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by Alicia S. Landry, PhD, RDN, LDN, SNS, Nina Roofe, PhD, RDN, LD, FAND, Andreina Guedez, MS, Dietetic Intern, Taylor Sherrill, MS, Dietetic Intern, University of Central Arkansas

Patients who have been diagnosed with dementia or Alzheimer’s disease (AD) often experience unintentional weight loss. Malnutrition and unintentional weight loss may lead to the loss of ability to do activities of daily living related to meal consumption such as using feeding utensils and chewing/swallowing.1 Complications of malnourishment include greater infection rate, anemia, hypotension, and increased level of difficulty in healing wounds and pressure ulcers.

In patients who have a chronic illness, achieving or maintaining healthy body weight is critical. Healthy fats along with antioxidants, vitamins, and minerals are essential for optimal well-being and improved cognitive function. Unfortunately, patients diagnosed with AD or dementia often experience challenges related to meal consumption.1 Patients may be unable to self-feed or have loss of taste and swallowing function which makes food unappealing whether at home, assisted living, or in skilled nursing facilities. General recommendations to increase meal consumption in patients with AD or dementia include minimizing distractions, providing feeding assistance, modifying consistencies of food, or providing appetite stimulants. After seeing first-hand the challenges related to mealtimes and the resultant effects of diminished nutrient consumption in patients with AD or dementia, two graduate level dietetic interns committed to researching nutrient consumption in these patients.

Music therapy, defined as the use of music and its elements (sound, rhythm, melody, and harmony) as an intervention to optimize quality of life and improve health and wellbeing, 2, 3 has been used as a form of non-pharmacological treatment for patients with AD and dementia. Benefits of music therapy include improvement in recalling personal memories, common knowledge such as colors and events, general cognitive function, and increasing ability to speak plainly.3 Music therapy may provide an approach to increasing meal consumption in patients diagnosed with AD or dementia; 4 therefore, the purpose of this study was to determine the impact of music on meal consumption in individuals diagnosed with AD and dementia.

Noon meal consumption was measured over the course of six days; three with music and three without. The highest average means, on day two (527.47 g) and day four (625.27 g), were both days in which music was played for the participants. However, after computing means for music and non-music days, there was no significant difference between average meal consumption with or without music. There were several limitations noted in the research but providing music therapy may still be a promising alternative therapy. In future research, evaluating the administration of music (i.e. headphones, ambient noise), consistency of music playing (i.e. every meal, every day for a week), and type of music (i.e. classical, swing, jazz) are important considerations.

A second graduate student noted that since the prevalence of dementia has increased, innovative prevention/treatment strategies are even more relevant to provide cost savings and alleviate caretaker burden. Use of antioxidant vitamins to improve cognitive function in older adults has been examined to a limited extent.5 Quantifying current consumption of these vitamins (i.e., Vitamin C, Vitamin E, and β-carotene) in dementia patients is needed so that caretakers know if supplementation to the normal diet is warranted.

The researcher collected menus from a long term care facility for three days and then collected percentage eaten for all items offered for breakfast, lunch, and dinner, as well as age and diagnosis. Patients in this study met recommendations for Vitamin C and β-carotene; however, Vitamin E was deficient, providing some evidence that antioxidant vitamin intake in meals was not optimum.

Megadoses of antioxidant vitamins have shown an improvement in cognitive function; 5, 6 thus, dietary intake would need supplementation in order to achieve therapeutic effects in these patients. In facilities such as the one where this study was conducted, implementing use of standardized recipes and menu items like carrots, plant-based oils, citrus fruits, bell peppers, and other antioxidant rich foods could be one way to increase intake of Vitamin C, Vitamin E, and β-carotene in patients with AD or dementia.

While encouraging students to conduct research in settings like this may seem intimidating to mentors and advisors, rewards to the students and relationship building with the community are benefits. Unintended (but positive) outcomes from this research included updating menus for residents, reevaluating methods of meal service, and conducting presentations for long term care directors on ways to incorporate music therapy in daily activities for patients with AD or dementia. The students have been able to gain professional skills, research experience, and valuable community contacts through the process.

Finally, recognizing the impact that meal consumption may have on the health and well-being of a patient diagnosed with AD or dementia is critical to improving health and well-being. The incorporation of music during mealtimes along with appropriate vitamin supplementation may improve nutrient intake in patients with AD and dementia and thus warrants further research.

 

References:

  1. Gillette-Guyonnet S, Nourhashemi F, Andrieu S, De Glisezinski I., Ousset, PJ, Riviere D, Vellas B. Weight loss in Alzheimer Disease. Am J Clin Nutr 2000; 71: 637s-642s.
  2. Li C, Liu C, Yang Y, Chou M, Chen C, Lai C. Adjunct effect of music therapy on cognition in Alzheimer’s Disease in Taiwan: A pilot study. Neuropsychiatr Dis Treat 2015; 291. doi:10.2147/ndt.s73928
  3. Simmons-Stern NR, Budson AE, Ally BA. Music as a memory enhancer in patients with Alzheimer’s Disease. Neuropsychologia; 2010, 48(10): 3164-3167. doi:10.1016/j.neuropsychologia.2010.04.033.
  4. Fukui H, Arai A, Toyoshima K. Efficacy of music therapy in treatment for the patients with Alzheimer’s Disease. Int J Alzheimers Dis; 2012: 2012:531646. doi:10.1155/2012/531646.
  5. Li Y, Liu S, Man Y, Li N, Zhou Y. Effects of Vitamin E and C combined with β-carotene on cognitive function in the elderly. Experimental & Therapeutic Medicine 2015; 9(4): 1489-1493. doi: 3892/etm.2015.2274
  6. Viveky N, Toffelmire L, Thorpe L, Billinsky J, Alcorn J, Hadjistavropoulos T, Whiting SJ. Use of vitamin and mineral supplement in long-term care home residents. Appl Physiol Nutr Metab 2012; 37(1): 100-105. doi: 1139/H11-141