Enteral Nutrition in Dementia: A Systematic Review

Abstract

The aim of this systematic review is to evaluate the role of enteral nutrition in dementia. The prevalence of dementia is predicted to rise worldwide partly due to an aging population. People with dementia may experience both cognitive and physical complications that impact on their nutritional intake. Malnutrition and weight loss in dementia correlates with cognitive decline and the progress of the disease. An intervention for long term eating difficulties is the provision of enteral nutrition through a Percutaneous Endoscopic Gastrostomy tube to improve both nutritional parameters and quality of life. Enteral nutrition in dementia has traditionally been discouraged, although further understanding of physical, nutritional and quality of life outcomes are required. The following electronic databases were searched: EBSCO Host, MEDLINE, PubMed, Cochrane Database of Systematic Reviews and Google Scholar for publications from 1st January 2008 and up to and including 1st January 2014. Inclusion criteria included the following outcomes: mortality, aspiration pneumonia, pressure sores, nutritional parameters and quality of life. Each study included separate analysis for patients with a diagnosis of dementia and/or neurological disease. Retrospective and prospective observational studies were included. No differences in mortality were found for patients with dementia, without dementia or other neurological disorders. Risk factors for poor survival included decreased or decreasing serum albumin levels, increasing age or over 80 years and male gender. Evidence regarding pneumonia was limited, although did not impact on mortality. No studies explored pressure sores or quality of life.

Enteral feeding in neurological disorders

“…In addition, there was no difference between enteral tube insertion in an earlier or a later stage in the course of the disease in relation to survival outcome 64. Two recent reviews of observational studies also acknowledged the lack of evidence to suggest a positive correlation between enteral tube feeding and survival 65 66. The risks of enteral feeding in patients with advanced dementia are related to procedural complications, postinsertion tube management (eg, blockages and dislodgements) and the tendency of cognitively impaired patients to interfere with the tube (eg, by pulling the tube out) 59…”

Recent Advances in Enteral Nutrition

“…For instance, dementia is a long-term condition that impacts on people’s cognitive and physical abilities which can affect their nutritional intake, leading to malnutrition [9]. Malnutrition in patients with dementia appears to correlate with cognitive decline and the progression of the disease.…”

“…In a systematic review on the use of enteral nutrition in patients with advanced dementia, Finucance et al [10] did not find any improvements in the rates of aspiration, pressure sores and mortality and therefore concluded that enteral nutrition for patients with dementia should be discouraged [10]. In contrast, recent recommendations from the systematic review by Brooke and Ojo [9] challenged this position and instead suggested the need for a holistic assessment of patients with dementia requiring enteral nutrition and PEG tube placement. These assessments should include a diagnosis of patients—comorbidities, current stage of dementia, acute medical illness and its impact on nutritional status [9].…”

“…In contrast, recent recommendations from the systematic review by Brooke and Ojo [9] challenged this position and instead suggested the need for a holistic assessment of patients with dementia requiring enteral nutrition and PEG tube placement. These assessments should include a diagnosis of patients—comorbidities, current stage of dementia, acute medical illness and its impact on nutritional status [9]. …”

David Oliver: Tube feeding and deteriorating patients—guidelines can take us only so far

“…For instance, a systematic review of PEG feeding in patients with severe dementia found no improvement in survival and showed high complication rates 10. And these procedures carry a high risk of mortality in patients with severe disease and poor physical reserve 11121314…”