title: Percutaneous endoscopic gastrostomy for nutritional support in dementia patients.
abstract: BACKGROUND
  A link between aging, dementia and malnutrition is established and leads to poor prognosis. Endoscopic gastrostomy (PEG) is used without clear benefit on survival, nutritional status or quality of life.
  
  
  OBJECTIVE
  This work aims to assess the effectiveness of PEG-feeding for nutritional support in patients with dementia.
  
  
  METHODS
  We conducted an observational, longitudinal and retrospective study using records from patients with moderate-severe dementia that underwent PEG. Age, gender, dementia subtype and mortality were considered. Body mass index (BMI), serum albumin, transferrin and total cholesterol were recorded at the time of the PEG procedure (T0) and repeated after 3 months (T3). The evolution of those parameters was analysed and compared to survival.
  
  
  RESULTS
  We obtained data from 46 patients (16 men/30 women) between 50 and 94 years (M = 79 years). Most had Alzheimer's. Mean survival was 21 months. Mortality rate at 3 months was 15 %. At T0, 30 patients were undernourished according to BMI and 29, 31 and 16 patients displayed low albumin, transferrin and total cholesterol, respectively. Albumin (p < 0.01) and transferrin levels (p < 0.05) were significantly increased from T0 to T3. High albumin (r = 0.2), transferrin (r = 0.3) and cholesterol (r = 0.1) at T0 were positively correlated with longer survival.
  
  
  CONCLUSIONS
  Low albumin, transferrin and cholesterol were predictors of a poor survival. PEG improves low albumin and transferrin, serum markers of malnutrition and poor outcome. PEG should be considered on an individual basis in patients with moderate-severe dementia when risk of malnutrition and aspiration is present.
authors.affiliation: Gastroenterology Department, GENE-Enteral Feeding Team, Hospital Garcia de Orta, Almada, Portugal. goncalo.n@hotmail.com.
authors.forename: Gonçalo
authors.initials: G
authors.lastname: Nunes
authors.affiliation: Gastroenterology Department, GENE-Enteral Feeding Team, Hospital Garcia de Orta, Almada, Portugal.
authors.forename: Carla Adriana
authors.initials: CA
authors.lastname: Santos
authors.affiliation: Master in Economics, Nova School of Business and Economics, Lisbon, Portugal.
authors.forename: Carla
authors.initials: C
authors.lastname: Santos
authors.affiliation: Gastroenterology Department, GENE-Enteral Feeding Team, Hospital Garcia de Orta, Almada, Portugal.|CiiEM, Centro de investigação interdisciplinar Egas Moniz, Monte da Caparica, Portugal.
authors.forename: Jorge
authors.initials: J
authors.lastname: Fonseca
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D015992:Body Mass Index; D002784:Cholesterol / Q000097:blood; D003704:Dementia / Q000503:physiopathology*; D004750:Enteral Nutrition / Q000379:methods*; D005260:Female; D005774:Gastrostomy / Q000379:methods*; D006801:Humans; D008137:Longitudinal Studies; D008297:Male; D008875:Middle Aged; D009752:Nutritional Status; D018529:Nutritional Support / Q000379:methods; D011788:Quality of Life; D012189:Retrospective Studies; D012709:Serum Albumin / Q000032:analysis
chemical_list: D012709:Serum Albumin; D002784:Cholesterol
keywords: Dementia; Gastrostomy; Nutrition; PEG