Frame it with color - Alzheimer's and Eating Problems

"Frame it with color" might soon become a mealtime dictum for those caring for individuals with dementias such as Alzheimer's in the more advanced stages.

According to visual perception research from a team at Boston University, the use of boldly colored tableware is a mealtime aid to those with severe dementias such as Alzheimer's. Such tableware helps individuals overcome a diminished sensitivity to visual contrast, a condition often found among people with advanced dementia. With bright "frames" for the food and beverage in front of them, study participants were found to increase by 25 percent or more the amount they ate and drank.

Appearing in a recent issue of the journal Clinical Nutrition, the study's findings could lead to profound improvements in the nutritional welfare of individuals with advanced dementia -- and be a boon to their caregivers.

Although 40 percent of individuals with severe AD show a health-damaging degree of weight loss, reasons for this drop in weight have not been precisely defined. Most often, explanations point to depression, an inability to focus on more than one food at a time, and an inability to eat independently. The BU team took a different perspective on the problem. They asked, "What if weight loss occurs because individuals cannot distinguish a plate from the table setting, food from a plate, or liquid from its container?" What if visual impairment is an important factor?

The researchers screened for participants among the population in GRECC's long-term care units.

Individuals who had a current diagnosis of serious chronic mental illness, a neurological disease other than Alzheimer's, uncontrolled seizures, or hypertension or diabetes mellitus were excluded as candidates.

The study consisted of two phases, an initial study and a one-year follow-up study. Nine men were selected for the initial study. Participants were, on average, 82.7 years old, had an average of 13.3 years of education, and, in tests designed to measure cognitive status, scored an average 2.9 out of a possible 30. Each was able to eat independently.

The first study consisted of three consecutive 10-day test periods. Food and beverage intakes for participants were measured daily and calculated as percentages reflecting the amount an individual consumed of the total amount he was served during each 10-day period.

The investigators established baseline measures for the first 10 days. Participants' meals were served using standard VA tableware --white plates, white cups, and stainless-steel flatware. Baseline assessments were followed by a 10-day intervention period during which meals were served on high-contrast red tableware (plates, cups, and flatware), and then by a 10-day post-intervention period during which the white set was again used.

For the follow-up study, participants included five individuals from the initial study plus four new individuals. The group closely matched the first group in age (average, 83.1), years of education (average, 13.9), and cognitive status score (average, 3.2).

A total of seven 10-day test periods were included in the follow-up study, the first featuring use of standard VA white tableware. This was followed by 10-day periods using high-contrast blue tableware, low-contrast (pastel) red tableware, or pastel blue tableware with each "color" period punctuated by a 10-day use of the white tableware. The final period used the white set.

When the team looked at results for the first study and compared white with high-contrast tableware use, they found participants increased their food intake 24.6 percent and their liquid intake 83.7 percent when the bright red tableware was used. Similarly, in the follow-up study, the use of bright blue tableware boosted participants' food intake 25.1 percent and their liquid intake 29.8 percent. Use of high-contrast tableware seemed to have a slight carry-over effect, with results showing more than half the participants increased both food and beverage intake by 10 percent or more in post-intervention periods.

Compared with results from the use of high-contrast tableware, pastel dishes did little or nothing to spur participants' consumption, registering between zero and 5 percent change in intake amounts. Researchers also found that, under all "color" conditions, participants consumed significantly more food and liquid at lunch than at supper.

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http://www.clinicalnutritionjournal.com/article/S0261-5614%2803%2900210-3/abstract
Dunne TE, Neargarder SA, Cipolloni PB, Cronin-Golomb A. Visual contrast enhances food and liquid intake in advanced Alzheimer's disease. Clin Nutrition 2004; 23(4):533-538.

Background & aims: Patients with severe Alzheimer's disease (AD) in long-term care have deficient contrast sensitivity and poor food and liquid intake. The present study examined how contrast manipulations affect these intake levels.

Methods: Participants were nine men with advanced AD. Independent variables were meal type (lunch and supper) and condition (baseline, intervention, and post-intervention). Dependent variables were amount of food (grams) and liquid (ounces). Data were collected for 30 days (10 days per condition) for two meals per day. White tableware was used for the baseline and post-intervention conditions, and high-contrast red tableware for the intervention condition. In a follow-up study 1 year later, other contrast conditions were examined (high-contrast blue, low-contrast red and low-contrast blue).

Results: Mean percent increase was 25% for food and 84% for liquid for the high-contrast intervention (red) versus baseline (white) condition, with 8 of 9 participants exhibiting increased intake. In the follow-up study, the high-contrast intervention (blue) resulted in significant increases in food and liquid intake; the low-contrast red and low-contrast blue interventions were ineffectual.

Conclusions: Simple environmental manipulations, such as contrast enhancement, can significantly increase food and liquid intake in frail demented patients with AD.