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psychoneuro 2004; 30(9): 481-488
DOI: 10.1055/s-2004-835161
Schwerpunkt

© Georg Thieme Verlag Stuttgart · New York

Ernährung und Demenz

Nutrition and DementiaJürgen Bauer1 , Cornel Sieber2
  • 1Lehrstuhl für Innere Medizin V, Universität Erlangen-Nürnberg
  • 2Medizinische Klinik 2 - Schwerpunkt Geriatrie, Klinikum Nürnberg
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Publikationsverlauf

Publikationsdatum:
04. Oktober 2004 (online)

   Lizenzen und Reprints

Zusammenfassung

Die Anzahl von Demenzkranken in Deutschland wird im Rahmen der allgemeinen demographischen Entwicklung in den nächsten Jahrzehnten deutlich zunehmen. Eines der drängendsten Probleme in der Betreuung dieser Patienten ist das der angemessenen Ernährung in den verschiedenen Krankheitsstadien. Es geht hierbei zum einen um die Vermeidung einer frühzeitigen Mangelernährung, welche zusätzliche funktionelle Einbußen bedingen kann. Zum anderen gilt es auch, eine Übertherapie in späten Stadien der Erkrankung zu vermeiden. Demente Patienten sollten in frühen und mittleren Krankheitsstadien auf das Vorliegen einer Mangelernährung gescreent werden. Für durch eine Malnutrition gefährdete Patienten sollten in diesen Stadien inidviduelle Ernährungspläne erstellt werden. Die Einleitung einer enteralen Ernährung in fortgeschrittenen Demenzstadien sollte jeweils Folge einer sorgfältigen Einzelfallentscheidung sein.

Summary

As a consequence of the actual trends in demography the number of patients with dementia will steadily increase during the next decades. One of the most important problems in caring for these patients is to provide adequate nutrition during the different phases of this disease. On the one hand it is essential to avoid early malnutrition which may cause further functional impairment. On the other hand one is to withhold nutritional overtherapy in the final stages of dementia. Patients with dementia should be screened for malnutrition in the early and middle stages of this disease. For patients with risk of or with overt malnutrition individual nutritional plans should be provided. Enteral nutrition in advanced stages of dementia should only be untertaken after a careful and individualized analysis of the situation.

Keywords:

dementia - nutritional screening - enteral nutrition - percutaneous endoscopic gastrostomy - PEG - ethics

Literatur

  • 1 Akerlund BM, Norberg A. An ethical analysis of double blind conflicts as experienced by careworkers feeding severely demented patients.  Int J Nursing Studies. 1985;  22 207-216
    PubMedSuche in Google Scholar
  • 2 Alzheimer's Society .Food for thought. London: Alzheimer's Society 2000
    Suche in Google Scholar
  • 3 Andrieu S. et al. . Nutritional risk factors for institutional placement in Alzheimer's disease after one year follow-up.  J Nutr Health Aging. 2001;  5 113-117
    PubMedSuche in Google Scholar
  • 4 Balestreri L, Grossberg A, Brossberg GT. Behavioral and psychological symptoms of dementia as a risk factor for nursing home placement.  Int Psychogeriatr. 2001;  12 59-62
    PubMedSuche in Google Scholar
  • 5 Biernacki C, Barratt J. Improving the nutritional status of people with dementia.  Br J Nursing. 2001;  10 1104-1114
    PubMedSuche in Google Scholar
  • 6 Burns BJ. et al. . Mental health service use by the elderly in nursing homes.  Am J Public Health. 1993;  83 331
    PubMedSuche in Google Scholar
  • 7 Callahan CM. et al. . Outcomes of percutaneous endoscopic gastrostomy among older adults in a community setting.  J Am Geriatr Soc. 2000;  48 1048-1054
    PubMedSuche in Google Scholar
  • 8 Carver AD, Dobson AM. Effects of dietary supplementation of elderly hospital residents.  J Hum Nutr Diet. 1995;  8 389-394
    PubMedSuche in Google Scholar
  • 9 Cefalu CA. Appropriate dysphagia evaluation and managment of the nursing home patient with dementia.  Ann Long Term Care. 1999;  7 447-451
    PubMedSuche in Google Scholar
  • 10 De Mendonca CA Lima. et al. . Nutritional assessment in patients attending a psychogeriatric hospital.  Age and Nutrition. 1999;  10 9-13
    PubMedSuche in Google Scholar
  • 11 Dwolatzky T. et al. . A prospective comparison of the use of nasogastric and percutaneous endoscopic gastrostomy tubes for long-term enteral feeding in older people.  Clin Nutr. 2001;  20 535-540
    CrossrefPubMedSuche in Google Scholar
  • 12 Edwards NE, Beck AM. Animal assisted therapy and nutrition in Alzheimer's disease.  West J Nursing Res. 2002;  24 697-712
    PubMedSuche in Google Scholar
  • 13 Faxen-Irving G. et al. . The effect of nutritional intervention in elderly subjects residing in group-living for the demented.  Eur J Clin Nutr. 2002;  56 221-227
    CrossrefPubMedSuche in Google Scholar
  • 14 Gillick MR. Rethinking the role of tube feeding in patients with advanced dementia.  N Engl J Med. 2000;  20 206-210
    PubMedSuche in Google Scholar
  • 15 Golden A. et al. . Long-term survival of elderly nursing home residents after percutaneous endoscopic gastrostomy for nutritional support.  Nurs Home Med. 1997;  5 382-389
    PubMedSuche in Google Scholar
  • 16 Guigoz Y, Lauque S, Vellas BJ. Identifying the elderly at risk for malnutrition - The Mini Nutritional Assessment.  Clin Geriatr Med. 2002;  18 737-757
    CrossrefPubMedSuche in Google Scholar
  • 17 Heston LL, Gerrard J, Makris L. Inadequate treatment of depressed nursing home elderly.  J Am Geriatr Soc. 1992;  40 117-122
    PubMedSuche in Google Scholar
  • 18 Meier DE. et al. . High short-term mortality in hospitalized patients with advanced dementia: lack of benefit of tube feeding.  Arch Intern Med. 2001;  161 594-599
    CrossrefPubMedSuche in Google Scholar
  • 19 Miller DK. et al. . Abnormal eating attitudes and body image in older undernourished individuals.  J Am Geriatr Soc. 1991;  39 462
    PubMedSuche in Google Scholar
  • 20 Mitchell SL, Kiely DK, Lipsitz LA. The risk factors and impact on survival of feeding tube placement in nursing home residents with severe cognitive impairment.  Arch Intern Med. 1997;  157 327-332
    CrossrefPubMedSuche in Google Scholar
  • 21 Murphy LM, Lipman TO. Percutaneous endoscopic gastrostomy does not prolong survival in patients with dementia.  Arch Intern Med. 2003;  163 1351-1353
    CrossrefPubMedSuche in Google Scholar
  • 22 Nair S, Hretan H, Pitchumoni CS. Hypoalbuminemia is a poor predictor of survival after percutaneous endoscopic gastrostomy in elderly patients with dementia.  Am J Gastroenterol. 2000;  95 133-136
    CrossrefPubMedSuche in Google Scholar
  • 23 Pick N. et al. . Pulmonary aspiration in a long-term care setting: Clinical and laboratory observations and an analysis of risk factors.  J Am Geriatr Soc. 1996;  44 763-768
    PubMedSuche in Google Scholar
  • 24 Peck A, Cohen Ce, Mulvihill MN. Long-term enteral feeding of aged demented nursing home patients.  J Am Geriatr Soc. 1990;  38 1195-1198
    PubMedSuche in Google Scholar
  • 25 Rovner BW, German PS, Broadhead J. The prevalence and management of dementia and other psychiatric disorders in nursing homes.  Int Psychogeriatr. 1990;  2 13-24
    CrossrefPubMedSuche in Google Scholar
  • 26 Rudberg MA. et al. . Effectiveness of feeding tubes in nursing home residents with swallowing disorders.  J Parent Ent Nutr. 2000;  24 97-102
    PubMedSuche in Google Scholar
  • 27 Sanders DS. et al. . Survival analysis in percutaneous endoscopic gastrostomy feeding: A worse outcom in patients with dementia.  Am J Gastroenterol. 2000;  95 1472-1475
    CrossrefPubMedSuche in Google Scholar
  • 28 Wouters-Wesseling W. et al. . Study of the effect of a liquid nutrition supplement on the nutritional status of psycho-geriatric nursing home patients.  Eur J Clin Nutr. 2002;  56 245-251
    CrossrefPubMedSuche in Google Scholar
  • 29 Volkert D. et al. . Leitlinie Enterale Ernährung in der Geriatrie und geriatrisch-neurologischen Rehabilitation der Deutschen Gesellschaft für Ernährungsmedizin und der Deutschen Gesellschaft für Geriatrie e.V.  Aktuel Ernaehr Med. 2004;  29 1-28
    PubMedSuche in Google Scholar
  • 30 Volkert D. Ernährungszustand, Energie- und Substratstoffwechsel im Alter.  Aktuel Ernaehr Med. 2004;  29 19-197
    PubMedSuche in Google Scholar

Korrespondenzadresse:

Dr. Jürgen Bauer

Institut für Biomedizin des Alterns der FAU Erlangen-Nürnberg

Med. Klinik II - Klinikum Nürnberg

Heimerichstr. 58

90419 Nürnberg

eMail: bauer_j@klinikum-nuernberg.de