Dementia affects 50 million people worldwide (1). Increased preference for eating sweets during dementia is common (2). Let’s explore why that is and if it truly is a “problem.”
Frontotemporal Dementia
Frontotemporal dementia (FTD) is a progressive disorder with changes in behavior, speaking, motor skills, and executive functioning (3).
This is the leading type of early onset dementia (4).
The hypothalamus (part of the brain that controls many systems, including hunger) and other areas of the brain decreases in size.
This likely contributes to changes in eating behavior and food preferences (5, 6).
The reward processing pathways of the brain are impacted, which is linked to increased cravings for sweets (7). Eating habits can become more impulsive.
This is the type of dementia referenced in many research studies regarding sugar intake and dementia.
Alzheimer’s Disease
Alzheimer’s disease (AD) is a type of dementia causing memory loss and confusion. It accounts for 60% of all dementia cases (8).
Changes in eating patterns affect AD patients 3 times more often than other types of dementia (9).
Nutrition Implications of Dementia
Dementia impacts nutritional status in many ways (10) (11):
- Decreased appetite
- Increased appetite
- Swallowing difficulty (dysphagia)
- Hyperphagia (increased sense of strong hunger)
- Preference for sweets
- Preference for carbohydrates
- Eating non food items
- Unintentional weight loss
- Micronutrient deficiencies
- Impaired skin integrity
- Malnutrition
- Impaired taste
- Dehydration
Dementia and Eating Sweets
Dementia commonly leads to impaired taste (12). Taste buds decrease in size and number with age (13). Without high levels of sugar (or salt) foods likely taste very bland.
Many medications also cause taste changes. It is common for the elderly to be prescribed many medications.
Sense of smell, which impacts taste, decreases in even the healthy geriatric population. This occurs even more so in Alzheimer’s disease (14).
This all leads to an increased preference for sweets, because they actually taste good!
Grocery shopping can be difficult and many sugary foods have longer shelf lives.
Cognitive impairment can make preparing meals hard. Many sweets are also easy to have on hand and eat without any preparation.
Simple carbohydrates are usually easy to chew, which can become an increasing problem in the elderly.
Self feeding becomes a common problem in dementia. A lot of desserts and other sweets are finger foods, which can be easy for dementia patients to consume independently.
Is Sugar Intake a Problem?
Let’s compare the pros and cons of increased sweets consumption during dementia.
Pros
- A higher BMI may actually be protective for dementia patients (15). Higher sugar intake could make weight gain, and therefore higher BMI, easier.
- Sweets are higher in calories for smaller volumes. This makes meeting caloric needs easier with less intake.
- Dementia patients are at increased risk for weight loss with their disease process. Sweets are an easy way to add extra calories to a meal.
Cons
- Higher energy intake, particularly from carbohydrates (sugar) is associated with increased likelihood of impaired memory (16).
- A diet high in sugar may increase inflammation in the brain and also stimulate the reward center of the brain leading to more sugar intake (17).
- Higher intake of sugary beverages is linked to lower brain volume and poorer memory (18).
- Filling up on high sugar foods may limit other sources of nutrition, leading to nutrient deficiencies.
Incorporating Variety
Sweets are not the enemy, however adding variety to the diet can help prevent malnutrition and nutrient deficiencies.
Here are some strategies to add more foods:
- Serve sweet vegetables like carrots and sweet potatoes
- Sprinkle sugar on savory foods
- Try different herbs and spices for extra flavor
- Use condiments liberally
- Keep other ready to eat foods on hand and visible
- Serve more finger foods
- Encourage communal dining
- Serve easy to chew foods
- Modify diet textures as necessary
Read Best Foods for Dementia Patients to Eat
Practical Takeaways
Relying on sugar as the main source of intake is not ideal, however sometimes it is the only thing people with dementia will eat.
In these cases where intake is so limited the benefits far outweigh the risks.
Especially when dementia is in its later stages, it is unlikely that these individuals will live long enough to experience any potential negative consequences of excessive sugar intake.
Quality of life and comfort is of utmost importance for those with progressive, degenerative diseases like dementia.
If it comes down to eating dessert or nothing, which would you pick? It comes to a point with dementia where a calorie is calorie, no matter the source.
If sweets bring enjoyment, they can be used as a tool to help prevent or slow weight loss, instead of being something to be feared.
