Changes in eating habits, including a shift towards sweets or a simplification of meals, can be early indicators of dementia, according to neurologists.
While memory loss is a widely recognized symptom of dementia, which is an umbrella term for cognitive impairments with Alzheimer's disease being the most common, alterations in food preferences and mealtime routines can also signal a decline in cognitive function. These changes, however, are not definitive proof and should prompt a medical evaluation.
"As a neurologist who has spent decades studying brain health and memory, one of the most common questions I get from families is this: ‘My mother has started eating strangely. Does that mean she has Alzheimer’s?’" said Dr. Majid Fotuhi, a neurologist and author.
Fotuhi emphasized that new and unusual eating habits alone, if memory, judgment, and daily functioning appear otherwise normal, should not immediately cause alarm. Such changes could be linked to other conditions like depression, anxiety, medication side effects, or dental issues. A proper medical evaluation is crucial for identifying the cause.
Changes to Observe
One of the earliest signs noted by families is a shift from preparing elaborate meals to making simpler dishes, or ceasing to cook altogether. Dr. Joel Salinas, a clinical associate professor of neurology, explained that complex meals require planning and sequencing, abilities that dementia affects. Dr. Adam Mednick, a neurologist and author, added that difficulties with planning, shopping, and preparing meals can be early dementia signs.
Losing interest in food is another common symptom. This can stem from a reduced sense of smell, which diminishes the pleasure of eating, as much of what is perceived as taste is actually smell. Dr. Salinas noted that meals might be described as bland or flat.
Dementia can also impact interest in activities, including meals, due to associated depression. Furthermore, the social and sensory demands of mealtime, such as conversation and a stimulating environment, can become stressful for individuals with dementia.
Forgetting to eat or remembering that one has already eaten can occur because dementia impairs memory and the body's internal cues for hunger and fullness. "Dementia makes it difficult to interpret the body’s internal signals for hunger and fullness and to connect them to external cues, such as the time of day or the sight of food," Mednick said. This can lead to either eating too little or, in some instances, overeating.
Rigid food choices, where individuals eat the same meals repeatedly, are also common. This can be attributed to decision-making becoming effortful; eating a familiar meal removes one daily decision. "Familiar foods are also predictable, which can feel safer when so much else feels uncertain," Salinas explained. This rigidity can extend to other areas of life, such as insisting on a consistent daily schedule or clothing.
A notable craving for sweets is frequently reported. This change is often linked to damage in the brain's reward and impulse-control circuits. It is particularly common in those with frontotemporal dementia (FTD), which affects the frontal lobe's ability to regulate impulses and food choices, leading to a strong pull toward sweet and starchy foods.
Navigating Mealtime Challenges
For caregivers, managing these eating habit changes can be daunting. Experts suggest focusing on creating a positive mealtime environment rather than pressuring individuals to eat. Consistent meal schedules and serving familiar, liked foods can be beneficial.
Offering smaller meals, avoiding overly full plates, and considering finger foods can help if utensil use is difficult. Eating together can also serve as a reminder for individuals to eat.
To reduce confusion, it is recommended to set the table only at mealtimes and clear it between them. Minimizing distractions, such as turning off the TV during meals, can also aid focus.
When there are cravings for sweet or carbohydrate-dense foods, it is advisable to pair them with nutrient-dense options. Smoothies with ingredients like yogurt, fruit, and nut butter, or adding fruits and vegetables to snacks, can enhance nutritional value. The priority is ensuring adequate calorie intake and weight maintenance.
Consulting with healthcare providers or registered dietitians specializing in geriatrics can offer further strategies for stress-free and nourishing mealtimes. Ultimately, any significant change in eating habits warrants a medical evaluation to determine the underlying cause and appropriate support.