Some weight loss is an inevitable consequence of muscle wasting. However as motor neurone disease progresses, eating may become difficult and exhausting, and cause anxiety (MND Australia 2011).
Consult a dietitian for advice on maintaining optimal nutrition and hydration.
It is generally recognised that malnourishment is a relevant determinant of outcome in ALS (Chio and others 2009).
Miller and others 2009a
In ALS, factors that restrict adequate nutrition develop insidiously and progressively worsen.
Videofluoroscopic evaluation of the swallowing mechanism may identify food textures that can be handled successfully. However, it is not a required test to establish the presence or absence of dysphagia.
Strategies to maintain oral nutritional intake consist of altering food consistency and using nutritional supplements.
Ultimately, a percutaneous endoscopic gastrostomy (PEG) or equivalent device (e.g., radiologically inserted device [RIG]) may be needed as an alternative route for delivering nutrition. It is important to emphasize to patients that PEG does not eliminate oral feeding but offers a convenient method for administering medication and fluid and stabilising weight.
Maintaining good nutrition is a challenge for people with MND and their carers.
People with MND who have a gastrostomy may live longer and have an improved sense of well being (Katzberg and others 2011, Andersen and others 2007).
It is important that the person living with MND be aware of such options in good time in order to obtain maximum benefit. Assessment by a respiratory physician should be performed prior to PEG placement (MND Australia 2011).
The sphincter muscles themselves are not weakened by MND. Incontinence is therefore not a common problem. Constipation is, however, a frequent problem and can be caused by immobility, modified diet, poor fluid intake, medications - especially analgesics and anticholinergic drugs, and inability to strain due to weak abdominal, diaphragmatic and glottic muscles (MND Australia 2011).
