Proper nutrition is crucial to our overall health and wellbeing, including our cognition. An article published in the Canadian Family Physician (the peer-reviewed official publication of the College of Physicians of Canada) examines instances where malnourishment has potentially been misdiagnosed as dementia. The article titled, “Malnourishment masquerading as dementia” was written by Kwame Agyei (a medical student at the University of Toronto), and Dr. Donald Weaver (a neurologist at University Health Network) and can be found here.

Agyei and Dr. Weaver explain that malnutrition refers to “an imbalanced intake of energy or nutrients and includes these categories: being overweight – which is a risk factor for hypercholesterolemia, stroke, and diabetes, all of which can lead to cognitive impairment; being underweight, a state in which inadequate intake of nutrients and micronutrients can case cognitive decline; and being of normal weight but not consuming adequate levels of necessary nutrients and micronutrients, which is an understudied potential contributor to cognitive dysfunction.”

Recognizing malnourishment can be a difficult task, particularly where older adults may hide from their physicians and family members their inability to prepare nutritious meals, for fear of losing their independence.  Some barriers experienced by older adults to prepare nutritious meals includes, physical limitations, increased cost of living and the introduction of self-service checkouts.

The article highlights that physicians should be aware of normal weight malnutrition when assessing cognitive decline, particularly among patients with lower incomes.

Dr. Weaver and Agyei point to a case study where a patient, previously diagnosed with dementia, experienced an improvement in her memory and cognition after moving to long-term care. While living alone, the quality of her diet had declined, yet her weight remained in the normal range. In the circumstances, because dementia is a non-reversible disorder, and given the improvement seen in the patient’s cognition and memory, its likely that she had malnutrition-induced cognitive decline that was misdiagnosed as dementia.

In the case study, the patient was reluctant to disclose the difficulties she was experiencing in acquiring groceries for fear of losing her independence, she (like many elder adults) had a trepidation to using self-checkouts, and ultimately relied upon the limited food selection at a nearby grocery store. The article discusses this issue in the context of the broader issue of food deserts and food oases. A food desert is a geographic area with limited access to nutritious food, whereas an oasis has readily accessible fresh fruits, vegetables and other nutritious food items. The products in food deserts (and those commonly found in convenience stores) are processed for extended shelf life, higher in sugar and usually lower in micronutrients. The article identifies that food deserts are often inhabited by elders with limited or reduced mobility and lower incomes (making them a less attractive market for larger grocers with wider food options).

Some key points from the study are:

• When assessing patients with cognitive decline, efforts should be made to rule out other factors before diagnosing with dementia;
• Normal weight malnutrition is a possible reversible factor contributing to cognitive decline, and
• Elder adults may hide their difficulties in acquiring nutritious food out of fear of losing their independence.

Thanks for reading!
Sydney Osmar