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Dorothee Volkert, Anne Marie Beck, Gerd Faxén-Irving, Thomas Frühwald, Lee Hooper, Heather Keller, Judi Porter, Elisabet Rothenberg, Merja Suominen, Rainer Wirth, Michael Chourdakis
Institute for Biomedicine of Aging, Friedrich-Alexander-Universität Erlangen-Nürnberg, Nuremberg, Germany.
Dietetic and Nutritional Research Unit, Herlev and Gentofte University Hospital, Herlev, Denmark.
Clin Nutr. 2024 Jun;43(6):1599-1626. doi: 10.1016/j.clnu.2024.04.039. Epub 2024 May 8.
BACKGROUND & AIMS: Dementia is accompanied by a variety of changes that result in an increased risk of malnutrition and low-intake dehydration. This guideline update aims to give evidence-based recommendations for nutritional care of persons with dementia in order to prevent and treat these syndromes.
The previous guideline version was reviewed and expanded in accordance with the standard operating procedure for ESPEN guidelines. Based on a systematic search in three databases, strength of evidence of appropriate literature was graded by use of the SIGN system. The original recommendations were reviewed and reformulated, and new recommendations were added, which all then underwent a consensus process.
40 recommendations for nutritional care of older persons with dementia were developed and agreed, seven at institutional level and 33 at individual level. As a prerequisite for good nutritional care, organizations caring for persons with dementia are recommended to employ sufficient qualified staff and offer attractive food and drinks with choice in a functional and appealing environment. Nutritional care should be based on a written care concept with standardized operating procedures. At the individual level, routine screening for malnutrition and dehydration, nutritional assessment and close monitoring are unquestionable. Oral nutrition may be supported by eliminating potential causes of malnutrition and dehydration, and adequate social and nursing support (including assistance, utensils, training and oral care). Oral nutritional supplements are recommended to improve nutritional status but not to correct cognitive impairment or prevent cognitive decline. Routine use of dementia-specific ONS, ketogenic diet, omega-3 fatty acid supplementation and appetite stimulating agents is not recommended. Enteral and parenteral nutrition and hydration are temporary options in patients with mild or moderate dementia, but not in severe dementia or in the terminal phase of life. In all stages of the disease, supporting food and drink intake and maintaining or improving nutrition and hydration status requires an individualized, comprehensive approach. Due to a lack of appropriate studies, most recommendations are good practice points.
Nutritional care should be an integral part of dementia management. Numerous interventions are available that should be implemented in daily practice. Future high-quality studies are needed to clarify the evidence.
痴呆症伴随着各种变化，导致营养风险增加和摄入不足脱水。本指南更新旨在为痴呆症患者的营养护理提供循证建议，以预防和治疗这些综合征。
回顾了以前的指南版本，并按照 ESPEN 指南的标准操作程序进行了扩展。根据在三个数据库中的系统搜索，使用 SIGN 系统对适当文献的证据强度进行了分级。审查和重新制定了原始建议，并添加了新的建议，所有建议都经过了共识过程。
制定并达成了 40 项针对痴呆症老年人营养护理的建议，其中 7 项为机构层面的建议，33 项为个人层面的建议。作为良好营养护理的前提，建议照顾痴呆症患者的组织配备足够的合格员工，并在功能和吸引人的环境中提供有吸引力的食物和饮料选择。营养护理应基于具有标准化操作程序的书面护理概念。在个人层面，常规筛查营养不良和脱水、营养评估和密切监测是毋庸置疑的。通过消除营养不良和脱水的潜在原因，以及提供充足的社会和护理支持（包括帮助、餐具、培训和口腔护理），可以支持口服营养。建议使用口服营养补充剂来改善营养状况，但不能纠正认知障碍或预防认知能力下降。不建议常规使用专门针对痴呆症的 ONS、生酮饮食、ω-3 脂肪酸补充剂和开胃剂。在轻度或中度痴呆症患者中，肠内和肠外营养和水合作用是暂时的选择，但在严重痴呆症或生命终末期则不是。在疾病的所有阶段，支持食物和饮料摄入并维持或改善营养和水合状态需要采取个体化、全面的方法。由于缺乏适当的研究，大多数建议都是良好的实践要点。
营养护理应成为痴呆症管理的一个组成部分。有许多干预措施可供选择，应在日常实践中实施。需要未来进行高质量的研究来澄清证据。
