Many Alzheimer's patients have problems with eating and nutrition. They can range from not getting enough to eat, to gaining too much weight, to having trouble chewing and swallowing, to eating things they should not eat. A person with Alzheimer's might forget that she's eaten and ask to eat again, or not be able to sit down at the table long enough to get sufficient nutrition from a single meal. She may lose her ability to tell if a food or beverage is too hot to eat or drink, or may not remember her favorite foods.

It is extremely important that both the caregiver and the patient eat a balanced diet. A poor diet can worsen the patient's confusion. For instance, the person who snacks regularly on foods such as candy and pastries often experiences a "sugar high" followed by complaints of being tired, depressed or hungry. "Junk foods" can make the person more restless and disoriented and reduce the craving for regular meals and more nutritious foods.

If the patient is losing weight, it may not be directly related to their dementia. It often indicates another treatable problem. Ask the following questions:

• Does the patient have a problem with their mouth that would make eating difficult, such as sores, poorly fitting dentures, gum disease or dry mouth.
• Does the patient have an additional chronic disease the might lead to loss of appetite , such as intestinal, or cardiac problems or diabetes.
• Is the person constipated or depressed?
• Can the person see adequately ? Sometimes poor eating is related to not being able to see the food.

If you suspect any of the above, it is recommended that you consult with your physician about the best course of action.

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If the person is not eating a sufficient amount of food try the following:

• Prepare some of the person's favorite foods to tempt them.
• Serve a glass of juice before the meal to stimulate the appetite.
• Increase the person's physical activity , through walking or other exercise.
• Plan for small meals throughout the day rather than three large meals or offer nutritious snacks between meals and before bedtime.
• Speak to your physician about adding vitamin supplements .
• Give the person plenty to drink , especially in warm weather.
• Make positive use of distractions . If the person resists eating, take a break; involve her in another activity and return to eating later.
• Do not rush the person ; people with dementia often eat slowly.
• Consider the use of food supplements such as instant breakfast, eggnog mixes, yogurt, and milk shakes.
• Consult your physician about using high calorie liquid diet supplements like Ensure or Sustacal that you can purchase in most pharmacies.

Sometimes the environment is a cause of poor eating. Try the following:

• Minimize distractions, loud noises, and abrupt movements . Turn off the television and consider playing soothing music.
• Make sure that the dining area is well lit so that the person can easily see her food.
• Avoid patterned plates , tablecloths and placemats that might confuse and distract the patient - Use plain white plates or bowls and a placemat of a contrasting color
• Keep the table setting simple . Avoid placing objects on the table that might distract or confuse the individual, such as salt, pepper and ketchup.
• Place the food in a manner that looks appetizing.

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• Restrict portions when appropriate.

• Serve smaller portions of food at more frequent intervals and fill the gaps in between regular meals with healthy snacks.

• Limit or eliminate highly salted foods and sweets.

• If necessary consider putting a lock on the refrigerator or cabinets.

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It is best if the person with dementia can continue to feed themselves for as long as possible, even it means that she is eating with her hands and some of it falls on the floor.

• Don't serve steaming or extremely hot foods or liquids.
• Serve finger food or serve the meal in the form of a sandwich.
• Serve food in large bowls instead of plates or use plates with rims or protective edges. This makes it easier for the person to scoop up the food with their utensils.
• Set bowls and plates on a non-skid surface such as a cloth or towel.
• Use spoons with large handles instead of forks.
• Consider putting out only one utensil , if multiple ones confuse the person.
• Show the person how to eat by demonstrating eating behavior or by doing hand-in-hand feeding. After you get the first bite in her mouth, the person will often begin to eat.
• Use cups and mugs with lids to prevent spilling and fill glasses half full. Use straws that bend. (Cups with lids for children are readily available).
• Give the person the opportunity to eat with other family members for as long as possible.
• Prepare the meal ahead of time so that you can stay with the person during the meal.
• Offer the patient only one item of food on the plate at a time . A full plate with a meat, potato, and vegetable might overwhelm and confuse the person.
• Give the person plenty of time to eat . Keep in mind that it can often take an hour or more for a person with dementia to eat their meal.

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In the later stages of Alzheimer's disease, chewing, swallowing or choking is often a problem. Eating should be a monitored activity at this stage of the illness.

• Chop or cut food into bite-size pieces , and if swallowing is a problem, grind foods using a baby food grinder.
• Avoid foods like nuts, popcorn, and raw carrots that may get lodged in the throat.
• Encourage the person to sit up straight with her head slightly forward . If the person's head tilts backward, move it to a forward position.
• Serve soft foods such as applesauce, cottage cheese and scrambled eggs. A person who has problems chewing will benefit from foods of soft textures such as a peanut butter sandwich instead of a sandwich made of sliced meat, or a mashed potato rather than a fried potato. Turkey or chicken salads are better than sliced meat.
• Serve thicker liquids such as shakes , nectars and thick juices or serve a liquid along with the food.
• Gently move the person's chin to remind her to chew . The person with Alzheimer's sometimes has little sensation of food in her mouth.
• Stimulate chewing by touching the person's tongue with a fork or spoon or lightly stroke her throat to remind her to swallow.
• After the meal is over, check to see that the person has swallowed her food and that nothing remains in her mouth.
• Learn the Heimlich maneuver in order to help the person if choking occurs. To get more information enter the keywords "Heimlich maneuver" into your search engine.

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People with dementia are sometimes unable to differentiate between things that are good to eat and things that are not. This probably comes from damage to perception and memory. Some people will eat the condiments on the table, and some will eat nonfood items such as soap, soil in planters, or sponges. Once this type of problem occurs, remove any objects that may be confused with food.

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Sources: the Alzheimer's Disease and Related Disorders Association, Inc. and "The 36-Hour Day" Revised Edition by Nancy L. Mace, M.A., and Peter V. Rabins, M.d., M.P.H.

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