Step by Step: Boosting Brain Health with Alzheimer’s

👁️‍🗨️ March 2024

My patients have improved their appetite and have shifted their diets from being primarily carbohydrate-based to now prioritizing muscle-building foods, which likely include higher amounts of protein, calories, and essential nutrients to support muscle growth.

This dietary shift is generally okay and can be beneficial, as adequate protein, calories, and nutrients are critical for muscle repair and growth, especially for patients aiming to improve physical strength or recover from conditions like muscle wasting or malnutrition. Protein-rich foods (e.g., lean meats, eggs, dairy, legumes, or plant-based protein sources) combined with sufficient calories and micronutrients (like vitamins D, C, and minerals such as zinc and magnesium) support muscle synthesis and overall health.

⚠️However, there are a few considerations to ensure this change is safe and effective:

1.  Balance: Ensure their diet remains balanced with enough carbohydrates and healthy fats to fuel energy needs, as muscle-building requires a well-rounded intake.

2.  Individual Needs: Protein and calorie requirements vary based on age, weight, activity level, and health conditions. For example, 1.2–2.0 grams of protein per kilogram of body weight is often recommended for muscle building, but this should be tailored to each patient.

3.  Medical Conditions: For patients with conditions like kidney disease or liver issues, high protein intake may need to be monitored to avoid strain on these organs.

4.  Nutrient Quality: Focus on nutrient-dense foods (e.g., whole foods over processed ones) to maximize health benefits and avoid excessive intake of unhealthy fats or sugars.

5.  Hydration and Digestion: Increased protein intake requires adequate hydration and may need gradual introduction to avoid digestive discomfort.

Why Muscle Loss Occurs in Alzheimer’s

Muscle loss (sarcopenia) in Alzheimer’s patients can result from:

• Disease Progression: Alzheimer’s affects motor function and coordination in later stages, reducing muscle use and strength. Thinning legs suggest declining muscle mass, common in the moderate-to-severe stage.

• Nutrition Imbalance: Even with a good appetite, she may not be getting enough protein or calories to support muscle growth, especially if her diet still leans toward sweets (as you mentioned two years ago).

  •  Metabolic Changes: Alzheimer’s can alter metabolism, making it harder to maintain muscle, particularly in older adults.

  •  Medication Side Effects: Some Alzheimer’s medications (e.g., antipsychotics for agitation) can cause fatigue or muscle weakness, though this is less likely given her activity level.

👁️‍🗨️ August 2025

My patient’s thinning legs could indicate muscle loss (sarcopenia), which is concerning, especially for fall risk. Despite eating well, their current diet and exercise may not be sufficient to maintain muscle mass. Improving their regimen—likely with targeted resistance training and adequate protein intake—could help reduce muscle loss and enhance strength and stability.

Optimize Nutrition for Muscle Growth

Her improved appetite is a great foundation, but to build muscle, she needs adequate protein, calories, and nutrients. Since she liked sweets two years ago, ensure her diet prioritizes muscle-building foods:

• Increase Protein Intake:

  
  

  Goal: Aim for 0.5–0.8 grams of protein per pound of body weight daily (e.g., 60–100g for a 120-pound person), adjusted for Alzheimer’s patients’ needs. Consult her doctor for exact amounts.

  
  

• Sources:

  Based on your past interest in foods like salmon, chicken, and eggs, offer:

  
  

• Salmon:

   3–4 oz (85–113g) provides ~20–25g protein. Serve soft, mashed salmon for easy chewing if swallowing is an issue.

  
  

• Chicken Breast:

  3 oz (85g) offers ~26g protein. Shred it for easier eating.

  
  

• Eggs:

  2 large eggs give ~12g protein.

  Scramble with cheese for flavor.

  
  

• Greek Yogurt:

  1 cup (200g) has ~20g protein. Add fruit to appeal to her sweet preference.

  
  

• Protein Shakes:

  If she struggles with solid foods, try a protein shake (e.g., whey or plant-based) with 20–30g protein per serving. Blend with fruit for sweetness.

  
  

• Timing:

  Spread protein across meals (e.g., 20–30g per meal) to maximize muscle synthesis. Offer a protein-rich snack after exercise (e.g., yogurt or a shake).

  
  

• Calorie Surplus:

  Muscle growth requires extra calories. If her legs are thinning despite eating a lot, she may not be getting enough nutrient-dense foods. Include:

  
  

• Healthy Fats:

  Add avocado (e.g., 1/4 avocado, ~5g fat), olive oil (1 tbsp in meals), or almonds (1 oz, ~14g fat), as you previously showed interest in these.

  
  

• Carbs for Energy:

  Offer sweet potatoes (1 small, ~20g carbs) or oats (1/2 cup cooked, ~14g carbs), which you mentioned before, to fuel exercise and recovery.

  
  

• Hydration:

  Dehydration can worsen muscle loss. Ensure she drinks 6–8 cups of water daily, using flavored water or broth if plain water is unappealing.

👁️‍🗨️ August 2025

I started chair squats with my patient. She does 3 sets of 10 daily. Great start to build leg strength and reduce muscle loss.

💡 Exercising with individuals who have Alzheimer’s disease is an excellent way to support their physical and mental well-being while enhancing their quality of life. Research indicates that regular exercise may slow cognitive decline, improve mood, and help maintain physical function. Below are recommendations and considerations for engaging in exercise with Alzheimer’s patients. Prior to starting any exercise program, consult a physician or specialist to ensure the plan is tailored to the individual’s condition.

Recommended Exercises

1.  Walking

•  Why:

Simple, low-impact, and great for mood enhancement, especially outdoors.

•  How:

Take short walks (10–30 minutes) in a safe area like a park or neighborhood, matching the person’s pace.

•  Tips:

Engage in light conversation or point out scenery to stimulate mental engagement

.

2.  Light Stretching or Chair Yoga

•  Why:

Improves flexibility, maintains muscle strength, and reduces fall risk.

•  How:

Try seated stretches or simple yoga poses (e.g., chair yoga). Joining a guided class can be helpful.

•  Tips:

Keep movements slow and gentle. Playing calming music can make it more enjoyable.

3.  Dancing

•  Why:

Stimulates coordination, cognition, and joy through music and movement.

•  How:

Use familiar music from the person’s past and try simple dance steps or seated upper-body movements.

•  Tips:

Choose music they love to boost engagement and motivation.

4.  Gardening or Light Housework

•  Why:

Familiar tasks provide a sense of purpose and involve light physical activity.

•  How:

Water plants, do simple gardening, or perform light chores like wiping surfaces together.

•  Tips:

Break tasks into small, achievable steps to foster a sense of accomplishment.

5.  Balance Exercises

•  Why:

Alzheimer’s patients are at higher risk of falls, so balance training is crucial.

•  How:

Practice seated or supported exercises like standing on one leg (with support), toe raises, or sit-to-stand movements.

•  Tips:

Ensure a sturdy chair or railing is nearby for safety.

Key Considerations

•  Safety First:

Choose activities based on the person’s physical and cognitive abilities. Avoid overexertion and ensure a safe environment to prevent falls.

•  Routine:

Establish a consistent exercise schedule (e.g., same time daily) to reduce confusion. Even 10–20 minutes can be effective.

•  Make It Fun:

Focus on enjoyable activities to avoid frustration. Incorporate smiles, music, or light conversation for a positive experience.

•  Hydration and Rest:

Ensure they stay hydrated and take breaks as needed to avoid fatigue.

•  Adapt to Cognitive Needs:

If instructions are hard to follow, demonstrate movements and use simple, repeated cues.

Sample Daily Exercise Plan

•  Morning:

10-minute walk in the neighborhood, enjoying nature.

•  Afternoon:

5–10 minutes of chair yoga (e.g., arm raises, gentle leg stretches).

•  Evening:

10 minutes of light dancing or hand-clapping to favorite music.

Additional Notes

•  Group Activities:

Consider joining community programs or Alzheimer’s support group exercise classes. Social interaction can boost mood and cognition.

•  Caregiver Benefits:

Exercising together can reduce stress for caregivers, creating a shared positive experience.

•  Cultural Note:

In a Japanese context, activities like radio calisthenics (rajio taiso) or tai chi can be familiar and engaging due to their rhythmic, structured nature.