Medical Nutrition Therapy for Neurologic Disorders Chapter 43 Medical Nutrition Therapy for Neurologic Disorders

Neurologic Disease Classification 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 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

Nutrition 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

Nutrition Therapy in Neurologic Disorders—cont’d 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

Nutrition Therapy in Neurologic Disorders—cont’d 8. Multiple sclerosis —Antioxidant supplements —Evaluate health status —Distribute fluids throughout waking hours, limit before bed 9. Neurotrauma —Enteral/parenteral nutrition support

Nutrition Therapy in Neurologic Disorders—cont’d 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

Nutrition Therapy in Neurologic Disorders—cont’d 12. Spinal trauma —Enteral/parenteral nutrition support —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 Neurologic Disorders—cont’d 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 Excess

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

Spinal Cord Lying within the Vertebral Canal

Clinical Differences between Upper and Lower Motor Neuron Lesions

Basic Functions of Cranial Nerves

Techniques for Improving Acceptance Aroma Seasoning Layering/swirling Piping Molding Slurries Garnishing

Normal Vision

Hemianopsia

Swallowing Occurs in Three Phases

Swallowing Occurs in Three Phases—cont’d

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

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

Stroke—Medical and Nutritional Management Algorithm content developed by John Anderson, PhD, and Sanford C. Garner, PhD, 2000.

Nutrition-Related Factors and Stroke Risk (BMI = body mass index)

Alzheimer’s Disease—Cause Algorithm content developed by John Anderson, PhD, and Sanford C. Garner, PhD, 2000.

Alzheimer’s Disease—Pathophysiology Algorithm content developed by John Anderson, PhD, and Sanford C. Garner, PhD, 2000.

Alzheimer’s Disease—Medical and Nutritional Management Algorithm content developed by John Anderson, PhD, and Sanford C. Garner, PhD, 2000.

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

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

Diet for Easy Chewing and Swallowing

Typical Ketogenic Diet Menu Using MCT Oil

Progression of Multiple Sclerosis

Protein Redistribution in L-DOPA Therapy

Incomplete Spinal Cord Injury Syndromes

Sequelae of Spinal Cord Injury and Rehabilitation Challenges

Localizing 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.

Medical 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.

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

Brain 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.

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 Predictors of Poor Outcome after Head Injury Older age Low Glasgow Coma Scale 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