Medical Nutrition Therapy for Neurologic Disorders Chapter 43

Medical Nutrition Therapy for Neurologic Disorders

Chapter 43Chapter 43

Neurologic Disease ClassificationNeurologic Disease Classification

Neurologic diseases

—May have nutritional etiologies resulting from deficiency or excess

—Or may be nonnutritional in origin but have significant nutritional considerations

Neurologic diseases

—May have nutritional etiologies resulting from deficiency or excess

—Or may be nonnutritional in origin but have significant nutritional considerations

Nutrition Therapy in Neurologic DisordersNutrition Therapy in Neurologic Disorders

1. Adrenoleukodystrophy

—Lorenzo’s oil lowers VLCFA

2. Alzheimer’s

—Assess nutritional status

—Minimize distractions at mealtime

—Initiate smell or touch of food

—Hand guidance to initiate eating

—Provide nutrient-dense foods

1. Adrenoleukodystrophy

—Lorenzo’s oil lowers VLCFA

2. Alzheimer’s

—Assess nutritional status

—Minimize distractions at mealtime

—Initiate smell or touch of food

—Hand guidance to initiate eating

—Provide nutrient-dense foods

Nutrition Therapy in Neurologic Disorders—cont’dNutrition Therapy in Neurologic Disorders—cont’d

3. Amyotrophic lateral sclerosis (ALS)

—Prevent malnutrition and dehydration

—Monitor dysphagia

4. Epilepsy

—Ketogenic diet

5. Guillain-Barré syndrome

—Attain positive energy balance using high-energy and protein tube feedings

—Assess dysphagia

3. Amyotrophic lateral sclerosis (ALS)

—Prevent malnutrition and dehydration

—Monitor dysphagia

4. Epilepsy

—Ketogenic diet

5. Guillain-Barré syndrome

—Attain positive energy balance using high-energy and protein tube feedings

—Assess dysphagia

6. Migraine headache

—Adequate dietary intake

—Extensive record keeping of symptoms and foods

7. Myasthenia gravis

—Nutrient-dense foods at beginning of meal

—Small, frequent meals

—Limit physical activity prior to meals

6. Migraine headache

—Adequate dietary intake

—Extensive record keeping of symptoms and foods

7. Myasthenia gravis

—Nutrient-dense foods at beginning of meal

—Small, frequent meals

—Limit physical activity prior to meals

8. Multiple sclerosis

—Antioxidant supplements

—Evaluate health status

—Distribute fluids throughout waking hours, limit before bed

9. Neurotrauma

—Enteral/parenteral nutrition support

8. Multiple sclerosis

—Antioxidant supplements

—Evaluate health status

—Distribute fluids throughout waking hours, limit before bed

9. Neurotrauma

Nutrition Therapy in Neurologic Disorders—cont’dNutrition Therapy in Neurologic Disorders—cont’d10. Parkinson’s disease

—Drug-nutrient interactions

—Minimize dietary protein at breakfast and lunch

—Ensure nutritionally complete diet

11. Pernicious anemia

—B12 injections

—Diet liberal in HBV protein

—Diet supplemented with iron, vitamin C, and B vitamins

10. Parkinson’s disease

—Drug-nutrient interactions

—Minimize dietary protein at breakfast and lunch

—Ensure nutritionally complete diet

11. Pernicious anemia

—B12 injections

—Diet liberal in HBV protein

—Diet supplemented with iron, vitamin C, and B vitamins

12. Spinal trauma

—High fiber, adequate hydration to minimize constipation

—Dietary intake to maintain nutritional health and adequate weight

13. Stroke

—Prevention includes dietary alterations

—Maintain good nutritional status

—Assess possible dysphagia

—Enteral/parenteral support may be needed

12. Spinal trauma

—High fiber, adequate hydration to minimize constipation

—Dietary intake to maintain nutritional health and adequate weight

13. Stroke

—Prevention includes dietary alterations

—Maintain good nutritional status

—Assess possible dysphagia

—Enteral/parenteral support may be needed

Nutrition Therapy in NeurologicDisorders—cont’dNutrition Therapy in NeurologicDisorders—cont’d

14. Wernicke-Korsakoff syndrome

—Thiamin

—Adequate hydration

—Diet liberal in high-thiamin foods

—Eliminate ETOH

—Dietary protein may need to be restricted

14. Wernicke-Korsakoff syndrome

—Thiamin

—Adequate hydration

—Diet liberal in high-thiamin foods

—Eliminate ETOH

—Dietary protein may need to be restricted

Neurologic Syndromes Attributed to Nutritional Deficiency or ExcessNeurologic Syndromes Attributed to Nutritional Deficiency or Excess

Neurologic Syndromes Attributed to Nutritional Deficiency or Excess—cont’dNeurologic Syndromes Attributed to Nutritional Deficiency or Excess—cont’d

Spinal Cord Lying within the Vertebral CanalSpinal Cord Lying within the Vertebral Canal

Clinical Differences between Upper and Lower Motor Neuron LesionsClinical Differences between Upper and Lower Motor Neuron Lesions

Basic Functions of Cranial NervesBasic Functions of Cranial Nerves

Techniques for Improving AcceptanceTechniques for Improving Acceptance

Seasoning

Layering/swirling

Piping

Seasoning

Layering/swirling

Piping

Molding

Slurries

Garnishing

Molding

Slurries

Garnishing

Normal VisionNormal Vision

HemianopsiaHemianopsia

Swallowing Occurs in Three PhasesSwallowing Occurs in Three Phases

Swallowing Occurs in Three Phases—cont’dSwallowing Occurs in Three Phases—cont’d

Stroke—CauseStroke—Cause

Algorithm content developed by John Anderson, PhD, and Sanford C. Garner, PhD, 2000.

Stroke—PathophysiologyStroke—Pathophysiology

Stroke—Medical and Nutritional ManagementStroke—Medical and Nutritional Management

Nutrition-Related Factors and Stroke RiskNutrition-Related Factors and Stroke Risk

(BMI = body mass index)

Alzheimer’s Disease—CauseAlzheimer’s Disease—Cause

Alzheimer’s Disease—PathophysiologyAlzheimer’s Disease—Pathophysiology

Alzheimer’s Disease—Medical and Nutritional ManagementAlzheimer’s Disease—Medical and Nutritional Management

Practical Interventions for Eating-Related Behavioral Problems Common in Individuals with DementiaPractical Interventions for Eating-Related Behavioral Problems Common in Individuals with Dementia

Practical Interventions for Eating-Related Behavioral Problems Common in Individuals with Dementia —cont’dPractical Interventions for Eating-Related Behavioral Problems Common in Individuals with Dementia —cont’d

Diet for Easy Chewing and SwallowingDiet for Easy Chewing and Swallowing

Typical Ketogenic Diet Menu Using MCT OilTypical Ketogenic Diet Menu Using MCT Oil

Progression of Multiple SclerosisProgression of Multiple Sclerosis

Protein Redistribution in L-DOPA TherapyProtein Redistribution in L-DOPA Therapy

Incomplete Spinal Cord Injury SyndromesIncomplete Spinal Cord Injury Syndromes

Sequelae of Spinal Cord Injury and Rehabilitation ChallengesSequelae of Spinal Cord Injury and Rehabilitation Challenges

Localizing Signs of Mass LesionLocalizing Signs of Mass Lesion

Lesions in the central portion of the frontal lobes may cause speech impairment.

Lesions of the occipital lobes affect the visual field.

Lesions of the cerebellum and brainstem affect the cranial nerves.

Lesions in the spinal cord affect motor neurons

Lesions of the pituitary gland and hypothalamus may induce electrolyte or metabolic abnormalities and/or visual disturbances.

Lesions in the central portion of the frontal lobes may cause speech impairment.

Lesions of the occipital lobes affect the visual field.

Lesions of the cerebellum and brainstem affect the cranial nerves.

Lesions in the spinal cord affect motor neurons

Lesions of the pituitary gland and hypothalamus may induce electrolyte or metabolic abnormalities and/or visual disturbances.

Medical Nutrition TherapyMedical Nutrition Therapy

Cognitive and swallowing dysfunction usually affect nutritional management and place neurologic patients at risk for malnutrition.

The nutritional assessment should emphasize patterns of normal chewing, swallowing, and ingestion in addition to traditional assessment components.

Cognitive and swallowing dysfunction usually affect nutritional management and place neurologic patients at risk for malnutrition.

The nutritional assessment should emphasize patterns of normal chewing, swallowing, and ingestion in addition to traditional assessment components.

Nutritional SupportNutritional Support

Enteral nutrition support is the preferred modality for nutrition support in patients who cannot swallow or eat because of deteriorating neurologic disease.

Brain InjuryBrain Injury

400,000 new cases of brain injury occur each year in the United States

Most result from motor vehicle crashes.

Incidence is highest in young people and elderly; twice as often in males than females

Almost all patients with a severe head injury have some degree of disability.

400,000 new cases of brain injury occur each year in the United States

Most result from motor vehicle crashes.

Incidence is highest in young people and elderly; twice as often in males than females

Almost all patients with a severe head injury have some degree of disability.

Glasgow Coma Scale (GCS)Glasgow Coma Scale (GCS)

Strong prognostic value for neurologic recovery in head-injured patients (scale evaluating and quantitating the degree of coma by determining best responses to standardized stimuli)

Eye opening (4 Spontaneous–1 None)

Verbal response (5 Oriented–1 None)

Motor response (6 Follows command–1 None)

Severity of head injury: mild = GCS 13-15, moderate = GCS 9-12, severe = GCS 3-8

Strong prognostic value for neurologic recovery in head-injured patients (scale evaluating and quantitating the degree of coma by determining best responses to standardized stimuli)

Eye opening (4 Spontaneous–1 None)

Verbal response (5 Oriented–1 None)

Motor response (6 Follows command–1 None)

Severity of head injury: mild = GCS 13-15, moderate = GCS 9-12, severe = GCS 3-8

Strong Predictors of Poor Outcome after Head InjuryStrong Predictors of Poor Outcome after Head Injury

Older age

Low Glasgow ComaScale score

Pupil dilatation

Low blood pressure

All these variables have an additive effect on morbidity and mortality

Older age

Low Glasgow ComaScale score

Pupil dilatation

Low blood pressure

All these variables have an additive effect on morbidity and mortality

Inadequate oxygenation early after injury

Prolonged and/or difficult to control intracranial pressure

Inadequate oxygenation early after injury

Prolonged and/or difficult to control intracranial pressure

Medical Nutrition Therapy for Neurologic Disorders Chapter 43

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