Understanding total energy expenditure in people with dementia: A systematic review with directions for future research

Objective: Weight loss is a primary manifestation of dementia. This review aimed to systematically synthesise the literature on total energy expenditure (TEE) in people with dementia. Methods: The protocol, registered with PROSPERO, was reported against PRISMA guidelines. Eligible studies investigated TEE in people with dementia. Six electronic databases and a supplementary Internet search identified relevant publications. Results were synthesised narratively. Results: The final library considered the TEE of 358 participants. Two studies used the gold standard method of doubly labelled water (DLW); other studies used TEE measures validated against DLW. TEE varied considerably, from 6095 ± 1353 kJ to 9765 ± 2066 kJ. The TEE of community-dwelling people with dementia (range 8430 ± 2250 kJ-9765 ± 2066 kJ) was higher than in institutionalised groups (range 6095 ± 1353 kJ-7619 ± 1827 kJ). Conclusions: New technologies will enable future research in this patient population to be less burdensome than those reliant on DLW measures. In planning future research, avoidance of selection bias and considering disease stage and movement are important considerations.