Alzheimer’s disease is the most common type of dementia. Persons with Alzheimer’s experience memory loss, have difficulty making decisions, and need assistance with daily household management, and life activities. It is estimated that one in ten persons over the age of 65 have Alzheimer’s or another form of dementia.

Alzheimer’s progresses in three main stages; mild, moderate, and severe. Behavioral changes in each stage affect the older adult’s ability and desire to eat, which in turn effects their nutritional needs. These changes usually lead to weight and muscle loss, and affect the quality of life for both older adult and caregiver.

Mild Alzheimer’s

In the early stages of Alzheimer’s the older adult is still able to eat independently. Caregivers should be aware that weight loss could occur. Smaller, more frequent meals, are a good strategy to increase overall food consumption. Eating together, and not alone, is another strategy to encourage eating well. Scientists have identified foods which may be helpful in supporting the immune system of those with Alzheimer’s. Foods to consider are fish and poultry, tomatoes, cruciferous vegetables (broccoli, cauliflower, cabbage, kale, radishes, and turnips), fruit, and leafy dark green vegetables (spinach, chard, romaine lettuce). High-fat dairy products and red meat should be eaten sparingly. A physician or other medical provider should be consulted before changing diets, as some of the recommended foods may adversely react with medications taken for other medical conditions.

Moderate Alzheimer’s

Weight loss and behavioral changes become more noticeable during moderate Alzheimer’s. In this stage, the older adult is more distracted and has trouble focusing on the task of eating. The older adult becomes more passive and is unable to initiate a request for food. The ability to control hand movements, and hand-eye coordination decreases. Emotions become flat; a person who once enjoyed eating and social company around the dinner table, may no longer connect with food or others. They may seem to withdraw and turn inward. Some older adults may have difficulty recognizing food, and forget how to use utensils.

Weight loss may become more noticeable. Older adults who are agitated and who wander, may burn more calories than they consume. Medications used to treat Alzheimer’s and other diseases can decrease appetite, and may cause stomach upset, nausea, and diarrhea. Structural changes in the brain can reduce the feelings of hunger and thirst. Some may experience ‘dry mouth’ which can affect the ability to swallow.

Increasing food intake during this stage requires more effort from the caregiver. Caregivers need to interact positively and encourage eating. They may need to demonstrate how to use the fork to eat. They may need to give the older adult instructions and use words like, “chew, swallow.” Finger foods, like small sandwiches, deviled eggs, fish patties, and cheese and vegetable/fruit platters are good choices for older adults who are struggling to use utensils. Agitated older adults may need to eat in a quiet area, free from distractions. Food should be kept near room temperature, especially if the older adult has trouble determining the temperature of food.

Sometimes oral nutritional supplements are needed to ensure the older adult receives enough protein, nutrients, and calories. Oral supplements are either liquids or powders mixed into liquids which have protein, vitamins, and minerals used to promote optimal nutrition. Not all are nutritionally complete, so consultation with medical providers is recommended. Oral supplements have been shown to help older adults increase weight.

Severe Alzheimer’s

As Alzheimer’s worsens, the older adult will experience increasing difficulty chewing and swallowing. Less saliva will be produced which also impacts chewing and swallowing. Coughing and choking become commonplace. Malnutrition and dehydration are serious concerns. Aspiration pneumonia can happen if food or liquid is not swallowed properly and goes down the windpipe instead of the food pipe. Unfortunately, aspiration pneumonia is a common cause of death for people with late stage Alzheimer’s.

Watering down food may increase the tendency to aspirate. Adding a food thickener to purees or liquids can help decrease choking and coughing. The texture of foods needs to be monitored. Dietary supplements are often used for protein and added nutritional value. Before adding thickeners to food, consult with a medical expert to determine the best thickener to use. In severe cases for older adults who are unable to swallow, tube feeding may be recommended. A naso gastric tube is used short-term or when the older adult cannot handle more intrusive medical procedures. A tube is inserted through the nose and passed down the esophagus until it reaches the stomach. Alternatively, percutaneous endoscopic gastrostomy (PEG), is a medical procedure in which a flexible feeding tube is placed through the abdominal wall and into the stomach. Thus, nutrition, fluids, and medications can be put directly into the stomach. Scientists are currently debating the clinical value of these procedures for older adults who will continue experiencing cognitive loss.

As with all medical conditions it is important to consult with a doctor, speech therapists, nutritionists, gastroenterologists, and nurses who can use their expertise to help identify symptoms, assess clinical need, and provide patient specific recommendations to maintain health and well-being.

IMPORTANT REMINDER:  This article is intended only to provide general information. It does not provide definitive medical advice. Consult a doctor about specific conditions and concerns.


Colling KB. (2000). A taxonomy of passive behaviors in people with Alzheimer’s disease. Journal of Nursing Scholarship;32(3):239-44.
National Collaborating Centre for Acute Care (UK). Nutrition Support for Adults: Oral Nutrition Support, Enteral Tube Feeding and Parenteral Nutrition. London: National Collaborating Centre for Acute Care (UK); 2006 Feb. (NICE Clinical Guidelines, No. 32.) 8, Oral nutrition support in hospital and the community. Available from:
Akiko Kamikado Pivi, G., & Maria de Andrade Vieira, N., & Botelho da Ponte, J., & Santos Coca de Moraes, D., & Henrique Ferreira Bertolucci, P. (2017). Nutritional management for Alzheimer’s disease in all stages: mild, moderate, and severe. Nutrire, 42:1. DOI 10.1186/s41110-016-0025-7