[Enteral nutrition and major neurocognitive disorders: For whom? When?]

Malnutrition is a common condition in patients with dementia, especially in severe cases. It is associated with cognitive decline. Enteral nutrition (EN) should be considered when a high-calorie, high-protein oral diet fails and after a careful assessment of the benefit-risk balance. In the presence of dementia, the initiation of EN should be a multidisciplinary decision. Guidelines from scientist society recommend reserving EN for patients with mild to moderate cognitive disorders for a short period to manage a reversible acute episode. In individuals with severe dementia, no benefit on survival or quality of life has been demonstrated, but rather increased mortality. Oral feeding should then be favored, with individualized adaptations such as a supportive environment, ergonomic adjustments, human assistance, proper oral hygiene. Providing regular information and support to caregivers is indispensable to explain the prognosis.