Objective To investigate the effects of intermittent oral to esophageal feeding on cognitive function, nutritional status and intestinal flora in elderly patients with Alzheimer"s disease. Methods According to the random number table method, 113 elderly patients with Alzheimer"s disease from June 2021 to June 2023 were divided into control group (56 cases) and observation group (57 cases). The control group was given nasogastric tube, and the observation group was given intermittent oral to esophageal tube feeding with gastrointestinal nutrition. Anthropometric indices, cognitive function, nutritional status, intestinal flora level and complication rate were compared between the two groups. Results The triceps skin fold thickness, body mass index and upper arm muscle circumference in observation group were higher than those in control group (P<0.05). The score of Alzheimer"s Disease Cognitive Function Rating Scale (ADAS-cog) in the observation group was lower than that in the control group (P<0.05). The score of Montreal Cognitive Assessment Scale (MoCA) in observation group was higher than that in control group (P<0.05). The levels of hemoglobin, serum albumin and total protein in observation group were higher than those in control group (P<0.05). The number of bifidobacterium and lactobacillus in observation group was higher than that in control group (P<0.05). The number of enterobacter and Clostridium perfringens enterococcus in observation group was lower than that in control group (P<0.05). The complication rate of the observation group was lower than that of the control group (P<0.05). Conclusion Intermittent oral to esophageal feeding can improve the nutritional status, cognitive function and intestinal flora of the elderly patients with Alzheimer"s disease and reduce the incidence of complications.