The behavior of a person with dementia manipulating, smearing, or sorting their food, often termed “playing with food,” can be confusing and distressing for caregivers. This action is not willful defiance, but a direct manifestation of neurological decline impacting the complex process of eating. The inability to recognize food or execute the learned motor sequence for eating is rooted in specific brain changes. Understanding the underlying cognitive deficits and environmental triggers is the first step toward managing this common symptom and ensuring adequate nutrition.
Underlying Cognitive and Sensory Changes
The most direct neurological causes for food manipulation are impairments in recognition and coordination, known respectively as agnosia and apraxia. Agnosia is the inability to recognize objects despite intact sensory function. The person may look at food but fail to recognize it as something to be consumed, or may mistake a non-food item, like a napkin, for an edible item. This deficit is further complicated by apraxia, which is the loss of the learned ability to perform purposeful movements, such as the sequence required to pick up a fork and bring food to the mouth. When the motor program is lost, the hand may resort to simpler movements, resulting in the food being pushed, sorted, or smeared instead of eaten.
Changes in executive function also contribute significantly by impairing the brain’s ability to plan and organize a complex task like eating a meal. This cognitive decline makes it difficult to filter out distractions, sustain attention, or sequence the steps from the first bite to the last. The person may become easily distracted, causing them to pause mid-action and begin manipulating the food as a substitute activity for consumption.
Sensory processing deficits further alter the experience of eating, prompting unusual interactions with food. Dementia often causes a decline in visual contrast sensitivity and depth perception, making it difficult to distinguish food from the plate or the table surface. A person may push food around because they cannot perceive it clearly against a low-contrast background, such as mashed potatoes on a white plate.
A diminished sense of taste and smell, common in dementia, can reduce the motivation to eat or cause rejection of previously favorite foods. When food no longer offers the expected sensory reward, a person may examine it more closely with their hands, leading to manipulation. This sensory change can also lead to a preference for sweeter foods, as the taste of sugar is retained longer than other flavors.
Contributing Physical and Environmental Factors
Factors external to the person’s neurological state can intensify or trigger food manipulation behaviors. A dining environment that is too noisy or cluttered provides excessive sensory input that compromised executive function cannot filter out. Background noise from a television, conversation, or clatter of dishes can easily distract the person, causing them to lose focus on eating and revert to simpler, repetitive hand movements.
Physical discomfort and poor positioning can also lead to a reluctance to eat, manifesting as food refusal or manipulation. Issues such as ill-fitting dentures, mouth pain, or fatigue can make chewing and swallowing an arduous process. If a person is seated uncomfortably or cannot easily reach the food, frustration may be misdirected toward the food itself, leading to pushing it away or handling it haphazardly.
The presentation of the meal itself can be a major trigger for confusion and manipulation. Offering too many food items at once, or using patterned plates and tablecloths, creates visual clutter that overwhelms perceptual abilities. This visual confusion makes it difficult to discern which item is food and which is the plate, leading to tentative touching, sorting, or smearing. Feeling rushed during a meal can also heighten anxiety, causing the person to abandon the complex task of eating for a less demanding interaction with the food.
Intervening When Food Manipulation Occurs
Practical intervention strategies focus on simplifying the mealtime experience and capitalizing on retained sensory and motor abilities. One effective technique is to use high-contrast dishware to counteract the decline in visual perception. Studies show that using a bright red plate, which provides strong contrast against most foods, can increase food intake by as much as 25% in patients with advanced Alzheimer’s disease by making the food more visible.
Caregivers should simplify the plate by presenting only one food item at a time, reducing the visual and cognitive burden of choice. Offering food that can be picked up without utensils, such as small sandwiches, fruit slices, or cooked vegetables, can bypass the apraxia associated with using cutlery. This approach meets the person at their current functional level and reduces the opportunity for manipulation.
Adaptive tools are another useful means of redirecting the behavior toward consumption. Specialized utensils with large, easy-to-grip handles or weighted silverware can make self-feeding easier and more successful for those with motor control issues. Non-slip placemats or suction-cup bowls can stabilize the plate, preventing the person from accidentally spilling or pushing the food away when attempting to scoop.
When manipulation begins, gentle verbal cueing or modeling the eating action by eating alongside the person can prompt them to resume the task without confrontation. Avoiding rushing and creating a calm, quiet dining setting by minimizing noise and clutter helps the person focus their attention on the food. Modifying the texture of the food, such as softening or pureeing, can also reduce the need to examine or reject the item, promoting comfortable consumption.