Can you forget how to swallow? Why do Alzheimer’s patients eventually stop eating?

I am sending this question directly to my co-author Dr. Rosemary Laird, an amazing Geriatrician and Medical Director of the Aging Institute at Health First Hospital system in Melbourne, Florida. Dr. Laird is a wonderful expert in geriatric medicine, a friend, and the co-author of Take Your Oxygen First:

Alzheimer's is a disease that affects the brain. As the disease progresses to later stages and the changes in brain move from the memory and thinking centers, it creates "memory loss" in some of the physical parts of the body as well. Even the somewhat automatic actions, such as chewing and swallowing, become uncoordinated and ineffective. Ultimately, the brain is responsible to make the decision to swallow.

Similar to how you might see a patient with Alzheimer's disease become less steady on their feet or a bit more clumsy when using utensils, a patient may eventually "forget" how to swallow. In some cases, this may lead to a diminished gag reflex and drooling.  At initial signs of difficulty, help with swallowing may be available through the use of thickening agents and new eating techniques recommended by a speech-language therapist.

For some patients, these changes in ability to chew and swallow result in their eating and drinking less. For other patients, while they maintain ability to chew and swallow, they lose the usual response to hunger that leads us to eat throughout the day.

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Caring for someone with swallowing issues, also known as dysphagia, presents some very unique challenges. Dysphagia is usually indicative of a significant progression of dementia, and the need for increased care and supervision. Oftentimes, when swallowing is no longer possible it is a sign that a hospice evaluation should be conducted to determine if end-of-life care is appropriate.