title: ESPEN guidelines on nutrition in dementia.
abstract: BACKGROUND
  Older people suffering from dementia are at increased risk of malnutrition due to various nutritional problems, and the question arises which interventions are effective in maintaining adequate nutritional intake and nutritional status in the course of the disease. It is of further interest whether supplementation of energy and/or specific nutrients is able to prevent further cognitive decline or even correct cognitive impairment, and in which situations artificial nutritional support is justified.
  
  
  OBJECTIVE
  It is the purpose of these guidelines to cover these issues with evidence-based recommendations.
  
  
  METHODS
  The guidelines were developed by an international multidisciplinary working group in accordance with officially accepted standards. The GRADE system was used for assigning strength of evidence. Recommendations were discussed, submitted to Delphi rounds and accepted in an online survey among ESPEN members.
  
  
  RESULTS
  26 recommendations for nutritional care of older persons with dementia are given. In every person with dementia, screening for malnutrition and close monitoring of body weight are recommended. In all stages of the disease, oral nutrition may be supported by provision of adequate, attractive food in a pleasant environment, by adequate nursing support and elimination of potential causes of malnutrition. Supplementation of single nutrients is not recommended unless there is a sign of deficiency. Oral nutritional supplements are recommended to improve nutritional status but not to correct cognitive impairment or prevent cognitive decline. Artificial nutrition is suggested in patients with mild or moderate dementia for a limited period of time to overcome a crisis situation with markedly insufficient oral intake, if low nutritional intake is predominantly caused by a potentially reversible condition, but not in patients with severe dementia or in the terminal phase of life.
  
  
  CONCLUSIONS
  Nutritional care and support should be an integral part of dementia management. In all stages of the disease, the decision for or against nutritional interventions should be made on an individual basis after carefully balancing expected benefit and potential burden, taking the (assumed) patient will and general prognosis into account.
authors.affiliation: Institute for Biomedicine of Aging (IBA), Friedrich-Alexander-Universität (FAU) Erlangen-Nürnberg, Nuremberg, Germany. Electronic address: dorothee.volkert@fau.de.
authors.forename: Dorothee
authors.initials: D
authors.lastname: Volkert
authors.affiliation: Department of Medicine, Aristotle University of Thessaloniki (AUTH), Greece.
authors.forename: Michael
authors.initials: M
authors.lastname: Chourdakis
authors.affiliation: Division of Clinical Geriatrics, Department of Neurobiology, Care Sciences and Society, Karolinska Institutet, Stockholm, Sweden.
authors.forename: Gerd
authors.initials: G
authors.lastname: Faxen-Irving
authors.affiliation: Department of Geriatric Acute Care, Krankenhaus Hietzing, Vienna, Austria.
authors.forename: Thomas
authors.initials: T
authors.lastname: Frühwald
authors.affiliation: Department of Geriatrics, Neurosciences and Orthopedics, Catholic University of the Sacred Heart, Rome, Italy.
authors.forename: Francesco
authors.initials: F
authors.lastname: Landi
authors.affiliation: Unit of Primary Health Care, Helsinki University Central Hospital, Helsinki, Finland.
authors.forename: Merja H
authors.initials: MH
authors.lastname: Suominen
authors.affiliation: Department of Geriatrics, Medical School, University of Antwerp, Belgium.
authors.forename: Maurits
authors.initials: M
authors.lastname: Vandewoude
authors.affiliation: Institute for Biomedicine of Aging (IBA), Friedrich-Alexander-Universität (FAU) Erlangen-Nürnberg, Nuremberg, Germany; St. Marien-Hospital Borken, Department for Internal Medicine and Geriatrics, Borken, Germany.
authors.forename: Rainer
authors.initials: R
authors.lastname: Wirth
authors.affiliation: Nutritional Support Unit, Centre Hospitalier Universitaire de Nice, Nice, France.
authors.forename: Stéphane M
authors.initials: SM
authors.lastname: Schneider
mesh_terms: D000368:Aged; D001066:Appetite / Q000502:physiology; D003072:Cognition Disorders / Q000178:diet therapy; D003704:Dementia / Q000178:diet therapy*; D019587:Dietary Supplements; D018450:Disease Progression; D019317:Evidence-Based Medicine; D015525:Fatty Acids, Omega-3 / Q000008:administration & dosage; D006801:Humans; D044342:Malnutrition / Q000178:diet therapy; D018977:Micronutrients / Q000008:administration & dosage; D018673:Nutrition Policy; D009752:Nutritional Status; D018529:Nutritional Support; D016032:Randomized Controlled Trials as Topic; D016896:Treatment Outcome; D015431:Weight Loss
chemical_list: D015525:Fatty Acids, Omega-3; D018977:Micronutrients
keywords: Dementia; Guideline; Malnutrition; Nutritional interventions; Nutritional support