Avaliação Nutricional e Cognitiva de Pacientes com Diagnóstico Clínico da Doença de Alzheimer

Abstract

The Alzheimer’s disease (AD) is characterized by several changes in the nutritional and cognitive state. Considering that, the following study’s goal is to evaluate the nutritional and cognitive state of patients with AD who are users of the Program specialist drug delivery from the public health care in Guarapuava - Paraná - Brazil. 30 patients participated in the study to whom home visits took place for the nutritional and cognitive evaluation. The nutritional evaluation was composed by anthropometric evaluation (weight, height, body mass, arms and calves’ circumference), nourishing evaluation (using a 24-hour food recall), Mini Nutritional Assessment (MNA) and biochemical evaluation (serum albumin). The cognitive evaluation was performed by using the Mini Mental State Examination (MMSE). Variables were also evaluated, family income, schooling, marital status, smoke and alcohol consumption before AD, comorbidities, medicine consumption and light physical activity practice. For the diseases staging the Clinical Dementia Rating scale was used. The statistical analysis were made using the tests: Anova, Kruskal-Wallis, Dunn’s test, Fisher’s exact test, and chi-square test. The significance number was established in p<0.05. The analyzed sample was composed by 60% (n=18) of female gender and 40% (n=12) of male gender with an average age of 77. Among the medicine taken by the patients the antipsychotics were the only ones that presented association to the nutritional state of the patients, considering the majority who consumed it was suffering undernutrition (p=0.007). Related to the comorbidities, the systemic arterial hypertension was the most frequent among patients, 66.6% (n=20). It was possible to verify the statistical difference between the disease’s stages and the age (p=0.042), considering that the elder patients were in an advanced stage of the disease. The weight average presented a decreasing between the disease’s stages, however there was no significant difference (p=0.061). The averages of the MNA values showed a significant difference between the AD’s stages (p=0.042), in other words, a diminish in the MNA’s score following the disease’s gravity. The biochemical evaluation of albumin between stages of AD also reported significant difference (p=0.047), having a decrease in the values found according to the AD evolution, being the smaller values met in the grave stage. The nourishing evaluation showed that 40% (n=12) of the patients presented energetic consumption which was adequate. Among the macronutrients only the proteins had adequate consumption by all the patients. Relating to the micronutrients, none was consumed in an adequate way by all the patients. Nevertheless, the nutritional value of nourishing (macro and micronutrients) of the patients in the different stages of AD did not present significant statistical difference. According to the MMSE only three patients did not present cognitive decrease. The score average of the MMSE of non-alphabetized was of 10.2±7.2 and the alphabetized was of 13.8±6.9. It is possible to conclude that the patients with AD present cognitive deficiency and undernutrition, however, the nourishing consumption was similar between the stages of the disease and thus seems not to have direct association with the disease’s progression.