Review ArticleEfficacy of Mealtime Interventions for Malnutrition and Oral Intake in Persons With Dementia A Systematic ReviewBorders, James C. MS, CCC-SLP*; Blanke, Samantha BS†; Johnson, Stephen MLS‡; Gilmore-Bykovskyi, Andrea PhD, RN§,∥,¶; Rogus-Pulia, Nicole PhD, CCC-SLP∥,¶,#,**Author Information *Department of Biobehavioral Sciences, Teachers College, Columbia University, New York, NY †University of Wisconsin-Madison ‡Ebling Library for the Health Sciences **Department of Communication Sciences and Disorders, University of Wisconsin-Madison ∥Department of Medicine, Division of Geriatrics and Gerontology #Department of Surgery, Division of Otolaryngology-Head and Neck Surgery, School of Medicine and Public Health, University of Wisconsin-Madison §University of Wisconsin-Madison School of Nursing ¶Geriatric Research Education and Clinical Center (GRECC), William S. Middleton Memorial Veterans Hospital, Madison, WI The article was partially prepared at the William S. Middleton Veterans Affairs Hospital in Madison, WI (GRECC manuscript number #009-2020). The views and content expressed in this article are solely the responsibility of the authors and do not necessarily reflect the position, policy, or official view of the Department of Veterans Affairs, the U.W. government, or the NIH. Sponsor for A.G.-B. is K76AG060005 (PI: A.G.-B.), which is designed to provide A.G.-B. with the training required for success as an independent clinician-scientist focused on improving Alzheimer disease identification to promote greater participation in research and access to effective care and therapies, specifically targeting high-risk disadvantaged populations. Sponsor for N.R.-P. is 5K23AG057805-02 and is designed to provide N.R.-P. with the training required for success as an independent, clinician-scientist researching interventions to improve the care of dysphagia in patients with Alzheimer disease. The remaining authors declare no conflicts of interest. Reprints: Nicole Rogus-Pulia, PhD, CCC-SLP, Geriatric Research Education and Clinical Center (GRECC), William S. Middleton Memorial Veterans Hospital, 2500 Overlook Terrace, Madison GRECC (11G), Room D4240, Madison, WI 53705 (e-mail: [email protected]). Alzheimer Disease & Associated Disorders: October–December 2020 - Volume 34 - Issue 4 - p 366-379 doi: 10.1097/WAD.0000000000000387 Buy SDC Metrics Abstract Malnutrition and weight loss are highly prevalent in persons with Alzheimer’s disease and related dementias. Oral intake is an important interventional target for addressing these nutritional consequences. However, the efficacy of interventions remains poorly understood as prior syntheses have failed to examine the impact of intervention approaches on malnutrition and hypothesized mechanisms of action in persons with dementia. This review aimed to determine the efficacy of mealtime interventions to improve oral intake and nutritional outcomes in persons with dementia. Four databases yielded 1712 studies, resulting in 32 studies that met inclusion criteria. Studies included education, environmental modifications, feeding, oral supplementation, and other pharmacologic/ecopsychological interventions. While the majority of studies reported statistically significant improvements in at least 1 nutritional outcome, study design and outcome measures were heterogenous with many lacking adequate statistical power or blinding. Collectively, we found moderate evidence to suggest the efficacy of oral supplementation, and preliminary evidence to suggest that feeding interventions, education, and environmental modifications may confer improvements. Findings clarify the state of existing evidence regarding various interventional strategies for improving malnutrition in persons with dementia. While some approaches are promising, adequately powered and rigorously designed multidimensional intervention trials are needed to inform clinical decision-making in real-world contexts. Copyright © 2020 Wolters Kluwer Health, Inc. All rights reserved.