Cognitive function and caregiver burden: Predictive factors for eating behaviour disorders in Alzheimer's disease

Background: Patients with Alzheimer's disease (AD) commonly develop aversive feeding behaviours. These behaviours lead to weight loss and frequently to physicians using tube feeding. Little is known about factors correlated with feeding difficulties during AD. Objective: To investigate predictors of aversive feeding behaviours (AFBs) which occured during a one-year interval among AD patients living at home with a caregiver. Method: One-year study initiated in January 1998 with 224 AD patients and their caregivers. Main outcome measures: all patients underwent a nutritional, psychologic and functional evaluation at baseline and one year later. Feeding difficulties were assessed using the Feeding Dependency Scale and the Aversive Feeding Behaviour Inventory. The Burden Interview was also done to assess the material and emotional burden. Results: Initial feeding difficulties were significantly associated with the age of the caregiver, the severity of the disease and the initial patient's autonomy and psychological functioning (mood and behaviour disorders). AD patients, who lived with a more affected caregiver at baseline, developed feeding difficulties and AFBs during the follow-up. Logistic regression analysis showed a positive association between AFBs worsening and the initial caregiver's burden after controlling for counfounding factors. On the other hand, memory impairment was inversely associated with AFBs. Conclusion: Both cognitive impairment and family stress can help in predicting which AD patients living at home will develop AFBs. Nutritional information and support to families are probably the best strategies to prevent AFBs during AD and to improve consequently the patient's and caregiver's quality of life.