[Internal medicine aspects and characteristics of nutrition in patients with cerebral cognitive deficits].

The reason of cerebral disorders is estimated to be internal diseases in a quarter of the patients. Metabolic causes could be hypoxemia, electrolyte disorders, disorders of the acid-base balance, liver diseases, renal diseases, metabolic disorders and chronic deficiency conditions of several vitamins and iron, cardiovascular causes include heart diseases, which go along with reduced cardiac output. Further cerebral disorders could also occur in cases of neoplasia, severe infections and chronic pain conditions. Also a lot of pharmacological agents given in high doses, especially psychotropic drugs, can cause confusion conditions and severe cerebral disorders. Physiological and pharmacological peculiarities in older people, which concern the absorption in the gastrointestinal tract, the distribution in the organism, the biotransformation and the excretion, are shown, further the problems of the aging process at the cell-level. Changes of the body composition respectively of the organs and organ systems, and the decrease of the low-fat body mass and the combined decrease of the whole body water represent the most important figure. As with increasing age the daily energy absorption and energy turnover decrease, the peculiarities of the nutrition are discussed in detail. While malnutrition in the outpatients with dementia is rare, there might be a lack especially in patients under hospital or rent house care in the presence of considerable mental and/or physical handicaps: this happens when home nursing is not possible any longer. Further guidelines for the handling of patients with eating-related behavioral problems are discussed. Through proper arrangements eating difficulties should be prevented and an adequate training of the relatives and the nursing stuff is advisable. Suitable medication and dietetic intervention may be prophylactic and curative against malnutrition especially in the field of vitamins, trace elements and other essential nutritive substances.