營養與阿茲海默症

對於失智症，目前雖沒有可以根治的藥物，但有多種方式旨於延緩其惡化。由於已有證據顯示血管危險因子會增加罹患失智症的風險，因而有人想藉由飲食療法及改變生活習慣來改善這些血管危險因子，以期降低罹患失智症的發生。近年來更有些臨床研究，以營養介入的方式，作為失智症的防治。本文即針對失智患者之飲食療法及營養策略做文獻回顧。文獻回顧的結果如下:維他命B 群含B6、B12 及葉酸的治療，雖可有效降低血清中同型半胱胺酸，但無法改善認知功能；深海魚中的n-3 不飽和和脂肪酸，對認知功能的改善，可能有幫助；若攝取富含抗氧化劑維他命E 的食物，可能可減緩認知功能的退化；而少量的紅酒，對老人的心血管及認知功能有正面助益，但過量則有害健康；地中海飲食，因攝食大量蔬菜、橄欖油、堅果及魚類，不但可防治心血管疾病，也可降低失智症的風險。臨床上，失智患者的飲食問題與其失智程度有關，適當的用藥及改善飲食環境及食物，可改善患者的飲食問題。對於重度失智患者是否必需使用管灌飲食則仍有爭議，必需在醫學倫理的考量下，兼重病人的營養與生活品質。

Owing to rapid increase in aging population, Alzheimer's dementia (AD) is one of the leading problems all over the world. Over the past few years, a number of clinical trials have been conducted to assess various potential treatments, which have put emphasis on the modification of vascular contribution to AD's pathophysiology, especially on the subjects of modifiable lifestyle and diet pattern. Recent studies showed the possibility of lowering risk of cognitive decline by following a Mediterranean diet which has high intake of vegetables, fruits, nuts, cereals, fish and monounsaturated fatty acid from olive oil. High fish consumption is associated with better cognitive function in late life. A small amount of red wine may be associated with reduced incident dementia, while overuse of alcohol could cause brain damage and increase risk of addiction. Treatment with vitamin B6, B12 and folic acid can lower serum homocysteine, but has no significant beneficial effect on cognitive function in patients with dementia. Strategies for feeding the patients with dementia should be modified according to individual factors, including cognitive and physical function, psychological status, and environmental factors. In patients with advanced dementia, oral feeding may be one of the most troublesome problems. Quality of life and nutritional necessaries are the most concerns in making the decision to use oral or tube feeding.