Eating difficulties in patients with probable dementia of the Alzheimer type

Seventy-three institutionalized patients suffering from probable dementia of the Alzheimer type (DAT) were surveyed for the presence of eating difficulties. Among 71 patients fed by natural means four different groups emerged: (1) patients who fed themselves (n = 17, 23.9%), (2) patients who had to be fed but posed no other eating problem (n = 13, 18.3%), (3) patients who refused food although they were able to swallow it (n = 18, 25.4%), and (4) patients who choked on liquid and/or solid food, some of whom also refused food (n = 23, 32.4%). Patients who fed themselves were in a less advanced stage of the disease than those who did not, and their average body weight was equal to the ideal weight. The remaining three groups, ie, those with different eating problems, did not differ in mean severity of DAT, and their body weights were significantly lower. The mortality rate during 2 years following the survey was similar in all four groups of patients, although tube feeding was used in only one case. The mortality rate was also similar in patients whose body weights were 20% or more below the median weight for their age, and in patients whose relative body weight was higher. The results of this study suggest that eating difficulties occur in a majority of institutionalized DAT patients, but can be managed without resorting to tube feeding.