Fasting for Patients with Dementia
Dr. Maram Khabbaz
Geriatric and Family Medicine Consultant
Dr. Husam Hamed
Geriatric and Family Medicine Consultant
Introduction:
Dementia: Dementia is an acquired disorder that is characterized by a decline in cognition involving one or more cognitive domains (learning and memory, language, executive function, complex attention, perceptual-motor, social cognition). Alzheimer disease (AD) is the most common cause of dementia and one of the leading sources of morbidity and mortality in the aging population. It is increasingly prevalent with advancing age, there were an estimated 4.5 million individuals over the age of 65 years living with clinical AD in the United States in 2011. This figure is projected to rise to 13.8 million in the United States and >130 million worldwide by 2050.
In general, the incidence of dementia doubles every 10 years after 60 years of age. There are more females than males with the disease, particularly over the age of 85 years, due to differences in life expectancy. Aside from age, the most clearly established risk factors for AD are a family history of dementia, rare dominantly inherited mutations in genes that impact amyloid in the brain, and the apolipoprotein E (APOE) epsilon 4 (e4) allele. Although most patients get dementia due to neurodegenerative conditions like Alzheimer disease (AD), Dementia with Lewy bodies (DLB), Frontotemporal dementia (FTD) and Parkinson disease dementia (PDD), some patients can have non-neurodegenerative dementias like Vascular dementia. Non -neurodegenerative Dementia may be reversible, or progression can be slowed or halted, if the underlying cause can be identified and adequately treated. Mixed dementia refers to the coexistence of more than one dementia-producing pathology, most commonly AD and vascular dementia.
Memory difficulty is the most common chief complaint; in addition, patients with dementia also have difficulty with one or more of the following:
· Retaining new information (e.g., trouble remembering events)
· Handling complex tasks (e.g., balancing a checkbook)
· Reasoning (e.g., unable to cope with unexpected events)
· Spatial ability and orientation (e.g., getting lost in familiar places)
· Language (e.g., word finding)
· Behavior
Management of Dementia: The first step in management is an accurate diagnosis of the type of dementia. At present, most of the treatment is symptomatic management. In this regard, important management issues include treatment of behavioral disturbances, environmental manipulations to support function, and counseling with respect to safety issues. A close discussion with the patient's caregiver is essential.
Effect of Dementia on the Ability to Fast: Patients with dementia have a decreased ability to make decisions. This is an important issue as these patients become increasingly unable to make decisions for themselves and may not fully understand the implications of fasting. The likelihood of diminished capacity is related to the severity of cognitive impairment. The decision to fast therefore will depend upon patient ability to understand why he or she is fasting and what it entails. Family members can be instrumental in helping patients make these decisions.
Effects of Fasting on the Patient’s Health:
General Recommendations and Precautions
Dementia affects patients’ ability to comprehend the idea of fasting and increase the risk of forgetting that he/she is fasting which can increase the stress on the patient and the caregiver.
As dementia advances, there is increased risk of malnutrition and dehydration as patient will have decreased appetite and oral intake.
Table 1 attempts to classify possible effects of dementia and clinical situations into the following three categories:
Safe Conditions: (Do not pose any health risk on the patient and medically safe to fast)
Conditions with Uncertain Risk: (Variable risks and cannot make common recommendations. Patients need to discuss with physician)
Likely Harmful Conditions: (Fasting poses clear health risk on the patients and better medically NOT to fa
Table 1. Effects of Fasting on the Patient’s Health
About Nutrition
Nutrition in patients with dementia can be an issue any way as they often forget to eat or may not feel the hunger. Their appetite often decreases and fasting can add additional risk of dehydration and malnutrition. Caregivers should consult with the patient’s physicians to mitigate these risks.
About Medications
Dementia medication is usually scheduled once or twice daily, and can be safely take it at either Suhoor or Iftar, or both.
Table 2: Scheduling Medications During Fasting
