Pica and Dementia

Has your partner with dementia ever tried to eat something inedible, like paper or soap, and left you wondering why or what to do about it? What you may be witnessing is known as pica. Pica is most easily described as a condition where someone repeatedly consumes non-nutritive or non-food items. For example, people with pica may chew or swallow paper, soap, dirt, cornstarch, cardboard, or buttons. The range of items consumed by individuals with pica is vast and can differ by person.

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Pica is most commonly observed in:

• children
• pregnant women
• individuals with certain mental health or cognitive conditions (such as intellectual disabilities, autism, schizophrenia, and dementia)

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For this blog post, we’ll focus on how pica can appear in people with dementia. It’s important to understand that consuming inedible items is rarely a deliberate choice; rather, it often stems from neurological changes. One key factor is a deficit in semantic memory—the part of long-term memory that stores general knowledge about the world, including what objects are and their purpose. When areas of the brain that support semantic memory, such as the anterior temporal lobe, are damaged, a person may lose the understanding that certain objects are not meant to be eaten.

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Most of the time, we only know what’s edible because we’ve learned it and retained that information. However, even as adults, we sometimes pause and wonder if something is safe to eat. Take a decorated cake, for example—you might ask yourself, "are these flowers edible, or just for decoration?" That hesitation comes from knowing most flowers aren’t edible. Yet bakers often use safe alternatives like non-toxic flowers, gum paste, or rice paper to make decorations that can be eaten. Now, imagine if brain changes caused you to forget what a flower is or that many flowers are inedible. In that case, you might eat the flowers on the cake without hesitation.

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When dementia affects the frontal and temporal lobes of the brain, pica is more likely to appear because these areas play a role in executive function, semantic memory, and behavior regulation. Pica is especially common in frontotemporal dementia and Alzheimer’s disease, though it can occur with any type of dementia. It tends to show up in the early stages of frontotemporal dementia and the later stages of Alzheimer’s disease. However, not everyone with dementia will develop pica. For reference, about 10% of Alzheimer's disease patients develop pica behaviors

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Other common triggers for pica can be physiological or emotional. For example:

• Hunger or dehydration: If basic needs aren’t met, the person may try to eat whatever is nearby in an effort to satisfy their needs.
• Nutritional deficiencies: Low levels of minerals like iron or zinc can trigger unusual cravings, sometimes for non-nutritive items such as ice or cornstarch.
• Sensory cravings: Some people have a stronger need for oral stimulation and may be drawn to certain textures, like crunchy or soft items.
• Medications: Certain drugs can cause dry mouth or change appetite and taste, sometimes making non-food items seem appealing.
• Emotional distress: Anxiety, stress, or frustration may trigger pica behaviors, as the person seeks comfort or self-soothing.
• Lack of engagement: Boredom or not having enough to do can result in chewing or eating non-food or non-nutritive items as a form of stimulation.

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Since there can be so many different triggers for pica, the way that you address it can vary—the solution should fit the problem. The one thing NOT to do though, is to scold, shame, or become angry in any way. Remember, we just shared that emotional distress can be a trigger for pica. So, it's best to avoid reacting in a way that would cause emotional distress for your partner.

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Instead, here are 6 practical tips for managing pica:

• Stay calm and redirect to a safer alternative: If your partner reaches for a non-food or non-nutritive item, gently remove it and offer a safe snack or chewable object instead. You might say, “Here, let’s try this instead,” while giving them an edible item with a similar texture. For example, if they’re chewing on something soft, provide a soft snack rather than something hard to make the switch feel natural. Eating the new item alongside them can also reinforce the change. Some caregivers also have success using chewable jewelry for sensory stimulation—but this is best for those seeking to chew, not for individuals trying to actually eat or swallow items.
• Keep them well-fed and hydrated: Regular, balanced meals, snacks, and plenty of fluids can lessen the urge to eat non-food or non-nutritive items. Offering chewy or crunchy foods can also help meet oral cravings in a safe way.
• Check for underlying needs: Nutritional deficiencies, dehydration, or medication side effects can contribute to pica. If you notice new or worsening behaviors, talk with a healthcare provider. They may recommend blood work, supplements, or a referral to a registered dietitian to support a balanced diet. A speech-language pathologist can also assess oral motor function and suggest safe, individualized food and non-food alternatives.
• Remove tempting items: Keep paper, coins, small toys, and other non-food or non-nutritive objects your partner may reach for out of sight and out of reach—especially anything dangerous or toxic. Cabinet locks or secure storage options can also add another layer of safety if needed.
• Keep them engaged: Boredom or restlessness can increase pica. Simple enjoyable activities like folding laundry, watering plants, or listening to music can provide safe stimulation and distract your partner from pica behaviors.
• Supervise as necessary: Keep a close eye to prevent accidents while still supporting independence whenever possible. Be mindful that partners with pica may hide inedible items in their mouth, clothing (like pockets, sleevees, and bras), or even around the home (like in couch cushions). These behaviors can come and go, and may surface more during certain times, such as when your partner is hungry or feeling anxious.

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Leaving pica unchecked can put your partner at serious risk. Pica is not harmless. In the short term, eating non-food items can cause choking, poisoning, or dangerous blockages in the digestive tract. Over time, repeated pica behaviors can lead to malnutrition, infections, or injuries that may require hospitalization. By recognizing and responding to pica early, you can protect your partner from immediate harm and reduce the likelihood of long-term complications. While it can be challenging, your efforts are appreciated and truly make a difference in keeping your partner safe and supported. Even removing one hazard or swapping one non-food item for a better alternative can help.

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References: 

https://www.ncbi.nlm.nih.gov/books/NBK532242/

‍https://emedicine.medscape.com/article/914765-overview?form=fpf

https://superiorseniorhomecare.com/caring-for-people-with-dementia-understanding-pica/

https://serenityhomecare.ca/2025/04/23/how-to-manage-dementia-and-pica-to-keep-loved-ones-safe

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