Expert: Mary Gordon - 2/6/2010

Question
My Mom for yrs. didn't eat milk or it's by products. She is diagnosed w/ AD. She eats everything now. Some days she'll eat 3 sandwiches in 3 hrs. time. Says she never ate and she's hungry. She also loves sweets which she hides in her drawers in her bedroom. She is healthy. Should I be concerned of her eating habits? I live with her and I'm seeing so many changes.

Answer
Hi Karen, some people with dementia may eat too much food. They can forget they have just eaten or they may have a persistent desire for certain foods, such as sweets and snack on these throughout the day. It can be a problem if the sweets kill their appetite for more nutritious foods at meal time, or if they start to gain weight from overeating.

If weight gain becomes an issue, try to keep a good supply of healthy snacks on hand, like pieces of fresh fruit or vegetables like carrot or celery sticks. If sweets are an issue, I'd keep them out of the house - if you do the shopping, you can control her supply, or store them somewhere she can't get at them. I know you don't want to be mean to her, but you don't want her health to be impacted by overeating or too much sugar. You will also want to make sure she is getting enough protein and vitamins.

The overeating is particularly common with the frontal lobe dementias (sometimes called frontotemporal dementia or FTD - there are several types within the category). You might want to ask her specialist if she might have a frontal lobe dementia rather than Alzheimer's. They all end up in the same place (i.e. incurable, progressive, and ultimately leading to complete incapacitation and death). However, it is worth knowing if she might have a frontal lobe dementia, just because some of the symptoms can be a bit different and it always helps to have some idea what to expect.

Binge eating is not uncommon in dementia - although it is most common in FTD. It is called hyperphagia. Feeling full is not just about having a full stomach. You feel full when your brain tells you you have had enough and if that mechanism is damaged, you can keep eating. Another theory is that serotonin levels in the brain are impacted by the dementia, and the compulsion to eat sweets in particular is an effort to boost those levels.

There are several studies that show that people with dementia related hyperphagia will continue to eat as long as food is put in front of them (i.e. if you put three lunches in front of her one after the other, she probably would keep eating). As I said, this may because she doesn't recall eating each one, and her brain isn't telling her body that it has eaten enough.

One of the reasons her taste in food will change is that the brain damage profoundly impacts her ability to smell and taste - which means things she formerly disliked may no longer be unpleasant to her. Because of loss and changes in smell and taste, sometimes they develop a preference for very strong flavors or very sweet things because they can still taste them.

I would try to keep her busy and occupied as a distraction from food - if you can redirect her to some activity, it might help. I don't know if you have considered adult daycare, but it can be a tremendous boon to a caregiver, since the daycare can keep her supervised and occupied all day and provide her with opportunities for socializing, activities, and exercise that would be close to impossible to provide in the home environment.
It also can give you a break knowing she is supervised and busy, and you get some rest, or accomplish some tasks or errands.

You might want to keep your eye on her to make sure she doesn't try to eat non-food items. Believe it or not, this does happen. It is as though they develop a sort of oral fixation, and they can mistake things like soaps or candles for food and try to eat them. So food or non-food, put everything you don't want her to eat out of sight entirely. Out of sight can be out of mind, if you put them somewhere she won't think to look.

A more common problem than your mother is experiencing is a loss of appetite, leading to real problems keeping weight on the person. That brings its own set of challenges. Be prepared that that might be ahead - they also develop a lot of trouble with the mechanics of eating due to loss of muscular control - i.e. feeding themselves, chewing, swallowing etc. and these factors can lead to weight loss.

Hang in there, and come back with any questions at all. Hope this helps.

Mary