Glucose administration prior to a divided attention task improves tracking performance but not word recognition: evidence against differential memory enhancement?

The Impact of Free and Added Sugars on Cognitive Function: A Systematic Review and Meta-Analysis

A relationship between excessive sugar consumption and cognitive function has been described in animal models, but the specific effects of sugars in humans remains unclear. This systematic review and meta-analysis aimed to evaluate the current knowledge, research characteristics, and quality of evidence of studies investigating the impacts of free and added sugars on human cognition in healthy participants. The review identified 77 studies (65 experimental trials, n = 3831; 9 cross-sectional studies, n = 11,456; and 3 cohort studies, n = 2059). All cohort studies and eight of the nine cross-sectional studies found significant positive correlations between added sugar consumption and risk of cognitive impairment. Four studies identified reduced risk of cognitive impairment associated with natural fructose-containing foods. The majority of randomised control trials assessed short-term glucose facilitation effects on cognitive outcomes. The results from these studies suggest the need for a tightly regulated blood glucose level, dependent on individualised physiological factors, for optimal cognitive function. A meta-analysis of a subset of studies that assessed the impact of glucose on recall found improvements in immediate free recall compared to controls (p = 0.002). The findings highlight the potentially detrimental effect of excessive, long-term, or prenatal added sugar consumption on cognitive function. Further research is needed to examine the specific effects of free and added sugars on cognitive function.

The Impact of Free Sugar on Human Health-A Narrative Review

The importance of nutrition in human health has been understood for over a century. However, debate is ongoing regarding the role of added and free sugars in physiological and neurological health. In this narrative review, we have addressed several key issues around this debate and the major health conditions previously associated with sugar. We aim to determine the current evidence regarding the role of free sugars in human health, specifically obesity, diabetes, cardiovascular diseases, cognition, and mood. We also present some predominant theories on mechanisms of action. The findings suggest a negative effect of excessive added sugar consumption on human health and wellbeing. Specific class and source of carbohydrate appears to greatly influence the impact of these macronutrients on health. Further research into individual effects of carbohydrate forms in diverse populations is needed to understand the complex relationship between sugar and health.

Sex Differences in Cognition Across Aging

Sex and gender differences are seen in cognitive disturbances in a variety of neurological and psychiatry diseases. Men are more likely to have cognitive symptoms in schizophrenia whereas women are more likely to have more severe cognitive symptoms with major depressive disorder and Alzheimer's disease. Thus, it is important to understand sex and gender differences in underlying cognitive abilities with and without disease. Sex differences are noted in performance across various cognitive domains - with males typically outperforming females in spatial tasks and females typically outperforming males in verbal tasks. Furthermore, there are striking sex differences in brain networks that are activated during cognitive tasks and in learning strategies. Although rarely studied, there are also sex differences in the trajectory of cognitive aging. It is important to pay attention to these sex differences as they inform researchers of potential differences in resilience to age-related cognitive decline and underlying mechanisms for both healthy and pathological cognitive aging, depending on sex. We review literature on the progressive neurodegenerative disorder, Alzheimer's disease, as an example of pathological cognitive aging in which human females show greater lifetime risk, neuropathology, and cognitive impairment, compared to human males. Not surprisingly, the relationships between sex and cognition, cognitive aging, and Alzheimer's disease are nuanced and multifaceted. As such, this chapter will end with a discussion of lifestyle factors, like education and diet, as modifiable factors that can alter cognitive aging by sex. Understanding how cognition changes across age and contributing factors, like sex differences, will be essential to improving care for older adults.

Cognitive glucose sensitivity-proposing a link between cognitive performance and reliance on external glucose uptake

Existing evidence on the effects of glucose supplementation on cognitive performance appears inconclusive. Metabolic switching offers an approach to explain such incoherent findings based on differences in cognitive functioning after fasting. We propose a new construct, cognitive glucose sensitivity (CGS), which quantifies individual performance gain due to glucose supplementation. We tested the hypothesis that the effects of glucose ingestion depend on CGS, cognitive task domain, and sex. In addition, the relationship between CGS and body mass index (BMI) was examined. Seventy-one participants (48 female) were tested in two conditions each (deprivation baseline vs. glucose supplementation), performing tasks from different cognitive domains (memory and executive functioning). We found significant evidence for a correlation of deprivation baseline performance and CGS across domains (Corsi-Block-Tapping Task: r = -0.57, p < 0.001; Go-No-Go Task: r = 0.39, p = 0.001; word list recall: r = -0.50, p < 0.001). Moreover, individual CGS differed significantly between tasks (p = 0.018). Only in men, BMI was significantly related to CGS in a word recall paradigm (r = 0.49, p = 0.017). Our findings support the notion that the effects of glucose depend on CGS, task domain, and sex. The effort to reduce performance impairment (short-term) might sacrifice independence from external glucose (long term), possibly via declining blood glucose regulation. Therefore, CGS could be regarded as a candidate to enhance our understanding of the etiology of unhealthy eating.

Effects of alcohol hangover on attentional resources during a verbal memory/psychomotor tracking dual attention task

BACKGROUND

Alcohol hangover (AH) is associated with impaired attention and memory performance. However, whether this effect is related to reduced attentional resources remains unclear.

AIMS

A dual-attention paradigm was employed to assess the effects of AH on attentional resources, delayed memory recognition, and the interaction between attentional load and AH. Mental effort and perceived performance during AH and control conditions were also assessed.

METHODS

A seminaturalistic, crossover design was used. In total, 25 healthy social drinkers aged 18-35 years, visited the laboratory following a typical night out drinking (Hangover condition) and after alcohol abstinence (control) between 8:30 am and 12:30 pm, with conditions counterbalanced. Attentional load was manipulated via the presence (dual attention) or absence of psychomotor tracking during verbal memory encoding. Perceived mental effort and performance were measured using the NASA-TLX. Participants' recollected alcohol consumption was used to compute estimated blood alcohol level (eBAC).

RESULTS

Compared with the control visit, AH was associated with reduced recognition accuracy (particularly more false negatives), higher "tracking costs" (poorer accuracy) in the dual attention condition, increased ratings of "mental demand," "effort," and "frustration," and lower ratings of task performance. There was also a significant main effect of attentional load with poorer recognition accuracy and response time in the dual attention condition. There were no significant interaction effects between hangover and attentional load.

CONCLUSION

These findings suggest that reduced attentional resources contribute to the cognitive deficits associated with AH including impaired memory consolidation. They further suggest that while hungover, participants are aware of these deficits but are unable to compensate.

Effect of glucose and sucrose on cognition in healthy humans: a systematic review and meta-analysis of interventional studies

CONTEXT

Evidence suggests that plasma glucose levels may influence cognitive performance, but this has not been systematically reviewed and quantified.

OBJECTIVE

The aim of this review was to investigate the potential effects of glucose and sucrose, compared with placebo, on cognition in healthy humans.

DATA SOURCES

The electronic databases PubMed and Web of Science were searched up to December 2019. Reference lists of selected articles were checked manually.

STUDY SELECTION

Randomized controlled trials or crossover trials that compared glucose or sucrose with placebo for effects on cognition were eligible.

DATA EXTRACTION

Potentially eligible articles were selected independently by 2 authors. Risk of bias was assessed through the Cochrane Collaboration tool. Standardized mean differences (SMDs) were obtained from random-effects meta-analyses for a subsample of studies that reported the same outcomes.

RESULTS

Thirty-seven trials were identified, of which 35 investigated the effect of glucose consumption compared with placebo on cognition. Two studies found no effect of glucose on cognition, while the others found mixed results. Only 3 of the 37 studies investigated the effects of sucrose intake, reporting mixed results. Meta-analyses revealed a significantly positive effect of glucose compared with control, but only when a verbal performance test (immediate word recall) was used in parallel-design studies (SMD = 0.61; 95%CI, 0.20-1.02; I2 = 0%). Twenty-four studies were classified as having high risk of bias for the selection procedure.

CONCLUSIONS

A limited body of evidence shows a beneficial effect of glucose in individuals performing immediate verbal tasks. High-quality trials with standardized cognitive measurements are needed to better establish the effect of glucose or sucrose on cognition.

SYSTEMATIC REVIEW REGISTRATION

PROSPERO registration number CRD42019122939.

Further Evidence of Benefits to Mood and Working Memory from Lipidated Curcumin in Healthy Older People: A 12-Week, Double-Blind, Placebo-Controlled, Partial Replication Study

Curcumin (a flavonoid isolated from turmeric) affects several processes involved in neurocognitive aging. We have previously reported that short term (4-weeks) administration of a highly bioavailable curcumin preparation (Longvida©) improved working memory and reduced fatigue and stress reactivity in a healthy older cohort. The present trial (ACTRN12616000484448) was a partial replication study, evaluating similar effects at 4 and 12-weeks Longvida© supplementation. A double-blind, placebo-controlled, parallel-groups trial was conducted. Eighty participants aged 50-80 years (mean = 68.1, SD = 6.34) were randomised to receive Longvida© (400 mg daily containing 80 mg curcumin) or a matching placebo. Assessment took place at baseline then following 4 and 12 weeks treatment. Outcome measures included cognitive performance, mood and biomarkers. Compared with placebo, curcumin was associated with several significant effects. These included better working memory performance at 12-weeks (Serial Threes, Serial Sevens and performance on a virtual Morris Water Maze), and lower fatigue scores on the Profile of Mood States (POMS) at both 4 and 12-weeks, and of tension, anger, confusion and total mood disturbance at 4-weeks only. The curcumin group had significantly elevated blood glucose. These results confirm that Longvida© improves aspects of mood and working memory in a healthy older cohort. The pattern of results is consistent with improvements in hippocampal function and may hold promise for alleviating cognitive decline in some populations.

Fuel for Thought? A Systematic Review of Neuroimaging Studies into Glucose Enhancement of Cognitive Performance

A transient improvement in cognitive performance can be observed following the ingestion of a glucose drink, a phenomenon known as the ‘glucose facilitation effect’. The effect has been studied thoroughly in the last three decades, but its neural underpinnings remain a matter of speculation. A systematic review was conducted to evaluate the current evidence from studies applying neuroimaging or neurophysiological methods to investigate the glucose enhancement effect. Eleven studies met the inclusion criteria of using neuroimaging in conjunction with cognitive outcomes. Six studies employed electroencephalography (EEG), four used functional magnetic resonance imaging (fMRI) and one employed functional near-infrared spectroscopy (fNIRS). All but one study reported modulation of neurophysiology or neuroimaging markers following glucose, while only five studies reported significant changes in cognitive outcomes. The evidence suggests that glucose administration enhances neurocognitive markers of episodic memory and attentional processes underpinned by medial temporal and frontal activation, sometimes in the absence of measurable behavioural effects. Further exploration of glucose facilitation using neuroimaging measures with increased sample sizes is warranted to replicate these findings.

Functional Connectivity of the Anterior and Posterior Hippocampus: Differential Effects of Glucose in Younger and Older Adults

The hippocampus features structurally and functionally distinct anterior and posterior segments. Relatively few studies have examined how these change during aging or in response to pharmacological interventions. Alterations in hippocampal connectivity and changes in glucose regulation have each been associated with cognitive decline in aging. A distinct line of research suggests that administration of glucose can lead to a transient improvement in hippocampus-dependent memory. Here, we probe age, glucose and human cognition with a special emphasis on resting-state functional connectivity (rsFC) of the hippocampus along its longitudinal axis to the rest of the brain. Using a randomized, placebo-controlled, double-blind, crossover design 32 healthy adults (16 young and 16 older) ingested a drink containing 25 g glucose or placebo across two counter balanced sessions. They then underwent resting-state functional magnetic resonance imaging (rs-fMRI) and cognitive testing. There was a clear dissociation in the effects of glucose by age. Magnitude change in rsFC from posterior hippocampus (pHPC) to medial frontal cortex (mPFC) was correlated with individual glucose regulation and gains in performance on a spatial navigation task. Our results demonstrate that glucose administration can attenuate cognitive performance deficits in older adults with impaired glucose regulation and suggest that increases in pHPC-mPFC rsFC are beneficial for navigation task performance in older participants.

Effects of glucose and sucrose on mood: a systematic review of interventional studies

Context

Glucose is the main energy source for the brain, and as such, manipulation of glucose supply may affect brain function. It has been suggested that a change in blood glucose may influence mood.

Objective

The aim of this review was to investigate the potential effects of glucose and sucrose, compared with placebo, on mood.

Data Sources

The electronic databases PubMed and Scopus were searched. Reference lists of selected articles were checked manually.

Data Extraction

Randomized controlled trials or crossover trials comparing the effects of glucose or sucrose on mood that were published up to May 2017 were eligible. Potentially eligible articles were selected independently by 2 reviewers.

Results

In total, 19 studies were found. Thirteen studies investigated the effects of glucose consumption compared with placebo on mood. Seven of these 13 studies found no effect of glucose on mood. The other 6 studies found small and partial effects that may also be due to other factors like palatability and expectation. Seven of the 19 studies investigated the effects of sucrose ingestion versus placebo on mood. None of these studies found a positive effect on mood, and 1 study observed an adverse effect. One of the studies investigated the effects of both glucose and sucrose.

Conclusions

The results from this review show limited effects of glucose ingestion on mood and no effect of sucrose on mood.

Sugar rush or sugar crash? A meta-analysis of carbohydrate effects on mood

The effect of carbohydrate (CHO) consumption on mood is much debated, with researchers reporting both mood improvements and decrements following CHO ingestion. As global consumption of sugar-sweetened products has sharply increased in recent years, examining the validity of claims of an association between CHOs and mood is of high importance. We conducted a systematic review and meta-analysis to evaluate the relationship between acute CHO ingestion and mood. We examined the time-course of CHO-mood interactions and considered the role of moderator variables potentially affecting the CHO-mood relationship. Analysis of 176 effect sizes (31 studies, 1259 participants) revealed no positive effect of CHOs on any aspect of mood at any time-point following their consumption. However, CHO administration was associated with higher levels of fatigue and less alertness compared with placebo within the first hour post-ingestion. These findings challenge the idea that CHOs can improve mood, and might be used to increase the public's awareness that the 'sugar rush' is a myth, inform health policies to decrease sugar consumption, and promote healthier alternatives.

Attentional and working memory performance following alcohol and energy drink: A randomised, double-blind, placebo-controlled, factorial design laboratory study

Alcohol mixed with energy drinks (AMED) studies have typically not shown antagonism of acute alcohol effects by energy drink (ED), particularly over relatively short time frames. This study investigated the effects of alcohol, ED, and AMED on attentional and working memory processes over a 3 h period. Twenty-four young adults took part in a randomised, double-blind, placebo-controlled, factorial, 4-arm study. They were administered 0.6g/kg alcohol and 250 ml ED (containing 80 mg caffeine), and matching placebos alone and in combination. A battery of attentional and working memory measures was completed at baseline then 45, 90 and 180 min post-treatment. Alcohol produced a characteristic shift in speed/accuracy trade-off, having little effect on reaction times while increasing errors on all attentional measures (4-choice Reaction Time, Number Pairs and Visual Search), as well as a composite Attentional error score and one working memory task (Serial Sevens). ED alone improved two working memory measures (Memory Scanning accuracy and Digit-Symbol reaction times) and improved speed of responding on a composite Working Memory score. There was no consistent pattern of AMED vs. alcohol effects; AMED produced more errors than alcohol alone on one attentional measure (Visual Search errors) at 45 min only whereas AMED resulted in fewer errors on the Serial Sevens task at 90 min and better Digit-Symbol accuracy and reaction time at 45 min. Alcohol consumption increases error rate across several attentional and working memory processes. Mutual antagonism between alcohol and ED showed no consistent pattern and likely reflects a complex interaction between caffeine and alcohol levels, phase of the blood alcohol limb, task domain and cognitive load.

Regional Cerebrovascular Reactivity and Cognitive Performance in Healthy Aging

Cerebrovascular reactivity (CVR) reflects the response of brain blood vessels to vasoactive stimuli, such as neural activity. The current research assessed age-related changes in regional CVR to 5% CO2 inhalation in younger (n = 30, range: 21-45 years) and older (n = 29, range: 55-75 years) adults, and the contribution of regional CVR to cognitive performance using blood-oxygen-level dependent contrast imaging (BOLD) functional magnetic resonance imaging (fMRI) at 3T field strength. CVR was measured by inducing hypercapnia using a block-design paradigm under physiological monitoring. Memory and attention were assessed with a comprehensive computerized aging battery. MRI data analysis was conducted using MATLAB® and SPM12. Memory and attention performance was positively associated with CVR in the temporal cortices. Temporal lobe CVR influenced memory performance independently of age, gender, and education level. When analyzing age groups separately, CVR in the hippocampus contributed significantly to memory score in the older group and was also related to subjective memory complaints. No associations between CVR and cognition were observed in younger adults. Vascular responsiveness in the brain has consequences for cognition in cognitively healthy people. These findings may inform other areas of research concerned with vaso-protective approaches for prevention or treatment of neurocognitive decline.

The Effects of Carbohydrates, in Isolation and Combined with Caffeine, on Cognitive Performance and Mood-Current Evidence and Future Directions

This review examines the effects of carbohydrates, delivered individually and in combination with caffeine, on a range of cognitive domains and subjective mood. There is evidence for beneficial effects of glucose at a dose of 25 g on episodic memory, but exploration of dose effects has not been systematic and the effects on other cognitive domains is not known. Factors contributing to the differential sensitivity to glucose facilitation include age, task difficulty/demand, task domain, and glucoregulatory control. There is modest evidence to suggest modulating glycemic response may impact cognitive function. The evidence presented in this review identifies dose ranges of glucose and caffeine which improve cognition, but fails to find convincing consistent synergistic effects of combining caffeine and glucose. Whilst combining glucose and caffeine has been shown to facilitate cognitive performance and mood compared to placebo or glucose alone, the relative contribution of caffeine and glucose to the observed effects is difficult to ascertain, due to the paucity of studies that have appropriately compared the effects of these ingredients combined and in isolation. This review identifies a number of methodological challenges which need to be considered in the design of future hypothesis driven research in this area.

Nutrients for neurocognition in health and disease: measures, methodologies and mechanisms

Effective pharmaceutical treatments for age-related cognitive decline have proved elusive. There is, however, compelling evidence that nutritional status and supplementation could play crucial roles in modifying the expression of cognitive change through the lifespan. Subjective memory impairment and mild cognitive impairment can be harbingers of dementia but this is by no means inevitable. Neurocognitive change is influenced by a variety of processes, many of which are involved in other aspects of systemic health, including cardiovascular function. Importantly, many of these processes are governed by mechanisms which may be modified by specific classes of bioactive nutrients. There is increasing, converging evidence from controlled trials that nutritional interventions can improve mood and cognitive function in both clinical and healthy populations. Specific examples include selected botanical extracts such as the flavonoids. Some nutritional supplements (e.g. broad-spectrum micronutrient supplementation) appear to support improved cognitive function, possibly through redressing insufficient nutrient status (i.e. suboptimal but above the threshold for frank deficiency). Recent mechanistic research has unveiled physiologically plausible, modifiable, cognition-relevant targets for nutrition and nutraceuticals. These include processes involved in both systemic and central vascular function, inflammation, metabolism, central activation, improved neural efficiency and angiogenesis. The advent and development of human neuroimaging methodology have greatly aided our understanding of the core central mechanisms of cognitive change. Different imaging modalities can provide insights into modifiable central mechanisms which may be targeted by bioactive nutrients. The latter may contribute to slowing age-related decline through supporting neurocognitive scaffolding mechanisms.

Glucose improves object-location binding in visual-spatial working memory

RATIONALE

There is evidence that glucose temporarily enhances cognition and that processes dependent on the hippocampus may be particularly sensitive. As the hippocampus plays a key role in binding processes, we examined the influence of glucose on memory for object-location bindings.

OBJECTIVE

This study aims to study how glucose modifies performance on an object-location memory task, a task that draws heavily on hippocampal function.

METHODS

Thirty-one participants received 30 g glucose or placebo in a single 1-h session. After seeing between 3 and 10 objects (words or shapes) at different locations in a 9 × 9 matrix, participants attempted to immediately reproduce the display on a blank 9 × 9 matrix. Blood glucose was measured before drink ingestion, mid-way through the session, and at the end of the session.

RESULTS

Glucose significantly improves object-location binding (d = 1.08) and location memory (d = 0.83), but not object memory (d = 0.51). Increasing working memory load impairs object memory and object-location binding, and word-location binding is more successful than shape-location binding, but the glucose improvement is robust across all difficulty manipulations. Within the glucose group, higher levels of circulating glucose are correlated with better binding memory and remembering the locations of successfully recalled objects.

CONCLUSIONS

The glucose improvements identified are consistent with a facilitative impact on hippocampal function. The findings are discussed in the context of the relationship between cognitive processes, hippocampal function, and the implications for glucose's mode of action.

Glucose and the wandering mind: not paying attention or simply out of fuel?

RATIONALE/OBJECTIVES

The impact of raising glycaemia by ingestion of a glucose drink has revealed cognitive facilitation, particularly for memory and attention. This study aimed to extend current knowledge by examining, for the first time, whether glucose load also moderates task-related (TRT) and task-unrelated thoughts (TUT) during activities that vary in their requirement for sustained attention.

METHOD

A 2 (25 g glucose vs. placebo) × 2 (fast vs. slow version of the Sustained Attention to Response Task (SART)) repeated measures, counterbalanced design was used with 16 healthy adults. Self-report questionnaires probed participants' levels of TRT and TUT during SART performance. Prior to testing, the Short Imaginal Processes Inventory (SIPI) was also administered to help pinpoint the nature of thought processes during the task before and after treatment.

RESULTS

Analysis of variance revealed no significant effect of treatment; however, we report a pattern of results that is consistent with glucose facilitation effects on task accuracy for more demanding attention tasks (d = 0.56). Additionally, glucose improved the monitoring and task reflection as measured by TRT (d = 0.33) in the more demanding task but no effect on TUT. Probing the nature of thought processes further, we also report two novel correlations (in the placebo) between fears of failure (indexed by the SIPI) and the number of TUT episodes and perceived poor attention control (indexed by the SIPI) and number of TUT and speculate that glucose may act to buffer against TUT episodes under externally demanding situations.

CONCLUSIONS

These data extend previous research examining the glucose facilitation effect to the processing of internal thought processes.

Glucose administration and cognitive function: differential effects of age and effort during a dual task paradigm in younger and older adults

RATIONALE

Current research suggests that glucose facilitates performance on cognitive tasks which possess an episodic memory component and a relatively high level of cognitive demand. However, the extent to which this glucose facilitation effect is uniform across the lifespan is uncertain.

METHODS

This study was a repeated measures, randomised, placebo-controlled, cross-over trial designed to assess the cognitive effects of glucose in younger and older adults under single and dual task conditions. Participants were 24 healthy younger (average age 20.6 years) and 24 healthy older adults (average age 72.5 years). They completed a recognition memory task after consuming drinks containing 25 g glucose and a placebo drink, both in the presence and absence of a secondary tracking task.

RESULTS AND CONCLUSIONS

Glucose enhanced recognition memory response time and tracking precision during the secondary task, in older adults only. These findings do not support preferential targeting of hippocampal function by glucose, rather they suggest that glucose administration differentially increases the availability of attentional resources in older individuals.

Acute effects of dietary constituents on motor skill and cognitive performance in athletes

Performance in many sports is at least partially dependent on motor control, coordination, decision-making, and other cognitive tasks. This review summarizes available evidence about the ingestion of selected nutrients or isolated compounds (dietary constituents) and potential acute effects on motor skill and/or cognitive performance in athletes. Dietary constituents discussed include branched-chain amino acids, caffeine, carbohydrate, cocoa flavanols, Gingko biloba, ginseng, guarana, Rhodiola rosea, sage, L-theanine, theobromine, and tyrosine. Although this is not an exhaustive list, these are perhaps the most researched dietary constituents. Caffeine and carbohydrate have the greatest number of published reports supporting their ability to enhance acute motor skill and cognitive performance in athletes. At this time, there is insufficient published evidence to substantiate the use of any other dietary constituents to benefit sports-related motor skill or cognitive performance. The optimal dose and timing of caffeine and carbohydrate intake promoting enhanced motor skill and cognitive performance remain to be identified. Valid, reliable, and sensitive batteries of motor skills and cognitive tests should be developed for use in future efficacy studies.

Anti-stress effects of lemon balm-containing foods

Lemon balm (Melissa officinalis) has been used historically and contemporarily as a modulator of mood and cognitive function, with anxiolytic effects following administration of capsules, coated tablets and topical application. Following a pilot study with lemon balm extract administered as a water based drink, which confirmed absorption of rosmarinic acid effects on mood and cognitive function, we conducted two similar double-blind, placebo-controlled, crossover studies. These evaluated the mood and cognitive effects of a standardised M. officinalis preparation administered in palatable forms in a beverage and in yoghurt. In each study a cohort of healthy young adults' self-rated aspects of mood were measured before and after a multi-tasking framework (MTF) administered one hour and three hours following one of four treatments. Both active lemon balm treatments were generally associated with improvements in mood and/or cognitive performance, though there were some behavioral "costs" at other doses and these effects depended to some degree on the delivery matrix.

Effects of two doses of glucose and a caffeine-glucose combination on cognitive performance and mood during multi-tasking

BACKGROUND

This study assessed the effects of two doses of glucose and a caffeine-glucose combination on mood and performance of an ecologically valid, computerised multi-tasking platform.

MATERIALS AND METHODS

Following a double-blind, placebo-controlled, randomised, parallel-groups design, 150 healthy adults (mean age 34.78 years) consumed drinks containing placebo, 25 g glucose, 60 g glucose or 60 g glucose with 40 mg caffeine. They completed a multi-tasking framework at baseline and then 30 min following drink consumption with mood assessments immediately before and after the multi-tasking framework. Blood glucose and salivary caffeine were co-monitored.

RESULTS

The caffeine-glucose group had significantly better total multi-tasking scores than the placebo or 60 g glucose groups and were significantly faster at mental arithmetic tasks than either glucose drink group. There were no significant treatment effects on mood. Caffeine and glucose levels confirmed compliance with overnight abstinence/fasting, respectively, and followed the predicted post-drink patterns.

CONCLUSION

These data suggest that co-administration of glucose and caffeine allows greater allocation of attentional resources than placebo or glucose alone. At present, we cannot rule out the possibility that the effects are due to caffeine alone Future studies should aim at disentangling caffeine and glucose effects.

A systematic review of the effects of experimental fasting on cognition

Numerous investigations have been conducted on the impact of short-term fasting on cognition in healthy individuals. Some studies have suggested that fasting is associated with executive function deficits; however, findings have been inconsistent. The lack of consensus regarding the impact of short-term fasting in healthy controls has impeded investigation of the impact of starvation or malnutrition in clinical groups, such as anorexia nervosa (AN). One method of disentangling these effects is to examine acute episodes of starvation experimentally. The present review systematically investigated the impact of short-term fasting on cognition. Studies investigating attentional bias to food-related stimuli were excluded so as to focus on general cognition. Ten articles were included in the review. The combined results are equivocal: several studies report no observable differences as a result of fasting and others show specific deficits on tasks designed to test psychomotor speed, executive function, and mental rotation. This inconsistent profile of fasting in healthy individuals demonstrates the complexity of the role of short-term fasting in cognition; the variety of tasks used, composition of the sample, and type and duration of fasting across studies may also have contributed to the inconsistent profile. Additional focused studies on neuropsychological profiles of healthy individuals are warranted in order to better develop an understanding of the role of hunger in cognition.

Response variability to glucose facilitation of cognitive enhancement

Glucose facilitation of cognitive function has been widely reported in previous studies (including our own). However, several studies have also failed to detect glucose facilitation. There is sparsity of research examining the factors that modify the effect of glucose on cognition. The aims of the present study were to (1) demonstrate the previously observed enhancement of cognition through glucose administration and (2) investigate some of the factors that may exert moderating roles on the behavioural response to glucose, including glucose regulation, body composition (BC) and hypothalamic–pituitary–adrenal axis response. A total of twenty-four participants took part in a double-blind, placebo-controlled, randomised, repeated-measures study, which examined the effect of 25 and 60 g glucose compared with placebo on cognitive function. At 1 week before the study commencement, all participants underwent an oral glucose tolerance test. Glucose facilitated performance on tasks of numeric and spatial working memory, verbal declarative memory and speed of recognition. Moderating variables were examined using several indices of glucoregulation and BC. Poorer glucoregulation predicted improved immediate word recall accuracy following the administration of 25 g glucose compared with placebo. Those with better glucoregulation showed performance decrements on word recall accuracy following the administration of 25 g glucose compared with placebo. These findings are in line with accumulating evidence that glucose load may preferentially enhance cognition in those with poorer glucoregulation. Furthermore, the finding that individuals with better glucoregulation may suffer impaired performance following a glucose load is novel and requires further substantiation.

Impact of postprandial glycaemia on health and prevention of disease

Postprandial glucose, together with related hyperinsulinemia and lipidaemia, has been implicated in the development of chronic metabolic diseases like obesity, type 2 diabetes mellitus (T2DM) and cardiovascular disease (CVD). In this review, available evidence is discussed on postprandial glucose in relation to body weight control, the development of oxidative stress, T2DM, and CVD and in maintaining optimal exercise and cognitive performance. There is mechanistic evidence linking postprandial glycaemia or glycaemic variability to the development of these conditions or in the impairment in cognitive and exercise performance. Nevertheless, postprandial glycaemia is interrelated with many other (risk) factors as well as to fasting glucose. In many studies, meal-related glycaemic response is not sufficiently characterized, or the methodology with respect to the description of food or meal composition, or the duration of the measurement of postprandial glycaemia is limited. It is evident that more randomized controlled dietary intervention trials using effective low vs. high glucose response diets are necessary in order to draw more definite conclusions on the role of postprandial glycaemia in relation to health and disease. Also of importance is the evaluation of the potential role of the time course of postprandial glycaemia.

Glucose enhancement of recognition memory: differential effects on effortful processing but not aspects of 'remember-know' responses

The administration of a glucose drink has been shown to enhance cognitive performance with effect sizes comparable with those from pharmaceutical interventions in human trials. In the memory domain, it is currently debated whether glucose facilitation of performance is due to differential targeting of hippocampal memory or whether task effort is a more important determinant. Using a placebo-controlled, double-blind, crossover 2(Drink: glucose/placebo) × 2(Effort: ± secondary task) design, 20 healthy young adults' recognition memory performance was measured using the 'remember-know' procedure. Two high effort conditions (one for each drink) included secondary hand movements during word presentation. A 25 g glucose or 30 mg saccharine (placebo) drink was consumed 10 min prior to the task. The presence of a secondary task resulted in a global impairment of memory function. There were significant Drink × Effort interactions for overall memory accuracy but no differential effects for 'remember' or 'know' responses. These data suggest that, in some circumstances, task effort may be a more important determinant of the glucose facilitation of memory effect than hippocampal mediation. This article is part of a Special Issue entitled 'Cognitive Enhancers'.

Near-infrared imaging of the effects of glucose ingestion and regulation on prefrontal activation during dual-task execution in healthy fasting older adults

RATIONALE

Glucose enhancing effects in older adults have mostly been observed for episodic memory, but have recently been found for attentional control performance. Yet, brain activation patterns underlying these effects are still unknown.

OBJECTIVE

The present study examined the acute effects of glucose ingestion on prefrontal brain activation during the execution of a divided attention task in fasting non-diabetic older adults.

METHODS

Twenty older adults (60 years and older) took part in the study that included two experimental sessions. After an overnight fast, participants received either a glucose drink (50 g) or a placebo (saccharin) drink, following which they completed a dual-task. During task execution, prefrontal activation was recorded with functional near-infrared spectroscopy (fNIRS). A repeated-measures design was used such that each participant served as his or her own control. The two experimental sessions were counterbalanced among participants and were performed two weeks apart.

RESULTS

When participants were in the glucose condition, they showed similar dual-task costs for both tasks, whereas in the placebo condition they prioritized one task over the other, with a significantly larger dual-task cost for the non-prioritized task (p<0.01). Differential brain activation was also observed in right ventral-lateral prefrontal regions for oxygenated hemoglobin and deoxygenated hemoglobin, with more activation apparent in the glucose condition (p<0.05). Furthermore, behavioral and activation data were influenced by individual differences in glucose regulation.

CONCLUSIONS

Glucose ingestion appears to momentarily enhance fasting seniors' capacity to coordinate more equally two concurrent tasks and this is reflected in brain activation patterns.

The effect of glucose dose and fasting interval on cognitive function: a double-blind, placebo-controlled, six-way crossover study

RATIONALE

Previous research has identified a number of factors that appear to moderate the behavioural response to glucose administration. These include physiological state, dose, types of cognitive tasks used and level of cognitive demand. Another potential moderating factor is the length of the fasting interval prior to a glucose load.

OBJECTIVES

Therefore, we aimed to examine the effect of glucose dose and fasting interval on mood and cognitive function.

METHODS

The current study utilised a double-blind, placebo-controlled, balanced, six period crossover design to examine potential interactions between length of fasting interval (2 versus 12 hours) and optimal dose for cognition enhancement.

RESULTS

Results demonstrated that the higher dose (60 g) increased working memory performance following an overnight fast, whereas the lower dose (25 g) enhanced working memory performance following a 2-h fast.

CONCLUSIONS

The data suggest that optimal glucose dosage may differ under different conditions of depleted blood glucose resources. In addition, glucoregulation was observed to be a moderating factor. However, further research is needed to develop a model of the moderating and mediating factors under which glucose facilitation is best achieved.

Breakfast skipping in prepubertal obese children: hormonal, metabolic and cognitive consequences

BACKGROUND AND AIMS

Skipping breakfast influences cognitive performance. The aim of our study was to investigate the relationship between the variation of hormonal and metabolic postprandial parameters induced by breakfast consumption or fasting and cognitive performance in obese children.

METHODS

Cross-sectional study for repeated measures. Memory and attention assessment tests, hormones and nutrient oxidation were measured before and after consuming breakfast vs fasting in 10 prepubertal obese children.

RESULTS

Fasting induced a significant (P<0.05) increase of the Overall Index of the Continuous Performance Test II (a global index of inattention) and the Test of Memory and Learning Word Selective Reminding (a test of verbal memory), whereas no changes were found after breakfast. Fasting was associated with a reduction of insulin and an increase in glucagon, with no changes in glucose. The increase in inattention was associated with a reduction of carbohydrate oxidation (ρ=-0.66, P<0.05). We found no difference in the area under the curve of peptide YY and glucagon-like peptide-1 after breakfast or fasting, whereas Ghrelin was significantly lower. No association between postprandial hormone variation and cognitive performance was found.

CONCLUSIONS

Attention and visual memory performance in the morning were reduced when the children skipped breakfast. No association was found with hormones or metabolic changes, but we did find an association with a reduction of carbohydrate oxidation. Nevertheless, these preliminary findings need confirmation in larger sample size.

Carbohydrates for improving the cognitive performance of independent-living older adults with normal cognition or mild cognitive impairment

BACKGROUND

Mild cognitive impairment (MCI) is an intermediate state between normal cognition and dementia in which daily function is largely intact. This condition may present an opportunity for research into the prevention of dementia. Carbohydrate is an essential and easily accessible macronutrient which influences cognitive performance. A better understanding of carbohydrate-driven cognitive changes in normal cognition and mild cognitive impairment may suggest ways to prevent or reduce cognitive decline.

OBJECTIVES

To assess the effectiveness of carbohydrates in improving cognitive function in older adults.

SEARCH STRATEGY

We searched ALOIS, the Cochrane Dementia and Cognitive Improvement Group Specialized Register on 22 June 2010 using the terms: carbohydrates OR carbohydrate OR monosaccharides OR disaccharides OR oligosaccharides OR polysaccharides OR CARBS. ALOIS contains records from all major healthcare databases (The Cochrane Library, MEDLINE, EMBASE, PsycINFO, CINAHL, LILACS) as well as from many trial databases and grey literature sources.

SELECTION CRITERIA

All randomised controlled trials (RCT) that have examined the efficacy of any form of carbohydrates in normal cognition and MCI.

DATA COLLECTION AND ANALYSIS

One review author selected and retrieved relevant articles for further assessment. The remaining authors independently assessed whether any of the retrieved trials should be included. Disagreements were resolved by discussion. 

MAIN RESULTS

There is no suitable RCT of any form of carbohydrates involving independent-living older adults with normal cognition or mild cognitive impairment.

AUTHORS' CONCLUSIONS

There are no suitable RCTs on which to base any recommendations about the use of any form of carbohydrate for enhancing cognitive performance in older adults with normal cognition or mild cognitive impairment. More studies of many different carbohydrates are needed to tease out complex nutritional issues and further evaluate memory improvement.

Glucose enhancement of memory is modulated by trait anxiety in healthy adolescent males

Glucose administration is associated with memory enhancement in healthy young individuals under conditions of divided attention at encoding. While the specific neurocognitive mechanisms underlying this 'glucose memory facilitation effect' are currently uncertain, it is thought that individual differences in glucoregulatory efficiency may alter an individual's sensitivity to the glucose memory facilitation effect. In the present study, we sought to investigate whether basal hypothalamic-pituitary-adrenal axis function (itself a modulator of glucoregulatory efficiency), baseline self-reported stress and trait anxiety influence the glucose memory facilitation effect. Adolescent males (age range = 14-17 years) were administered glucose and placebo prior to completing a verbal episodic memory task on two separate testing days in a counter-balanced, within-subjects design. Glucose ingestion improved verbal episodic memory performance when memory recall was tested (i) within an hour of glucose ingestion and encoding, and (ii) one week subsequent to glucose ingestion and encoding. Basal hypothalamic-pituitary-adrenal axis function did not appear to influence the glucose memory facilitation effect; however, glucose ingestion only improved memory in participants reporting relatively higher trait anxiety. These findings suggest that the glucose memory facilitation effect may be mediated by biological mechanisms associated with trait anxiety.

Consumption of cocoa flavanols results in acute improvements in mood and cognitive performance during sustained mental effort

Cocoa flavanols (CF) positively influence physiological processes in ways that suggest their consumption may improve aspects of cognitive function. This study investigated the acute cognitive and subjective effects of CF consumption during sustained mental demand. In this randomized, controlled, double-blinded, balanced, three period crossover trial 30 healthy adults consumed drinks containing 520 mg, 994 mg CF and a matched control, with a three-day washout between drinks. Assessments included the state anxiety inventory and repeated 10-min cycles of a Cognitive Demand Battery comprising of two serial subtraction tasks (Serial Threes and Serial Sevens), a Rapid Visual Information Processing (RVIP) task and a 'mental fatigue' scale, over the course of 1 h. Consumption of both 520 mg and 994 mg CF significantly improved Serial Threes performance. The 994 mg CF beverage significantly speeded RVIP responses but also resulted in more errors during Serial Sevens. Increases in self-reported 'mental fatigue' were significantly attenuated by the consumption of the 520 mg CF beverage only. This is the first report of acute cognitive improvements following CF consumption in healthy adults. While the mechanisms underlying the effects are unknown they may be related to known effects of CF on endothelial function and blood flow.

Glucose enhancement of human memory: a comprehensive research review of the glucose memory facilitation effect

The brain relies upon glucose as its primary fuel. In recent years, a rich literature has developed from both human and animal studies indicating that increases in circulating blood glucose can facilitate cognitive functioning. This phenomenon has been termed the 'glucose memory facilitation effect'. The purpose of this review is to discuss a number of salient studies which have investigated the influence of glucose ingestion on neurocognitive performance in individuals with (a) compromised neurocognitive capacity, as well as (b) normally functioning individuals (with a focus on research conducted with human participants). The proposed neurocognitive mechanisms purported to underlie the modulatory effect of glucose on neurocognitive performance will also be considered. Many theories have focussed upon the hippocampus, given that this brain region is heavily implicated in learning and memory. Further, it will be suggested that glucose is a possible mechanism underlying the phenomenon that enhanced memory performance is typically observed for emotionally laden stimuli.

The acute effects of glucose ingestion on attentional control in fasting healthy older adults

RATIONALE

Glucose enhancing effects have been observed in older adults mainly for episodic memory, but have been under-investigated for attentional functions, which are very sensitive to aging.

OBJECTIVE

The present study examined the acute effects of glucose ingestion on different attentional tasks in fasting healthy older adults.

METHODS

In a between-subjects design, 44 participants (60 years and older) were randomly assigned to a glucose (50 g) or saccharin (placebo) condition after 12 h of fasting. Participants were tested on neuropsychological tests of attention (trail A and B, modified Stroop) and on a computerized dual-task.

RESULTS

Participants in the glucose group were faster than the placebo group to complete the switching condition of the modified Stroop test (p < 0.01) and showed a smaller dual-task cost in the divided attention task (p < 0.05).

CONCLUSIONS

Glucose ingestion appears to momentarily enhance attentional performances in seniors who have fasted for 12 h in tasks requiring switching and dividing attention.

Glucose effects on long-term memory performance: duration and domain specificity

RATIONAL

Previous research has suggested that long-term verbal declarative memory is particularly sensitive to enhancement by glucose loading; however, investigation of glucose effects on certain memory domains has hitherto been neglected. Therefore, domain specificity of glucose effects merits further elucidation.

OBJECTIVES

The aim of the present research was to provide a more comprehensive investigation of the possible effects of glucose administration on different aspects of memory by 1) contrasting the effect of glucose administration on different memory domains (implicit/explicit memory; verbal/non-verbal memory, and recognition/familiarity processes), 2) investigating whether potential effects on memory domains differ depending on the dose of glucose administered (25 g versus 60 g), 3) exploring the duration of the glucose facilitation effect (assessment of memory performance 35 min and 1 week after encoding).

METHODS

A double-blind between-subjects design was used to test the effects of administration of 25 and 60 g glucose on memory performance.

RESULTS

Implicit memory was improved following administration of 60 g of glucose. Glucose supplementation failed to improve face recognition performance but significantly improved performance of word recall and recognition following administration of 60 g of glucose. However, effects were not maintained 1 week following encoding.

CONCLUSIONS

Improved implicit memory performance following glucose administration has not been reported before. Furthermore, the current data tentatively suggest that level of processing may determine the required glucose dosage to demonstrate memory improvement and that higher dosages may be able to exert effects on memory pertaining to both hippocampal and non-hippocampal brain regions.

Does the brain consume additional glucose during self-control tasks?

A currently popular model of self-control posits that the exertion of self-control relies on a resource, which is expended by acts of self-control, resulting in less of this resource being available for subsequent acts of self-control. Recently, glucose has been proposed as the resource in question. For this model to be correct, it must be the case that A) performing a self-control task reduces glucose levels relative to a control task and B) performing a self-control task reduces glucose relative to pre-task levels. Evidence from neurophysiology suggests that (A) is unlikely to be true, and the evidence surrounding (B) is mixed, and is unlikely to be true for subjects who have not recently fasted. From the standpoint of evolved function, glucose might better be thought of as an input to decision making systems rather than as a constraint on performance.

Glucose modulates event-related potential components of recollection and familiarity in healthy adolescents

INTRODUCTION

Behavioural evidence supports the notion that oral glucose ingestion enhances recognition memory judgements based on recollection, but not familiarity. The present study sought to clarify and extend upon these behavioural findings by investigating the influence of glucose administration on event-related potential (ERP) components that are thought to be differentially mediated by recollection and familiarity processes in healthy adolescents.

METHODS

In a within-subjects design, participants performed a recognition memory task, during which time electroencephalogram (EEG) was recorded, subsequent to ingestion of either (a) glucose or (b) placebo in a counterbalanced order.

RESULTS

Response times during the recognition memory task were observed to be faster for the glucose condition, relative to a placebo control. Further, glucose ingestion was associated with an enhanced left parietal old/new ERP effect (a marker of recollection) and an enhanced mid-frontal old/new ERP effect (known to be mediated by familiarity).

DISCUSSION

These findings (a) support the results of previous research that the 'glucose memory facilitation effect' can be extended to healthy adolescents, but (b) suggest that glucose enhances both the recollection and familiarity components of recognition memory. The observed ERP profile has important implications for the proposal that glucose specifically targets the hippocampus in modulating cognitive performance.