*4.2. Nutritional Strategies and Management*

Breaking the vicious circle between malnutrition and cognitive impairment can help patients and reduce the impact of this degenerative condition [25,28].

The management of elderly adults who are malnourished or at malnutrition risk should be multimodal and multidisciplinary, as reported by Salva et al. in their nutritional intervention program, "The NutriAlz", aimed at preventing weight loss patients affected by dementia [28].

A routine and impersonalized hospital nutrition in elderly patients carries an increased risk of mortality compared with individualized nutritional support [31]. Especially, patients with dementia and cognitive impairment hospitalized for acute diseases often require individualized strategies to maintain adequate caloric intake.

Moreover, eating difficulties is a factor associated with low food intake [29]. Therefore, attention must be paid to oral frailty, defined as a gradual age-related loss of oral function along with decline in cognitive and physical function [32]. In addition, altered eating behavior and dysphagia are factors to be managed in these frail hospitalized patients [26]. These patients have impaired oral motor skills, particularly chewing function, oral diadochokinesis, swallowing and salivary disorders, all associated with few teeth left in the oral cavity [29,32].
