggests that nurse-related behavioural determinants such as attitude, self-efficacy, motivation and ability should be addressed to improve CNs' competences in healthy eating support. In addition, based on self-reported need for additional knowledge, it is recommended to pay attention to evidence-based behaviour change techniques, dealing with patient autonomy, and diet in relation to cancer, gastrointestinal diseases, severe psychiatric diseases and dementia.

The STROBE Statement was followed for reporting.

Persons with dementia frequently experience mealtime behavioral problems that can result in reduced or lack of intake of food or fluids. Multiple underlying causes and expressions of mealtime behavioral problems complicate its interpretation and intervention, because problems originating from cognitive and functional decline and behavioral changes may interact. Healthcare professionals and family caregivers may encounter a variety of practical and moral dilemmas in dealing with these problems. We aimed at a better understanding of mealtime behavioral problems and related complex issues in nursing home residents with dementia from a daily practice perspective.

We used a mixed-method Group Concept Mapping approach in this study, and collected data online with a panel of 67 healthcare professionals, researchers and relatives from across The Netherlands. The participants contributed to either or all of the following phases: (1) the generation of ideas (brainstorm), (2) sorting, and (3) rating of the ideas. Subsequent phases included data analysis with Groupwisdom® software and interpretation of the results. Multidimensional scaling and hierarchical cluster analysis resulted in a concept map visualizing the coherence and importance of ideas. Bridging values were calculated, with low values indicating a distinct, clear concept.

Brainstorming resulted in 285 statements representing 85 ideas. The concept map visualized three categories capturing ten clusters which describe the management of mealtime behavioral problems, causes of mealtime behavioral problems, and expressions and interpretations of mealtime behavioral problems. Concepts reflecting direct consequences, ethical components, and considerations to handle challenging situations overlapped on the concept map with the highest bridging values (range 0.58-0.87).

This study added to unraveling the complex nature of mealtime behavioral problems, as perceived in practice. It is recommended to comprehensively analyze all components in the management of these problems, in particular being aware of ethical factors and align care for residents with dementia accordingly.

Due to the continuous aging of the population and consequent increase in dementia, focus on its prevention is of growing importance for public health. Since effective pharmacological treatments are not yet available, other determinants of cognitive decline have become fundamental. Several studies have indicated that the Mediterranean diet (MedDiet) is associated with reduced incident cognitive decline and dementia, but few studies have been conducted in persons already diagnosed with Alzheimer's disease (AD). We age-matched 73 patients with mild-moderate AD with 73 controls (mean age for the whole group = 76.5 ± 6.5; 67.5% women). The cases had a significantly lower adherence to the MedDiet and lower physical activity vs. controls, where only one participant (1.4%) had a high adherence to the MedDiet among cases compared to 5.5% among controls, while 52.5% of the cases had a moderate adherence to the MedDiet vs. 82.2% in controls. In multivariate analysis, only the presence of AD was significantly associated with a lower adherence to the MedDiet vs. controls. Other factors examined (gender, age, physical activity level, multimorbidity, and polypharmacy) were not significantly associated with adherence to the MedDiet. Thus, AD patients had a low adherence to the MedDiet and very low physical activity. Public health strategies aimed at promoting the Mediterranean diet and physical activity for older people should be a priority.

Persons living with dementia and informal caregivers are at a higher risk for malnutrition. Most caregivers are not experts at identifying nutritional complications of dementia. Therefore, we aimed to identify nutrition knowledge and challenges related to feeding and caring for persons with dementia to develop a meaningful intervention.

A mixed-methods approach was used. Eight focus groups were conducted with caregivers of persons living with dementia (n = 28) and healthcare professionals (n = 23). Data was analysed using NVivo software. A questionnaire was administered to identify nutritional challenges. A modified food frequency questionnaire assessed food patterns of caregivers and persons with dementia. Results were compared to Mediterranean-DASH Intervention for Neurodegenerative Delay (MIND) dietary guidelines. Data were analysed using SPSS software.

Four major themes emerged: forgetting to eat, developing food aversions, strong preferences for sweets and weight changes. Findings revealed common strategies used to improve nutrition intake included cueing, supplements and quiet eating environment. Caregivers were impacted by stress leading to poorer food choices and exhaustion. Recommendations for a caregiver program made by participants included education, resources and support. Findings from the food frequencies questionnaire survey showed most participants had a lower dietary diversity compared to the MIND diet guidelines.

With both groups being more prone to malnutrition, this research shows that participants were less likely to obtain adequate nutrition for brain health. Additionally, caregivers are dealing with nutrition issues themselves and their person living with dementia. The findings support the need for registered dietitians to provide tailored nutrition interventions for these families.

The main risk factors for major complications and early mortality after the positioning of percutaneous endoscopic gastrostomy (PEG) reported in the literature are old age, multimorbidity, and the use of inappropriate methods for PEG positioning. A proper PEG positioning technique and adequate post-positioning patient management and surveillance are the main protective factors, but the information on protective factors in the literature is much poorer. The aim of this study was to provide more information on PEG-related complications and mortality in geriatric patients treated with long-term enteral nutrition administered by PEG according to a specific home enteral nutrition (HEN) protocol.

This was a retrospective study based on data from 136 elderly patients in whom PEG was positioned from 2017 to 2023 at the geriatric hospital IRCCS INRCA, Ancona (Italy), 88 of whom were treated with HEN. Data on PEG-related complications, duration of HEN, hospitalizations, and mortality were analyzed.

No complications were registered during or immediately after the PEG positioning. The prevalence of a major complication-buried bumper-was in the lower limit of the range reported in the literature (4.32%). The prevalence of minor complications such as peristomal leakage, inadvertent tube removal, and granulation tissue was higher than that reported in the literature (14.71%, 23.53%, 29.41%), while tube blockage and peristomal site infection were less frequent (8.82%, 38.23%). Three hospitalizations for PEG-related complications occurred. Both the all-cause 30-day mortality and within-two-months mortality were lower than those in the literature (1.92% and 3.84%).

The impact of the risk factors recognized by the literature on complications and mortality could be probably mitigated by improving the PEG placement techniques and pre- and post-PEG placement patient management practices. Data on the prevalence of complications and mortality must be interpreted in correlation to this information.

In view of the global demographic shift, a scientific symposium was organised by the European Society for Clinical Nutrition and Metabolism (ESPEN) to address nutrition-related challenges of the older population and provide an overview of the current state of knowledge.

Eighteen nutrition-related issues of the ageing global society were presented by international experts during the symposium and summarised in this report.

Anorexia of ageing, dysphagia, malnutrition, frailty, sarcopenia, sarcopenic obesity, and the metabolic syndrome were highlighted as major nutrition-related geriatric syndromes. Great progress has been made in recent years through standardised definitions of some but not all syndromes. Regarding malnutrition, the GLIM approach has shown to be suitable also in older adults, justifying its continuous implementation. For anorexia of ageing, a consensus definition is still required. Intervention approaches should be integrated and person-centered with the aim of optimizing intrinsic capacity and maintaining functional capacity. Landmark studies like EFFORT and FINGER have impressively documented the potential of individualised and multifactorial interventions for functional and health benefits. Combining nutritional intervention with physical training seems particularly important whereas restrictive diets and drug treatment should generally be used with caution because of undesirable risks. Obesity management in older adults should take into account the risk of promoting sarcopenia.

In the future, even more individualised approaches like precision nutrition may enable better nutritional care. Meanwhile all stakeholders should focus on a better implementation of currently available strategies and work closely together to improve nutritional care for older adults.

Due to cognitive impairments, people with dementia (PWD) often have difficulties in eating and drinking. This study aimed to assess the nutritional status, dietary quality and eating disturbance issues among PWD in Vietnam.

We conducted a cross-sectional study at the Vietnamese National Geriatric Hospital from April to December 2022. We used Mini-Mental State Exam (MMSE) to classify the severity levels of dementia. Mini Nutritional Assessment (MNA), 24-hour recall, eating disturbance questionnaires, and anthropometric indicators were used to evaluate the nutritional status, dietary quality, and eating disorders of study subjects.

Overall, among 63 study participants, 74.6 per cent of PWD were at risk of or having malnutrition. By dementia classification according to MMSE scale, people with moderate and severe dementia accounted for 53.3 per cent of those who met the recommended energy levels, compared to 42.4 per cent of people with mild dementia and normal people. In the above two groups, around three per cent of participants reached the recommended amount of fibre. Calcium (50-70%), vitamin A (80-90%), and D (90%) were found to be the most severe deficiency forms of minerals and vitamins in both male and female participants. The majority of participants (90.5%) had at least one form of eating disorders with the most frequent issue being appetite changes (76.2%) and swallowing issues (50.8%).

PWD in our sample frequently experienced malnutrition, a lack of essential nutrients, difficulties swallowing, changes in eating habits and appetite. It is neccesary to early screen and assess nutritional status and swallowing disturbance in PWD, and instruct their caregivers to prepare nutritious meals for them.

Multimodal lifestyle interventions can benefit overall health, including cognition, in populations at-risk for dementia. However, little is known about the effect of lifestyle interventions in patients with prodromal Alzheimer's disease (AD). Even less is known about dietary intake and adherence to dietary recommendations within this population making it difficult to design tailored interventions for them.

A 6-month MIND-ADmini pilot randomized controlled trial (RCT) was conducted among 93 participants with prodromal AD in Sweden, Finland, Germany, and France. Three arms were included in the RCT: 1) multimodal lifestyle intervention (nutritional guidance, exercise, cognitive training, vascular/metabolic risk management, and social stimulation); 2) multimodal lifestyle intervention + medical food product; and 3) regular health advice (control group). Adherence to dietary advice was assessed with a brief food intake questionnaire by using the Healthy Diet Index (HDI) and Mediterranean Diet Adherence Screener (MEDAS). The intake of macro- and micronutrients were analyzed on a subsample using 3-day food records.

The dietary quality in the intervention groups, pooled together, improved compared to that of the control group at the end of the study, as measured with by HDI (p = 0.026) and MEDAS (p = 0.008). The lifestyle-only group improved significantly more in MEDAS (p = 0.046) and almost significantly in HDI (p = 0.052) compared to the control group, while the lifestyle + medical food group improved in both HDI (p = 0.042) and MEDAS (p = 0.007) during the study. There were no changes in macro- or micronutrient intake for the intervention groups at follow-up; however, the intakes in the control group declined in several vitamins and minerals when adjusted for energy intake.

These results suggest that dietary intervention as part of multimodal lifestyle interventions is feasible and results in improved dietary quality in a population with prodromal AD. Nutrient intakes remained unchanged in the intervention groups while the control group showed a decreasing nutrient density.

ClinicalTrials.gov NCT03249688, 2017-07-08.

(1) To determine the prevalence of malnutrition risk in hospitalized patients at the end of life (EOL), (2) to evaluate which nutritional interventions are administered in hospitalized end-of-life patients with malnutrition risk and (3) to assess the association of end-of-life care and the administration of medical nutrition therapy in patients with malnutrition risk.

Cross-sectional multi-center study SETTING: Hospital PARTICIPANTS: Hospitalized adult patients MEASUREMENTS: Based on the valid and reliable questionnaire of the Nursing Quality Measurement 2.0 (LPZ), the parameters of demographic data, medical diagnoses, end-of-life phase, care dependency, malnutrition risk according to the Malnutrition Universal Screening Tool (MUST) and nutritional interventions conducted in patients at risk of malnutrition were assessed. Descriptive statistics and statistical tests were conducted. Logistic regression models were established to identify odds ratios (OR) and confidence intervals (CI) for the association of end-of-life care and the provision of medical nutrition therapy. This was done separately for oral nutritional supplements (ONS), enteral nutrition and parenteral nutrition as the respective dependent variables.

Of all 12,947 participants, 706 (5.5%) were in an end-of-life phase. The prevalence of malnutrition risk in end-of-life patients was 41.1% compared to 24.7% in other patients (p < 0.001). End-of-life patients with malnutrition risk received more nutritional interventions than other patients with malnutrition risk. The regression models showed that being at the end of life (CI 1.30, 2.63; p < 0.001), being treated by a dietitian (OR 6.02; CI 4.86, 7.45; p < 0.001), suffering from dementia (OR 1.85; CI 1.10, 3.12; p = 0.02) or cancer (OR 1.56; CI 1.25, 1.96; p < 0.001) increased the chance of receiving oral nutritional supplements. For receiving parenteral nutrition, being at the end of life (OR 1.68; CI 1.04, 2.71; p = 0.04), being treated by a dietitian (OR 5.80; CI 4.07, 8.25; p < 0.001), surgery within the previous two weeks (OR 1.58; CI 1.09, 2.30; p = 0.02), younger age (OR 0.99; CI 0.98, 1.00; p = 0.04), care dependency (OR 0.97; CI 0.96, 0.98; p < 0.001), suffering from a disease of the digestive system (OR 2.92; CI 2.07, 4.11; p < 0.001) or cancer (OR 2.44; CI 1.71, 3.49; p < 0.001) were independent predictors. Being at the end of life did not influence the application of enteral nutrition.

This study showed that nutritional interventions are often applied in end-of-life patients admitted to general hospitals. Being at the end of life was positively associated with the application of oral nutritional supplementation and parenteral nutrition. This data does not allow a conclusion about the appropriateness of using medical nutrition therapy in this study sample. Judging the appropriateness of medical nutrition therapy at the end of life is challenging because of the high variability of prognostication as well as the wishes and needs of the specific patients and their relatives that influences the appraisal of adequate interventions. Every decision about nutrition and hydration in end-of-life patients should be a shared decision and be based on advanced care planning principles.

To further develop and validate the Mealtime instrument, an observational instrument for assessing mealtime environments in nursing homes originating from the theoretical framework: Five Aspects Meal Model (FAMM).

A mealtime experience is significant for a sense of well-being. In nursing homes, residents' personal preferences, combined with their diagnoses and different stages of illness, influence their mealtime experience and provide a complexity that has been found difficult to assess. Using FAMM, a theoretical framework as its base, this study, attempts to look at different parts of the mealtime environment. FAMM structures the mealtime environment in to five aspects: room, meeting, product, management control system and atmosphere. This study's design includes instrument development and validation.

This study has been approved by the Swedish Ethical Review Authority (dnr 2019-05477).

Methodological study.

An existing instrument, the Mealtime instrument with FAMM as a theoretical framework, was used as a foundation for the development of the Five Aspects Mealtime Environment Observation Instrument (FAME-OI). Content validity index (CVI) was used to validate FAME-OI.

FAME-OI's item-CVI, scale-CVI and modified Kappa displayed high validity. Changes were made in its structure and phrasing. These developments resulted in having a distinct structure in FAME-OI, in reference to FAMM.

FAME-OI is applicable for clinical use in nursing homes and in research; however, adjustments may be needed before its use in other health care facilities.

Dementia is accompanied by a variety of changes that result in an increased risk of malnutrition and low-intake dehydration. This guideline update aims to give evidence-based recommendations for nutritional care of persons with dementia in order to prevent and treat these syndromes.

The previous guideline version was reviewed and expanded in accordance with the standard operating procedure for ESPEN guidelines. Based on a systematic search in three databases, strength of evidence of appropriate literature was graded by use of the SIGN system. The original recommendations were reviewed and reformulated, and new recommendations were added, which all then underwent a consensus process.

40 recommendations for nutritional care of older persons with dementia were developed and agreed, seven at institutional level and 33 at individual level. As a prerequisite for good nutritional care, organizations caring for persons with dementia are recommended to employ sufficient qualified staff and offer attractive food and drinks with choice in a functional and appealing environment. Nutritional care should be based on a written care concept with standardized operating procedures. At the individual level, routine screening for malnutrition and dehydration, nutritional assessment and close monitoring are unquestionable. Oral nutrition may be supported by eliminating potential causes of malnutrition and dehydration, and adequate social and nursing support (including assistance, utensils, training and oral care). Oral nutritional supplements are recommended to improve nutritional status but not to correct cognitive impairment or prevent cognitive decline. Routine use of dementia-specific ONS, ketogenic diet, omega-3 fatty acid supplementation and appetite stimulating agents is not recommended. Enteral and parenteral nutrition and hydration are temporary options in patients with mild or moderate dementia, but not in severe dementia or in the terminal phase of life. In all stages of the disease, supporting food and drink intake and maintaining or improving nutrition and hydration status requires an individualized, comprehensive approach. Due to a lack of appropriate studies, most recommendations are good practice points.

Nutritional care should be an integral part of dementia management. Numerous interventions are available that should be implemented in daily practice. Future high-quality studies are needed to clarify the evidence.

Primary care healthcare professionals (PCHPs) are pivotal in managing chronic diseases and present a unique opportunity for nutrition-related disease prevention. However, the active involvement of PCHPs in nutritional care is limited, influenced by factors like insufficient education, lack of resources, and time constraints. In this position paper The European Society for Clinical Nutrition and Metabolism (ESPEN) promotes the active engagement of PCHPs in nutritional care. We emphasize the importance of early detection of malnutrition by screening and diagnosis, particularly in all individuals presenting with risk factors such as older age, chronic disease, post-acute disease conditions and after hospitalization for any cause. ESPEN proposes a strategic roadmap to empower PCHPs in clinical nutrition, focusing on education, tools, and multidisciplinary collaboration. The aim is to integrate nutrition into medical curricula, provide simple screening tools for primary care, and establish referral pathways to address malnutrition systematically. In conclusion, we urge for collaboration with PCHP organizations to raise awareness, enhance nutrition skills, facilitate dietitian accessibility, establish multidisciplinary teams, and promote referral pathways, thereby addressing the underestimated clinical challenge of malnutrition in primary care.

Malnutrition is common in older adults, and its risk is greater in those living with dementia. Relative to cognitively healthy peers, the prevalence of malnutrition is also increased in individuals with early stages of cognitive disorders owing to pathophysiological, cognitive, and psychosocial changes related to cognitive impairment. Malnutrition is associated with adverse health outcomes, including faster cognitive and functional decline. Here, we provide an overview of the prevention, assessment, and management of malnutrition in older adults, with a special focus on the aspects that are important to consider in individuals with early stages of cognitive disorders. Strategies to prevent malnutrition include systematic screening for malnourishment using validated tools to detect those at risk. If the screening reveals an increased risk of malnutrition, a detailed assessment including the individual's nutritional, medical, and functional status as well as dietary intake should be performed. The management of malnutrition in the early stages of cognitive disorders should be based on the findings of a comprehensive assessment and be personalized according to the individual's specific characteristics. In the article, we also provide an overview of the evidence on vitamin supplements and specific dietary patterns to prevent cognitive decline or attenuate its progression.

Malnutrition is a major problem among older adults with type 2 diabetes mellitus (T2DM). Some studies suggest that well glycaemic control increases the risk of frailty due to reduced intake. Therefore, it could be hypothesised that adequate glycaemic controlled patients may be at risk of malnutrition. This study aimed to examine, in older adults with T2DM, the association between adequate glycaemic control and malnutrition as well as identify the risk factors for malnutrition. Data including general characteristics, health status, depression, functional abilities, cognition and nutrition status were analysed. Poor nutritional status is defined as participants assessed with the Mini Nutritional Assessment as being at risk of malnutrition or malnourished. Adequate glycaemic control refers to an HbA1c level that meets the target base in the American Diabetes Association 2022 guidelines with individualised criteria. There were 287 participants with a median (interquartile range) age of 64 (61-70) years, a prevalence of poor nutrition, 15 %, and adequate glycaemic control, 83·6 %. This study found no association between adequate glycaemic control and poor nutrition (P = 0·67). The factors associated with poor nutritional status were low monthly income (adjusted OR (AOR) 4·66, 95 % CI 1·28, 16·98 for income < £118 and AOR 7·80, 95 % CI 1·74, 34·89 for income £118-355), unemployment (AOR 4·23, 95 % CI 1·51, 11·85) and cognitive impairment (AOR 5·28, 95 % CI 1·56, 17·93). These findings support the notion that older adults with T2DM should be encouraged to maintain adequate glycaemic control without concern for malnutrition, especially those who have low income, unemployment or decreased cognitive functions.

To synthesize recommendations on assessing and managing behavioral and psychological symptoms of dementia (BPSDs) in existing clinical practice guidelines on dementia care to learn from and adapt recommendations to a Canadian context and language for describing BPSDs.

Systematic review.

Moderate to high-quality clinical practice guidelines on dementia care that made 1 or more recommendations on BPSD assessment or management.

We searched MEDLINE, Embase, JBI EBM, PsycINFO, AgeLine, and gray literature for clinical practice guidelines on dementia care making recommendations on BPSD, published between January 1, 2011, and October 13, 2022. Two independent reviewers conducted study screening and data abstraction. Four independent reviewers completed quality appraisal using the Appraisal of Guidelines for Research and Evaluation (AGREE) II tool; included guidelines had a mean overall AGREE II score ≥4.

Our systematic review identified 23 moderate to high-quality clinical practice guidelines (264 recommendations). The mean overall quality score on the AGREE II tool ranged from 4 to 6.5. Recommendations were clearly presented (mean clarity of presentation score 73.5%), but guideline applicability was not consistently addressed (mean applicability score 39.3%). BPSD was the most prevalent term describing neuropsychiatric symptoms (number of guidelines [n] = 14). People with lived experience contributed to 6 guidelines (26.1%). Ten guidelines (43.5%) described 1 or more health equity considerations. Guidelines made recommendations for assessing and managing agitation (n = 12), aggression (n = 10), psychosis (n = 11), depression (n = 9), anxiety (n = 5), apathy (n = 6), inappropriate sexual behavior (n = 3), nighttime behavior (n = 5), and eating disturbances (n = 3). There was substantial variability in recommendation statements, evidence quality assigned to each statement, and strength of recommendations.

There are several moderate to high-quality clinical practice guidelines making recommendations on BPSD assessment and management, but variability in recommendation statements across guidelines and insufficient consideration of guideline applicability may hamper guideline dissemination and implementation in clinical practice.

Hemodialysis (HD) and pressure injuries (PI) are both hypercatabolic states that may contribute to protein-energy wasting development. These conditions require increased energy and protein to prevent losses from HD and support wound healing. Nutrition support therapy using intradialytic parenteral nutrition (IDPN) with or without a combination of oral nutrition supplements has yielded positive outcomes among patients receiving HD with protein-energy wasting. However, IDPN is not a standard of care for patients with PI and receiving HD. No existing guidelines support its use with these combined complex medical conditions. We present a case of an older adult with PI receiving HD who required supplemental IDPN. This case demonstrated that IDPN helps wound healing, reduces the hospital length of stay, and enhances quality of life.

Learning and memory disorder is a cluster of symptoms caused by neuronal aging and other diseases of the central nervous system (CNS). Panax notoginseng saponins (PNS) are a series of saponins derived from the natural active ingredients of traditional Chinese medicine (TCM) that have neuroprotective effects on the central nervous system. In this paper, we review the ameliorative effects and mechanisms of Panax notoginseng saponin-like components on learning and memory disorders to provide valuable references and insights for the development of new drugs for the treatment of learning and memory disorders. Our summary results suggest that Panax ginseng saponins have significant effects on improving learning and memory disorders, and these effects and potential mechanisms are mediated by their anti-inflammatory, anti-apoptotic, antioxidant, β-amyloid lowering, mitochondrial homeostasis in vivo, neuronal structure and function improving, neurogenesis promoting, neurotransmitter release regulating, and probiotic homeostasis in vivo activities. These findings suggest the potential of Panax notoginseng saponin-like constituents as drug candidates for improving learning and memory disorders.

Malnutrition (MN) is a highly prevalent condition in the elderly. It is associated with functional impairment, disability, frailty, and sarcopenia. The aim was to analyze the capacity of GLIM and ESPEN criteria to diagnose MN in a sample of institutionalized psychogeriatric patients. Clinical and anthropometric data were collected in a cross-sectional study. Patients' frailty, dependence, functional capacity, MNA, hand-grip strength (HS), and sarcopenia were evaluated. Body composition (BC) was estimated by conventional bioimpedance analysis. MN diagnosis was established using the ESPEN and the GLIM criteria based on fat-free mass index (GLIM-FFMI), appendicular skeletal muscle mass index (GLIM-ASMMI), skeletal muscle mass index (GLIM-SMMI), and HS (mGLIM). Ninety-two patients (57.6% men; mean age: 79.4 years) were studied. Depending on the diagnosis criteria, MN prevalence was between 25% (ESPEN) and 41.3% (GLIM-SMMI). Agreement between ESPEN and all GLIM criteria was poor, but it was excellent between all GLIM criteria (kappa > 0.8). Phenotypic criteria carried more weight in the diagnosis of MN than etiological ones. Depending on the parameter used, the prevalence of reduced muscle mass was notably different. Differences in BMI, BC, inflammation, and albumin are detected by the GLIM-FFMI criteria in the MN and non-MN subjects. Also, this criterion is the only one that identified differences in phase angle (PhA) between these groups. In the elderly, PhA can be very useful to monitor nutritional status.

This study aimed to comprehensively explore the nutrition and gait of AD patients at different stages and the relationship between them.

A total of 85 AD patients were consecutively enrolled in this cross-sectional study and divided into the mild cognitive impairment (MCI) due to AD (AD-MCI) and the dementia due to AD (AD-D) groups. Demographic information, nutritional status, and gait performance were compared between the two groups, and the correlation between nutritional status and gait performance was subsequently analyzed by Pearson and Spearman correlation analyses.

The AD-D group had lower scores on Mini-Nutritional Assessment (MNA) and MNAm scales, lower levels of urea nitrogen, folic acid, and vitamin B12 in blood, and higher homocysteine level than those in the AD-MCI group (all p < 0.05). The AD-D group had slower step speed, shorter step length, and shorter stride length than those in the AD-MCI group (all p < 0.05). AD patients with decreased scores of MNA and MNAm scales, and declined levels of urea nitrogen and vitamin B12 in blood had reduced gait speed and gait cadence, and prolonged step length time and stride length time, whereas homocysteine showed the almost opposite results (all p < 0.05). In the AD-MCI group, the score of scale was negatively correlated with the coefficient of variation (CV) of stride length, and the folic acid level was negatively correlated with the CV of stride length and cadence (all p < 0.05).

AD patients at the dementia stage had worse nutritional status and gait performance than those at the MCI stage, which was associated with worse global cognition and activities of daily living. Poorer nutritional status was associated with higher gait variability in patients at the MCI stage and with poorer gait performance in patients at the dementia stage. Early identification and intervention of patients with nutritional risk or malnutrition may improve gait performance, thus reducing the risk of falling and cognitive decline, as well as the mortality.

Research on the relationship between diet and dementia among Koreans are lacking. This study investigated the association between dietary habits and dementia progression over 3 years in patients with Alzheimer's disease dementia (ADD).

This study included 705 patients with mild-to-moderate ADD. Dietary habits were assessed using the Mini Dietary Assessment Index, comprising 10 questions. Outcome measures included the Clinical Dementia Rating scale-Sum of Boxes (CDR-SB), Seoul-Instrumental Activities of Daily Living, Caregiver-Administered Neuropsychiatric Inventory (CGA-NPI), and neuropsychological test battery (NTB) z-scores, which were evaluated annually over 3 years.

In Q10 (eat all food evenly without being picky), the 3-year mean differences in CDR-SB (increases in scores represent worsening) compared to the "rarely" group were -1.86 [95% confidence interval (CI)=-3.64 - -0.09, p=0.039] for the "usually" group and -2.23 (95% CI=-4.40 - -0.06, p=0.044) for the "always" group. In Q7 (add salt or soy sauce to food when eating), the 3-year mean differences in CDR-SB compared to the "always" group were -2.47 (95% CI=-4.70 - -0.24, p=0.030) for the "usually" group and -3.16 (95% CI=-5.36 - -0.96, p=0.005) for the "rarely" group. The "rarely" and "usually" groups in Q7 showed significantly less decline in NTB z-score and CGA-NPI compared to the "always" group.

Eating a balanced diet and reducing salt intake were associated with a slower decline in dementia severity, cognition, and behavioral alterations in patients with ADD.

Malnutrition is the most common nutritional issue in Alzheimer's disease (AD) patients, but there is still a lack of a comprehensive evaluation of the nutritional status in AD patients. This study aimed to determine the potential association of various nutritional indices with AD at different stages.

Subjects, including individuals with normal cognition (NC) and patients diagnosed with AD, were consecutively enrolled in this cross-sectional study. Demographics, body composition, dietary patterns, nutritional assessment scales and nutrition-related laboratory variables were collected. Binary logistics regression analyses and receiver operating characteristic (ROC) curves were used to indicate the association between nutrition-related variables and AD at different stages.

Totals of 266 subjects, including 73 subjects with NC, 72 subjects with mild cognitive impairment due to AD (AD-MCI) and 121 subjects with dementia due to AD (AD-D) were included. There was no significant difference in dietary patterns, including Mediterranean diet and Mediterranean-DASH diet intervention for neurodegenerative delay (MIND) diet between the three groups. Lower BMI value, smaller hip and calf circumferences, lower Mini Nutritional Assessment (MNA) and Geriatric Nutritional Risk Index (GNRI) scores, and lower levels of total protein, albumin, globulin, and apolipoprotein A1 were associated with AD (all p < 0.05). Total protein and albumin levels had the greatest ability to distinguish AD from non-AD (AUC 0.80, 95% CI 0.74-0.84, p < 0.001), increased by combining calf circumference, MNA score and albumin level (AUC 0.83, 95% CI 0.77-0.88, p < 0.001). Albumin level had the greatest ability to distinguish NC from AD-MCI (AUC 0.75, 95% CI 0.67-0.82, p < 0.001), and MNA score greatest ability to distinguish AD-MCI from AD-D (AUC 0.72, 95% CI 0.65-0.78, p < 0.001).

Nutritional status of AD patients is significantly compromised compared with normal controls, and tends to be worsened with AD progresses. Early identification and intervention of individuals with nutritional risk or malnutrition may be significantly beneficial for reducing the risk, development, and progression of AD.