Abstract：
OBJECTIVE: Dementia is accompanied by a variety of changes that result in an increased risk of malnutrition and low-intake dehydration. This guideline update aims to give evidence-based recommendations for nutritional care of persons with dementia in order to prevent and treat these syndromes.
METHODS: The previous guideline version was reviewed and expanded in accordance with the standard operating procedure for ESPEN guidelines. Based on a systematic search in three databases, strength of evidence of appropriate literature was graded by use of the SIGN system. The original recommendations were reviewed and reformulated, and new recommendations were added, which all then underwent a consensus process.
RESULTS: 40 recommendations for nutritional care of older persons with dementia were developed and agreed, seven at institutional level and 33 at individual level. As a prerequisite for good nutritional care, organizations caring for persons with dementia are recommended to employ sufficient qualified staff and offer attractive food and drinks with choice in a functional and appealing environment. Nutritional care should be based on a written care concept with standardized operating procedures. At the individual level, routine screening for malnutrition and dehydration, nutritional assessment and close monitoring are unquestionable. Oral nutrition may be supported by eliminating potential causes of malnutrition and dehydration, and adequate social and nursing support (including assistance, utensils, training and oral care). Oral nutritional supplements are recommended to improve nutritional status but not to correct cognitive impairment or prevent cognitive decline. Routine use of dementia-specific ONS, ketogenic diet, omega-3 fatty acid supplementation and appetite stimulating agents is not recommended. Enteral and parenteral nutrition and hydration are temporary options in patients with mild or moderate dementia, but not in severe dementia or in the terminal phase of life. In all stages of the disease, supporting food and drink intake and maintaining or improving nutrition and hydration status requires an individualized, comprehensive approach. Due to a lack of appropriate studies, most recommendations are good practice points.
CONCLUSIONS: Nutritional care should be an integral part of dementia management. Numerous interventions are available that should be implemented in daily practice. Future high-quality studies are needed to clarify the evidence.
METHODS: The previous guideline version was reviewed and expanded in accordance with the standard operating procedure for ESPEN guidelines. Based on a systematic search in three databases, strength of evidence of appropriate literature was graded by use of the SIGN system. The original recommendations were reviewed and reformulated, and new recommendations were added, which all then underwent a consensus process.
RESULTS: 40 recommendations for nutritional care of older persons with dementia were developed and agreed, seven at institutional level and 33 at individual level. As a prerequisite for good nutritional care, organizations caring for persons with dementia are recommended to employ sufficient qualified staff and offer attractive food and drinks with choice in a functional and appealing environment. Nutritional care should be based on a written care concept with standardized operating procedures. At the individual level, routine screening for malnutrition and dehydration, nutritional assessment and close monitoring are unquestionable. Oral nutrition may be supported by eliminating potential causes of malnutrition and dehydration, and adequate social and nursing support (including assistance, utensils, training and oral care). Oral nutritional supplements are recommended to improve nutritional status but not to correct cognitive impairment or prevent cognitive decline. Routine use of dementia-specific ONS, ketogenic diet, omega-3 fatty acid supplementation and appetite stimulating agents is not recommended. Enteral and parenteral nutrition and hydration are temporary options in patients with mild or moderate dementia, but not in severe dementia or in the terminal phase of life. In all stages of the disease, supporting food and drink intake and maintaining or improving nutrition and hydration status requires an individualized, comprehensive approach. Due to a lack of appropriate studies, most recommendations are good practice points.
CONCLUSIONS: Nutritional care should be an integral part of dementia management. Numerous interventions are available that should be implemented in daily practice. Future high-quality studies are needed to clarify the evidence.
摘要：
目的：痴呆伴随着各种变化，导致营养不良和低摄入脱水的风险增加。本指南更新旨在为痴呆症患者的营养护理提供循证建议，以预防和治疗这些综合征。
方法：根据ESPEN指南的标准操作程序，对以前的指南版本进行了审查和扩展。基于对三个数据库的系统搜索，适当文献的证据强度通过使用SIGN系统进行分级。审查并重新拟订了最初的建议,并增加了新的建议，所有这些都经历了一个共识过程。
结果：制定并同意了40项针对老年痴呆症患者的营养护理建议，7个在机构层面，33个在个人层面。作为良好营养护理的先决条件，建议照顾痴呆症患者的组织雇用足够的合格人员，并在功能和吸引人的环境中提供有吸引力的食物和饮料。营养护理应基于具有标准化操作程序的书面护理概念。在个人层面,常规筛查营养不良和脱水，营养评估和密切监测是毋庸置疑的。口服营养可以通过消除营养不良和脱水的潜在原因得到支持。和充分的社会和护理支持(包括援助，餐具,培训和口腔护理)。建议口服营养补充剂以改善营养状况，但不能纠正认知障碍或预防认知功能下降。常规使用痴呆症特异性ONS，生酮饮食，不推荐使用omega-3脂肪酸补充剂和食欲刺激剂。肠内和肠外营养和水合是轻度或中度痴呆患者的临时选择，但不是在严重的痴呆症或生命的终末期。在疾病的所有阶段，支持食物和饮料的摄入，保持或改善营养和水合状态需要个性化，全面的方法。由于缺乏适当的研究，大多数建议都是好的做法点。
结论：营养护理应该是痴呆管理的一个组成部分。有许多干预措施应在日常实践中实施。未来需要高质量的研究来澄清证据。
方法：根据ESPEN指南的标准操作程序，对以前的指南版本进行了审查和扩展。基于对三个数据库的系统搜索，适当文献的证据强度通过使用SIGN系统进行分级。审查并重新拟订了最初的建议,并增加了新的建议，所有这些都经历了一个共识过程。
结果：制定并同意了40项针对老年痴呆症患者的营养护理建议，7个在机构层面，33个在个人层面。作为良好营养护理的先决条件，建议照顾痴呆症患者的组织雇用足够的合格人员，并在功能和吸引人的环境中提供有吸引力的食物和饮料。营养护理应基于具有标准化操作程序的书面护理概念。在个人层面,常规筛查营养不良和脱水，营养评估和密切监测是毋庸置疑的。口服营养可以通过消除营养不良和脱水的潜在原因得到支持。和充分的社会和护理支持(包括援助，餐具,培训和口腔护理)。建议口服营养补充剂以改善营养状况，但不能纠正认知障碍或预防认知功能下降。常规使用痴呆症特异性ONS，生酮饮食，不推荐使用omega-3脂肪酸补充剂和食欲刺激剂。肠内和肠外营养和水合是轻度或中度痴呆患者的临时选择，但不是在严重的痴呆症或生命的终末期。在疾病的所有阶段，支持食物和饮料的摄入，保持或改善营养和水合状态需要个性化，全面的方法。由于缺乏适当的研究，大多数建议都是好的做法点。
结论：营养护理应该是痴呆管理的一个组成部分。有许多干预措施应在日常实践中实施。未来需要高质量的研究来澄清证据。
