Dementia Appetite Changes: Why Hunger Can Increase or Decrease

Dementia can affect appetite in different ways. Some people lose interest in food, while others eat more frequently, forget that they have eaten or develop new food preferences.

These changes may be related to changes in brain function, memory, taste and smell, but physical illness, medication effects and the eating environment can also play a part.

A sudden or significant change in appetite should not automatically be attributed to dementia. It is important to check for other possible causes.

Key things to know

• Dementia affects appetite in both directions. Reduced appetite is more common overall, but increased appetite is not unusual.
• The changes come from the brain, not from willpower or habit. Hunger and fullness signals, smell, taste and memory of eating are all affected.
• Asking for a meal soon after eating usually means the memory of eating has gone, not that the person is hungry.
• A pull towards sweet food is common, partly because sweet taste is often the last to fade.
• Marked appetite change in frontotemporal dementia can be an early and prominent feature.
• Some medicines increase appetite and some reduce it. This is one of the few causes that can be acted on directly.
• Any sudden change in appetite should be assessed rather than assumed to be dementia.

Does dementia affect appetite?

Yes. Dementia can change appetite in either direction. Some people lose interest in food, while others eat more often, develop new food preferences or forget that they have recently eaten.

The reasons vary from person to person. Changes in memory, taste, smell and brain function can contribute, alongside physical health problems and medication effects. Understanding the cause is more useful than assuming the person is simply being difficult.

Why does dementia change appetite at all?

Appetite depends on several brain functions working together. Dementia disrupts them at different points, which is why the result varies so much between people.

Hunger and fullness signals

The brain helps regulate hunger, fullness and eating behaviour. Dementia can affect these processes, although the effects vary between individuals. Some people may continue eating because they have difficulty recognising fullness, while others may eat again because they cannot remember their last meal. Other factors, including thirst, boredom and changes in routine, may also play a part.

Smell and taste

Changes in taste and smell can make familiar foods less appealing. Some people begin to prefer stronger flavours, including sweeter or saltier foods, while others lose interest in eating. These changes vary, so it helps to offer different foods and notice which flavours the person enjoys.

Memory of having eaten

Short term memory difficulties mean the meal itself can be forgotten within minutes. The plate is cleared, the memory goes, and the person is left with no evidence they have eaten.

Combined with a fullness signal that may already be unreliable, this produces genuine, sincere requests for food that has just been finished.

Recognising food, eating difficulties and knowing what to do with it

As dementia progresses, some people find it harder to recognise food, use cutlery or concentrate on a meal. These difficulties can reduce food intake, while changes in judgement or eating behaviour may create different challenges for others. Offering familiar foods, simple utensils and enough time to eat can help.

Dementia, lack of appetite and weight loss

Many people with dementia eat less as the condition progresses, although the pattern differs between individuals. In some cases, reduced intake is linked to treatable problems such as mouth pain, constipation, infection, medication side effects, low mood or swallowing difficulties.

If appetite falls suddenly, do not assume it is simply part of dementia. Arrange a medical assessment to check for possible causes and identify any support the person may need.

Do dementia patients lose appetite?

Many do. It becomes more likely as the condition progresses, and in the later stages some people stop eating altogether.

Common causes worth checking include:

• Mouth pain, ulcers, thrush, tooth problems or dentures that no longer fit
• Constipation, which removes appetite completely and is easily missed
• Infection, particularly urine and chest infections
• Pain anywhere, especially where the person cannot describe it
• Medicine side effects, including nausea, drowsiness and dry mouth
• Low mood, which is common in dementia and treatable
• Difficulty swallowing
• An overwhelming or noisy mealtime environment

Check the treatable causes first, particularly if the change came on quickly. A sudden loss of appetite in someone who was eating well usually has a cause that can be found.

Reduced appetite, food refusal and stopping eating altogether are covered in more depth on our page about why people with dementia stop eating.

Dementia and appetite increase

Increased appetite in dementia is real and more common than most families are told. It can involve eating larger amounts, eating more often, asking repeatedly for food, or a marked shift towards sweet foods.

Does appetite increase in the later stages of dementia?

Usually not.Increased appetite can occur in dementia, but it does not follow a fixed pattern as the condition progresses. Many people experience reduced intake or swallowing difficulties in the later stages, while others may continue to seek food more often. If appetite changes suddenly, speak to the person's healthcare team to check for other possible causes.

Why do some people with dementia eat more?

Several mechanisms can act at once:

• Loss of the fullness signal. The meal never feels finished.
• Loss of the memory of eating. No recollection of the last meal, so hunger is assumed.
• Changed food preferences, typically towards sweet and highly flavoured foods.
• Repetitive behaviour. Eating can become a repeated action in the way that pacing or repeated questioning does.
• Boredom or lack of stimulation, where eating is the available activity.
• Distress or anxiety, where food is comforting and self-soothing.
• Medicine effects, including some medicines used for mood and for agitation.

Notice how few of these are about hunger. That is why offering more food often does not settle the request, and why addressing the underlying driver usually works better.

Differences between types of dementia

Marked changes in eating and food preference are a recognised and often early feature of frontotemporal dementia, particularly the behavioural form. These can include eating considerably more, a strong pull towards sweet foods, rigid food routines, and putting non-food items in the mouth.

In Alzheimer's disease, appetite change is more variable and more often follows the general pattern of increased intake earlier and reduced intake later.

If prominent changes in eating appear early, alongside changes in personality or behaviour, that is worth raising specifically with the clinical team. It can be diagnostically relevant rather than incidental.

This is usually a memory problem rather than hunger, and arguing about whether they have eaten rarely ends well.

Approaches that tend to work better:

• Offer a drink and something small, then redirect to an activity
• Keep a low-calorie snack available that can be offered without concern, such as cut vegetables or fruit
• Move away from the kitchen, since the setting itself prompts the request
• Change the subject to something absorbing rather than correcting the belief
• Leave a note or a cleared place setting if that reassures them, where it helps rather than distresses

Avoid saying "you have just eaten". It tends to produce either distress or a disagreement neither of you can win, and it does not remove the feeling.

Why the strong preference for sweet food?

Sweet taste is generally the last taste to fade, so as other flavours dull, sweet foods remain rewarding when others no longer are.

It is worth working with this rather than against it. Naturally sweet foods, fruit, yoghurt, milky puddings and smoothies can satisfy the preference while providing nutrition. Complete restriction usually causes distress without changing the underlying drive.

Where someone has diabetes, this needs a conversation with their healthcare team rather than a decision at home, since the balance between glucose control and eating enough is a clinical judgement.

Medicines that affect appetite

Some medicines reduce appetite, and some increase it. Both are worth reviewing.

Medicines used for mood, and antipsychotic medicines sometimes used for agitation or distress, can increase appetite and weight. NICE advises that antipsychotics should only be offered to people living with dementia who are at risk of harming themselves or others, or who are experiencing agitation, hallucinations or delusions causing them severe distress, and that psychosocial and environmental approaches should be offered as initial and ongoing management. NICE also directs prescribers to follow MHRA advice on prescribing antipsychotics to people living with dementia.

If appetite changed noticeably after a medicine was started or adjusted, raise it with the prescriber or pharmacist. Never stop or change a prescribed medicine yourself. If a dose is missed, follow the patient information leaflet and never take a double dose to make up for it.

Safety issues that come with increased appetite

Increased appetite brings practical risks that are worth planning for, and most of them can be managed with changes to the environment rather than to the person.

• Eating too fast, or too much at once, which increases choking risk, particularly if swallowing is already affected
• Putting non-food items in the mouth, which needs prompt attention and may indicate a change worth reporting
• Eating food that has spoiled, where the person no longer checks or cannot judge it
• Uncooked or unsafe food, where kitchen judgement has been affected
• Blood glucose problems where the person has diabetes
• Weight gain affecting mobility, which matters more where walking and transfers are already difficult

Practical measures that help:

1. Keep a small supply of easy, safe snacks visible and everything else out of sight
2. Clear the fridge of anything past its date routinely, since the person may not be able to judge it
3. Serve meals in courses rather than all at once, which slows the pace naturally
4. Sit with them while they eat where possible
5. Ask for a swallowing assessment if they eat very fast and cough or clear their throat afterwards

Night-time eating and broken routines

Some people with dementia wake and look for food at night. This usually reflects a disrupted body clock rather than genuine hunger.

Things that tend to help include keeping daytime routines consistent, getting natural daylight during the day, limiting caffeine later in the day, and keeping a small safe snack available so that a night-time search does not become a crisis or a fall risk.

If night waking is new or worsening, mention it to their healthcare team. Pain, needing the toilet, infection and medicine timing are all possible contributors and are more treatable than the sleep pattern itself.

When an appetite change or swallowing problems need medical assessment

Any sudden change in appetite deserves a review. NICE advises that where non-cognitive symptoms or behaviour changes appear, the person should first be assessed to exclude other causes, including physical health problems such as pain and infection, medicine side effects, and environmental and psychosocial factors.

Arrange an appointment for:

• A sudden increase or decrease in appetite
• Appetite change alongside new confusion, drowsiness or a fever
• Steady weight loss, or weight gain affecting mobility
• Any sign of swallowing difficulty
• Appetite change soon after a medicine was started or changed
• Suspected pain, constipation or low mood
• Eating non-food items
• Night-time eating that is new or causing falls risk

Seek urgent medical help if the person chokes, becomes breathless during or after eating, develops a fever with rapid breathing, becomes suddenly much more confused, or is very drowsy and hard to rouse.

Medical Disclaimer

This article is for general information only. It is not medical advice and it does not replace assessment by the healthcare professionals who know the person concerned.

Sudden changes in appetite, in either direction, should be assessed. Other causes, including pain, infection, constipation, low mood and medicine side effects, are common and often treatable.

Do not stop, start or adjust any prescribed medicine without advice, and do not change food textures or thicken drinks without a professional assessment. Where there are concerns about safety when eating or drinking, ask for a speech and language therapy assessment. Always read the patient information leaflet supplied with any medicine.

If the person chokes, becomes breathless during or after eating, develops a fever with rapid breathing, becomes suddenly much more confused, or is very drowsy and difficult to rouse, seek urgent medical help.