The intermediate and advanced stages of Alzheimer's disease (AD) are frequently associated with weight loss (WL), but WL may even precede the onset of cognitive symptoms. This review focuses on the possible aetiologic and temporal relationships between AD and WL. When WL occurs some years before any signs of cognitive impairment, it may be a risk factor for dementia due to deficiency of several micronutrients, such as vitamins and essential fatty acids, and consequent oxidative tissue damage. The leptin reduction associated with WL may also facilitate cognitive decline. The mechanisms potentially inducing WL in AD include lower energy intake, higher resting energy expenditure, exaggerated physical activity, or combinations of these factors. A hypermetabolic state has been observed in animals with AD, but has not been confirmed in human subjects. This latter mechanism could involve amyloid assemblies that apparently increase the circulating cytokine levels and proton leakage in mitochondria. WL may be caused by patients' increased physical activity as they develop abnormal motor behaviour (restlessness and agitation) and waste energy while trying to perform daily activities. During the course of AD, patients usually find it increasingly difficult to eat, so they ingest less food. AD-related neurodegeneration also affects brain regions involved in regulating appetite. The caregiver has an important role in ensuring an adequate food intake and controlling behavioural disturbances. In conclusion, WL is closely linked to AD, making periodic nutritional assessments and appropriate dietary measures important aspects of an AD patient's treatment.Weight loss: Alzheimer's disease: Dietary intake: Energy expenditure: Malnutrition Alzheimer's disease (AD) is the most common neurodegenerative disease of the brain, representing more than 50% of all dementia cases (1) . It is characterized by multiple cognitive deficits and progressive deterioration in functional performance, and leads to increasing disability and mortality. AD is frequently associated also with nutritional disorders and weight loss (WL), which is considered as one of the criteria for the clinical diagnosis of dementia (2) . The loss of body weight gives rise to loss of muscle mass and strength, and a greater risk of falls, functional dependence and worsening quality of life (3) . To prevent these negative consequences, it is important for clinicians to detect weight variations early and plan appropriate nutritional intervention.The majority of studies report that AD patients lose weight especially in the intermediate and advanced stages of the disease (4) , but some studies suggest that WL may start even several years before dementia sets in, and others indicate that it may occur just before the cognitive symptoms become manifest (5) . This variability in the onset of WL vis-à-vis the clinical signs of dementia, combined with the long latency period of AD, makes it difficult to ascertain the relationship between WL and AD. The question is not only whether WL ...