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Chang J, Liu M, Liu C, Zhou S, Jiao Y, Sun H, Ji Y. Effects of vitamins and polyunsaturated fatty acids on cognitive function in older adults with mild cognitive impairment: a meta-analysis of randomized controlled trials. Eur J Nutr 2024; 63:1003-1022. [PMID: 38300291 PMCID: PMC11139751 DOI: 10.1007/s00394-024-03324-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/10/2022] [Accepted: 01/09/2024] [Indexed: 02/02/2024]
Abstract
PURPOSE Vitamins and polyunsaturated fatty acids (PUFAs) have been studied extensively as safe and manageable nutrient interventions for mild cognitive impairment (MCI). The purpose of the current meta-analysis was to examine the effects of vitamins and PUFAs on cognition and to compare the effects of single and multiple nutrient subgroups in patients with MCI. METHODS Randomized controlled trials (RCTs) written in English and Chinese were retrieved from eight databases, namely, PubMed, CENTRAL, Embase, CINAHL, Web of Science, SinoMed, CNKI, and Wanfang Data, from their respective dates of inception until 16 July 2023. The quality of the included studies was assessed using the Cochrane Risk of Bias Tool 2.0. Meta-analyses were performed to determine the standardized mean differences (SMDs) in global cognitive function, memory function, attention, visuospatial skills, executive function, and processing speed between the supplement and control groups using 95% confidence intervals (CI) and I2. Prospero registration number: CRD42021292360. RESULTS Sixteen RCTs that studied different types of vitamins and PUFAs were included. The meta-analysis revealed that vitamins affected global cognitive function (SMD = 0.58, 95% CI = [0.20, 0.96], P = 0.003), memory function (SMD = 2.55, 95% CI = [1.01, 4.09], P = 0.001), and attention (SMD = 3.14, 95% CI = [1.00, 5.28], P = 0.004) in patients with MCI, and PUFAs showed effects on memory function (SMD = 0.65, 95% CI = [0.32, 0.99], P < 0.001) and attention (SMD = 2.98, 95% CI = [2.11, 3.84], P < 0.001). Single vitamin B (folic acid [FA]: SMD = 1.21, 95% CI = [0.87, 1.55]) supplementation may be more effective than multiple nutrients (FA and vitamin B12: SMD = 0.71, 95% CI = [0.41, 1.01]; and FA combined with docosahexaenoic acid [DHA]: SMD = 0.58, 95% CI = [0.34, 0.83]) in global cognitive function. CONCLUSIONS FA, vitamin B6, vitamin B12, and vitamin D may improve global cognitive function, memory function, and attention in patients with MCI. Eicosapentaenoic acid (EPA) and DHA may improve memory function and attention. We also noted that FA may exert a greater effect than a vitamin B combination (FA and vitamin B12) or the combination of FA and DHA. However, because of the low evidence-based intensity, further trials are necessary to confirm these findings.
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Affiliation(s)
- Jing Chang
- School of Nursing, Nanjing Medical University, 101 Longmian Avenue, Jiangning District, Nanjing, 211166, Jiangsu, China
| | - Minhui Liu
- School of Nursing, Ningxia Medical University, 1160 Shengli South Street of Xingqing District, Yinchuan, 750001, China
| | - Chang Liu
- School of Nursing, Nanjing Medical University, 101 Longmian Avenue, Jiangning District, Nanjing, 211166, Jiangsu, China
| | - Shiyu Zhou
- School of Nursing, Nanjing Medical University, 101 Longmian Avenue, Jiangning District, Nanjing, 211166, Jiangsu, China
| | - Yuchen Jiao
- School of Nursing, Nanjing Medical University, 101 Longmian Avenue, Jiangning District, Nanjing, 211166, Jiangsu, China
| | - Hongyu Sun
- School of Nursing, Peking University, 38 College Road, Haidian District, Beijing, 100191, China.
| | - Yan Ji
- School of Nursing, Nanjing Medical University, 101 Longmian Avenue, Jiangning District, Nanjing, 211166, Jiangsu, China.
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Perluigi M, Di Domenico F, Butterfield DA. Oxidative damage in neurodegeneration: roles in the pathogenesis and progression of Alzheimer disease. Physiol Rev 2024; 104:103-197. [PMID: 37843394 PMCID: PMC11281823 DOI: 10.1152/physrev.00030.2022] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/28/2022] [Revised: 03/30/2023] [Accepted: 05/24/2023] [Indexed: 10/17/2023] Open
Abstract
Alzheimer disease (AD) is associated with multiple etiologies and pathological mechanisms, among which oxidative stress (OS) appears as a major determinant. Intriguingly, OS arises in various pathways regulating brain functions, and it seems to link different hypotheses and mechanisms of AD neuropathology with high fidelity. The brain is particularly vulnerable to oxidative damage, mainly because of its unique lipid composition, resulting in an amplified cascade of redox reactions that target several cellular components/functions ultimately leading to neurodegeneration. The present review highlights the "OS hypothesis of AD," including amyloid beta-peptide-associated mechanisms, the role of lipid and protein oxidation unraveled by redox proteomics, and the antioxidant strategies that have been investigated to modulate the progression of AD. Collected studies from our groups and others have contributed to unraveling the close relationships between perturbation of redox homeostasis in the brain and AD neuropathology by elucidating redox-regulated events potentially involved in both the pathogenesis and progression of AD. However, the complexity of AD pathological mechanisms requires an in-depth understanding of several major intracellular pathways affecting redox homeostasis and relevant for brain functions. This understanding is crucial to developing pharmacological strategies targeting OS-mediated toxicity that may potentially contribute to slow AD progression as well as improve the quality of life of persons with this severe dementing disorder.
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Affiliation(s)
- Marzia Perluigi
- Department of Biochemical Sciences "A. Rossi Fanelli," Laboratory affiliated to Istituto Pasteur Italia-Fondazione Cenci Bolognetti, Sapienza University of Rome, Rome, Italy
| | - Fabio Di Domenico
- Department of Biochemical Sciences "A. Rossi Fanelli," Laboratory affiliated to Istituto Pasteur Italia-Fondazione Cenci Bolognetti, Sapienza University of Rome, Rome, Italy
| | - D Allan Butterfield
- Department of Chemistry and Sanders-Brown Center on Aging, University of Kentucky, Lexington, Kentucky, United States
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Shin YK, Seol GH. Effects of linalyl acetate on oxidative stress, inflammation and endothelial dysfunction: can linalyl acetate prevent mild cognitive impairment? Front Pharmacol 2023; 14:1233977. [PMID: 37576815 PMCID: PMC10416234 DOI: 10.3389/fphar.2023.1233977] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/03/2023] [Accepted: 07/21/2023] [Indexed: 08/15/2023] Open
Abstract
Mild cognitive impairment (MCI) is a major public health challenge with an increasing prevalence. Although the mechanisms underlying the development of MCI remain unclear, MCI has been reported to be associated with oxidative stress, inflammatory responses, and endothelial dysfunction, suggesting that agents that reduce these factors may be key to preventing MCI. Currently, no agents have been approved for the treatment of MCI, with the efficacy of commonly prescribed cholinesterase inhibitors remaining unclear. Relatively safe natural products that can prevent the development of MCI are of great interest. Linalyl acetate (LA), the major component of clary sage and lavender essential oils, has been shown to have a variety of pharmacological effects, including anti-hypertensive, anti-diabetic, neuroprotective, anti-inflammatory, and antioxidant properties, which may have the potential for the prevention of MCI. The present review briefly summarizes the pathogenesis of MCI related to oxidative stress, inflammatory responses, and endothelial dysfunction as well as the benefits of LA against these MCI-associated factors. The PubMed and Google Scholar databases were used to search the relevant literature. Further clinical research may lead to the development of new strategies for preventing MCI, particularly in high-risk populations with oxidative stress, inflammatory responses, and endothelial dysfunction (e.g., patients with hypertension and/or diabetes mellitus).
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Affiliation(s)
- You Kyoung Shin
- Department of Basic Nursing Science, College of Nursing, Korea University, Seoul, Republic of Korea
| | - Geun Hee Seol
- Department of Basic Nursing Science, College of Nursing, Korea University, Seoul, Republic of Korea
- BK21 FOUR Program of Transdisciplinary Major in Learning Health Systems, Graduate School, Korea University, Seoul, Republic of Korea
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Eat for better cognition in older adults at risk for Alzheimer's disease. Nutrition 2023; 109:111969. [PMID: 36801704 DOI: 10.1016/j.nut.2022.111969] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/27/2022] [Revised: 11/10/2022] [Accepted: 12/31/2022] [Indexed: 01/13/2023]
Abstract
Alzheimer's disease is a worldwide public health problem. However, the treatment method and treatment effects are limited. The stages of preclinical Alzheimer's disease are thought to be a better intervention period. Thus, in this review, food is given focus and the intervention stage put forward. We summarized the role of diet, nutrient supplementation, and microbioecologics in cognitive decline and found that interventions such as modified Mediterranean-ketogenic diet, nuts, vitamin B, and Bifidobacterium breve A1 are beneficial to cognition protection. Eating, rather than just taking medicine, is suggested to be an effective treatment method for older adults at risk for Alzheimer's disease.
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Cardelo MP, Corina A, Leon-Acuña A, Quintana-Navarro GM, Alcala-Diaz JF, Rangel-Zuñiga OA, Camargo A, Conde-Gavilan C, Carmona-Medialdea C, Vallejo-Casas JA, Carmona-Asenjo E, Ochoa-Sepulveda JJ, Aguera-Morales E, Delgado-Lista J, Katsiki N, Lopez-Miranda J, Perez-Jimenez F, Yubero-Serrano EM, Perez-Martínez P. Effect of the Mediterranean diet and probiotic supplementation in the management of mild cognitive impairment: Rationale, methods, and baseline characteristics. Front Nutr 2022; 9:1037842. [PMID: 36570150 PMCID: PMC9773830 DOI: 10.3389/fnut.2022.1037842] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/06/2022] [Accepted: 11/22/2022] [Indexed: 12/14/2022] Open
Abstract
Introduction Mild cognitive impairment (MCI) can progress to Alzheimer's disease (AD). When MCI is not properly controlled, the speed of deterioration can dramatically increase. Reduction of oxidative stress/inflammation and the modulation of the gut-brain axis could be new potential therapeutic targets for the prevention and treatment of AD. Consumption of specific nutrients, diets and probiotic supplementation have been evaluated for neurodegenerative disorders. We focus on a detailed description of the study methods and baseline characteristics of a clinical trial aiming to evaluate the efficacy of a combined nutritional intervention, i.e., a Mediterranean diet with probiotics, on cognitive capacity in a population with MCI. Methods In this randomized, latin-square crossover, double-blind, and controlled dietary intervention trial (clinicaltrials.gov NCT05029765), 47 MCI patients were randomized to consume three dietary interventions for 24-weeks each: (1) A Mediterranean diet supplemented with probiotics (109 colony-forming units of Lactobacillus rhamnosus and Bifidobacterium longum); (2) A Mediterranean diet + placebo; and (3) A Healthy diet according to the World Health Organization (WHO) recommendations. Participants will be evaluated before and after each of the three intervention periods (each 24-weeks, with a total of 72-weeks) for adherence to the assigned diet, blood tests, cognitive performance, gut microbiota analysis and functional neuroimaging studies. Results Fifty patients, ≥60 years-old and diagnosed with MCI, underwent randomization. A total of 47 patients completed follow-up dietary interventions (57.4% males), with a good glycemic control (HbA1c 5.8 ± 0.1%, fasting glucose and insulin 99.7 ± 3.3 mg/dL and 10.4 ± 0.9 mU/L, respectively), elevated systolic blood pressure (136.9 ± 2.1 mmHg) and increased degree of inflammation (high-sensitivity C-reactive protein, 8.8 ± 0.9 mg/dL). Baseline adherence to the Mediterranean diet was medium (7.5 ± 0.3 points on the score that ranged from 0 to 14 points). Conclusion The results of this clinical study would provide more evidence on the need for dietary therapeutic strategies, for clinical and individual practice, in the management of MCI patients to reduce the risk of AD development. Targeting lifestyle modifications in high-risk populations could prevent substantial cases of cognitive decline. Clinical trial registration [ClinicalTrials.gov], identifier [NCT05029765].
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Affiliation(s)
- Magdalena P. Cardelo
- Unidad de Gestión Clinica Medicina Interna, Lipids and Atherosclerosis Unit, Maimonides Institute for Biomedical Research in Córdoba (IMIBIC), Reina Sofía University Hospital, University of Córdoba, Córdoba, Spain,CIBER Physiopathology of Obesity and Nutrition (CIBEROBN), Institute of Health Carlos III, Madrid, Spain
| | - Andreea Corina
- Unidad de Gestión Clinica Medicina Interna, Lipids and Atherosclerosis Unit, Maimonides Institute for Biomedical Research in Córdoba (IMIBIC), Reina Sofía University Hospital, University of Córdoba, Córdoba, Spain,CIBER Physiopathology of Obesity and Nutrition (CIBEROBN), Institute of Health Carlos III, Madrid, Spain
| | - Ana Leon-Acuña
- Unidad de Gestión Clinica Medicina Interna, Lipids and Atherosclerosis Unit, Maimonides Institute for Biomedical Research in Córdoba (IMIBIC), Reina Sofía University Hospital, University of Córdoba, Córdoba, Spain,CIBER Physiopathology of Obesity and Nutrition (CIBEROBN), Institute of Health Carlos III, Madrid, Spain
| | - Gracia M. Quintana-Navarro
- Unidad de Gestión Clinica Medicina Interna, Lipids and Atherosclerosis Unit, Maimonides Institute for Biomedical Research in Córdoba (IMIBIC), Reina Sofía University Hospital, University of Córdoba, Córdoba, Spain,CIBER Physiopathology of Obesity and Nutrition (CIBEROBN), Institute of Health Carlos III, Madrid, Spain
| | - Juan F. Alcala-Diaz
- Unidad de Gestión Clinica Medicina Interna, Lipids and Atherosclerosis Unit, Maimonides Institute for Biomedical Research in Córdoba (IMIBIC), Reina Sofía University Hospital, University of Córdoba, Córdoba, Spain,CIBER Physiopathology of Obesity and Nutrition (CIBEROBN), Institute of Health Carlos III, Madrid, Spain
| | - Oriol Alberto Rangel-Zuñiga
- Unidad de Gestión Clinica Medicina Interna, Lipids and Atherosclerosis Unit, Maimonides Institute for Biomedical Research in Córdoba (IMIBIC), Reina Sofía University Hospital, University of Córdoba, Córdoba, Spain,CIBER Physiopathology of Obesity and Nutrition (CIBEROBN), Institute of Health Carlos III, Madrid, Spain
| | - Antonio Camargo
- Unidad de Gestión Clinica Medicina Interna, Lipids and Atherosclerosis Unit, Maimonides Institute for Biomedical Research in Córdoba (IMIBIC), Reina Sofía University Hospital, University of Córdoba, Córdoba, Spain,CIBER Physiopathology of Obesity and Nutrition (CIBEROBN), Institute of Health Carlos III, Madrid, Spain
| | - Cristina Conde-Gavilan
- Neurology Service, Maimonides Institute for Biomedical Research in Córdoba (IMIBIC), Reina Sofía University Hospital, Córdoba, Spain
| | - Claudia Carmona-Medialdea
- Neurology Service, Maimonides Institute for Biomedical Research in Córdoba (IMIBIC), Reina Sofía University Hospital, Córdoba, Spain
| | - Juan A. Vallejo-Casas
- Unidad de Gestión Clinica de Medicina Nuclear, Maimonides Institute for Biomedical Research in Córdoba (IMIBIC), Reina Sofía University Hospital, Córdoba, Spain
| | - Elvira Carmona-Asenjo
- Unidad de Gestión Clinica de Medicina Nuclear, Maimonides Institute for Biomedical Research in Córdoba (IMIBIC), Reina Sofía University Hospital, Córdoba, Spain
| | - Juan J. Ochoa-Sepulveda
- Neurology Service, Maimonides Institute for Biomedical Research in Córdoba (IMIBIC), Reina Sofía University Hospital, Córdoba, Spain
| | - Eduardo Aguera-Morales
- Neurology Service, Maimonides Institute for Biomedical Research in Córdoba (IMIBIC), Reina Sofía University Hospital, Córdoba, Spain
| | - Javier Delgado-Lista
- Unidad de Gestión Clinica Medicina Interna, Lipids and Atherosclerosis Unit, Maimonides Institute for Biomedical Research in Córdoba (IMIBIC), Reina Sofía University Hospital, University of Córdoba, Córdoba, Spain,CIBER Physiopathology of Obesity and Nutrition (CIBEROBN), Institute of Health Carlos III, Madrid, Spain
| | - Niki Katsiki
- Department of Nutritional Sciences and Dietetics, International Hellenic University, Thessaloniki, Greece,School of Medicine, European University Cyprus, Nicosia, Cyprus
| | - José Lopez-Miranda
- Unidad de Gestión Clinica Medicina Interna, Lipids and Atherosclerosis Unit, Maimonides Institute for Biomedical Research in Córdoba (IMIBIC), Reina Sofía University Hospital, University of Córdoba, Córdoba, Spain,CIBER Physiopathology of Obesity and Nutrition (CIBEROBN), Institute of Health Carlos III, Madrid, Spain
| | - Francisco Perez-Jimenez
- Unidad de Gestión Clinica Medicina Interna, Lipids and Atherosclerosis Unit, Maimonides Institute for Biomedical Research in Córdoba (IMIBIC), Reina Sofía University Hospital, University of Córdoba, Córdoba, Spain,CIBER Physiopathology of Obesity and Nutrition (CIBEROBN), Institute of Health Carlos III, Madrid, Spain
| | - Elena M. Yubero-Serrano
- Unidad de Gestión Clinica Medicina Interna, Lipids and Atherosclerosis Unit, Maimonides Institute for Biomedical Research in Córdoba (IMIBIC), Reina Sofía University Hospital, University of Córdoba, Córdoba, Spain,CIBER Physiopathology of Obesity and Nutrition (CIBEROBN), Institute of Health Carlos III, Madrid, Spain
| | - Pablo Perez-Martínez
- Unidad de Gestión Clinica Medicina Interna, Lipids and Atherosclerosis Unit, Maimonides Institute for Biomedical Research in Córdoba (IMIBIC), Reina Sofía University Hospital, University of Córdoba, Córdoba, Spain,CIBER Physiopathology of Obesity and Nutrition (CIBEROBN), Institute of Health Carlos III, Madrid, Spain,*Correspondence: Pablo Perez-Martínez,
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Pérez Palmer N, Trejo Ortega B, Joshi P. Cognitive Impairment in Older Adults: Epidemiology, Diagnosis, and Treatment. Psychiatr Clin North Am 2022; 45:639-661. [PMID: 36396270 DOI: 10.1016/j.psc.2022.07.010] [Citation(s) in RCA: 23] [Impact Index Per Article: 11.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
Cognitive impairment and dementia affect dozens of millions of people worldwide and cause significant distress to patients and caregivers and a financial burden to families and health care systems. Careful history-taking, cognitive and physical examination, and supplemental neuroimaging and fluid-based biomarkers can accurately diagnose neurocognitive disorders. Management includes non-pharmacological and pharmacological treatments tailored to the etiology and to the individual.
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Affiliation(s)
- Nicolás Pérez Palmer
- Department of Psychiatry, Yale School of Medicine, 300 George Street, Suite 901, New Haven, CT 06511, USA.
| | - Barbara Trejo Ortega
- Department of Psychiatry, Yale School of Medicine, 300 George Street, Suite 901, New Haven, CT 06511, USA
| | - Pallavi Joshi
- Banner Alzheimer's Institute, 901 East Willeta Street, Phoenix, AZ 85006, USA; Department of Psychiatry, University of Arizona College of Medicine-Phoenix, 475 North 5th, Phoenix, AZ 85004, USA
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Gil Martínez V, Avedillo Salas A, Santander Ballestín S. Vitamin Supplementation and Dementia: A Systematic Review. Nutrients 2022; 14:1033. [PMID: 35268010 PMCID: PMC8912288 DOI: 10.3390/nu14051033] [Citation(s) in RCA: 31] [Impact Index Per Article: 15.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/04/2022] [Revised: 02/24/2022] [Accepted: 02/26/2022] [Indexed: 02/04/2023] Open
Abstract
BACKGROUND Dementia is a syndrome characterized by progressive cognitive impairment that interferes with independent function in daily activities. Symptoms of dementia depend on its cause and vary greatly between individuals. There is extensive evidence supporting a relationship between diet and cognitive functions. This systematic review studies the efficacy of using vitamin supplements in the diet as a solution to nutritional deficiencies and the prevention of dementia and mild cognitive impairment. METHODS An intensive search of different databases (PubMed, Web of Science, and Cochrane CENTRAL) was performed. Articles that were published between 2011 and November 2021 were retrieved using the mentioned search strategy. This systematic review has been conducted according to the PRISMA statement. RESULTS Folic acid supplementation proved to have better outcomes on cognitive tests than their respective control groups. The combined supplementation of folic acid and vitamin B12 showed some discrepancies between studies. Thiamine as supplementation did not only prove to have a positive impact on cognitive performance when given alone but also when given in combination with folic acid. Regarding vitamin D supplementation, the results observed were not so encouraging. A concomitant supplementation of low-dose vitamin E and vitamin C was also not associated with an improvement of cognitive function. CONCLUSIONS The findings of this systematic review suggest that supplementation of B Complex vitamins, especially folic acid, may have a positive effect on delaying and preventing the risk of cognitive decline. Ascorbic acid and a high dose of vitamin E, when given separately, also showed positive effects on cognitive performance, but there is not sufficient evidence to support their use. The results of vitamin D supplementation trials are not conclusive in assessing the potential benefits that vitamin D might have on cognition.
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Affiliation(s)
| | - Ana Avedillo Salas
- Department of Pharmacology, Physiology and Legal and Forensic Medicine, Faculty of Medicine, University of Zaragoza, 50009 Zaragoza, Spain;
| | - Sonia Santander Ballestín
- Department of Pharmacology, Physiology and Legal and Forensic Medicine, Faculty of Medicine, University of Zaragoza, 50009 Zaragoza, Spain;
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The Role of Vitamin E in Slowing Down Mild Cognitive Impairment: A Narrative Review. Healthcare (Basel) 2021; 9:healthcare9111573. [PMID: 34828619 PMCID: PMC8625211 DOI: 10.3390/healthcare9111573] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/18/2021] [Revised: 11/15/2021] [Accepted: 11/17/2021] [Indexed: 11/17/2022] Open
Abstract
With the aging population, dementia emerges as a public health concern. In 2012, the Health and Retirement Study found that 8.8% of adults over 65 years suffered from dementia. The etiopathogenesis and treatment of dementia are not well understood. Antioxidant properties of Vitamin E and its major elements tocopherols and tocotrienols have been reported to be effective in slowing down the progression of dementia from its initial stage of Mild cognitive impairment (MCI). Therefore, the current review aims to explore the role of vitamin E on MCI. A literature search using the key words "Vitamin E, tocopherols, tocotrienols, and mild cognitive impairment" was conducted in MEDLINE (PubMed), CINAHL, and Google Scholar. The inclusion criteria were: (1) articles published in the past ten years; (2) published in English language; (3) published in peer-reviewed journals; and (4) descriptive and epidemiological or evaluation studies. Articles published prior to 2010, focused on other forms of dementia than MCI, grey literature and non-peer-reviewed articles were excluded. A total of 22 studies were included in the narrative synthesis. The results were equivocal. Eleven studies showed some level of the neuroprotective effect of Vitamin E, tocopherols and tocotrienols on the progression of MCI. The mixed results of this review suggest further exploration of the possible protective effects of Vitamin E on the development of dementia. Future studies can be conducted to decipher antioxidant properties of vitamin E and its association with slowing down the cognitive decline.
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Efficacy and Safety of Sesame Oil Cake Extract on Memory Function Improvement: A 12-Week, Randomized, Double-Blind, Placebo-Controlled Pilot Study. Nutrients 2021; 13:nu13082606. [PMID: 34444766 PMCID: PMC8399671 DOI: 10.3390/nu13082606] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/24/2021] [Revised: 07/25/2021] [Accepted: 07/27/2021] [Indexed: 11/17/2022] Open
Abstract
The goal of treatment for mild cognitive impairment (MCI) is to reduce the existing clinical symptoms, delay the progression of cognitive impairment and prevent the progression to Alzheimer’s disease (AD). At present, there is no effective drug therapy for AD treatment. However, early intake of dietary supplements may be effective in alleviating and delaying the MCI. This study aims to evaluate the effects of sesame oil cake extract (SOCE) supplementation on cognitive function in aged 60 years or older adults with memory impairment. A total of 70 subjects received either SOCE (n = 35) or placebo (n = 35) for 12 weeks based on random 1:1 assignment to these two groups. Cognitive function was evaluated by a computerized neurocognitive function test (CNT), and changes in the concentrations of plasma amyloid β (Aβ) proteins and urine 8-OHdG (8-hydroxy-2′-deoxyguanosine) were investigated before and after the experiment. Verbal learning test index items of the CNT improved markedly in the SOCE group compared to the placebo group (p < 0.05). Furthermore, plasma amyloid-β (1–40) and amyloid-β (1–42) levels in the SOCE group decreased significantly compared to that in the placebo group (p < 0.05). There was no statistically significant difference in urine 8-OHdG between the two groups (p > 0.05). Collectively, intake of SOCE for 12 weeks appears to have a beneficial effect on the verbal memory abilities and plasma β-amyloid levels of older adults with memory impairment.
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Reutzel M, Grewal R, Esselun C, Petry SF, Linn T, Brandt A, Bergheim I, Eckert GP. Effects of different standard and special diets on cognition and brain mitochondrial function in mice. Nutr Neurosci 2021; 25:1823-1835. [PMID: 33814001 DOI: 10.1080/1028415x.2021.1906392] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Abstract
Objectives: Human nutrition plays an important role in prevention or at least slowing down the progression of age- and diet-related diseases. Thereby, mitochondrial dysfunction represents one common underlying mechanism, which is being investigated in mouse models. However, the influence of the selected diets in preclinical studies on cognition and mitochondrial function has not yet been reported cohesively.Methods: Therefore, we present the results of three different studies that addressed this question. First, we investigated the influence of two standard control chow diets and a special diet low in antioxidants over 6 months in aged NMRI mice. Additionally, a 70% high-fat (HF) chow diet as well as a western-style diet (WSD) rich in lard and fructose were examined in C57/BL6 mice. Cognitive performance, mitochondrial function and bioenergetics in the brain were investigated. Moreover, cerebral expression of genes involved in biogenesis and antioxidant defence (citrate synthase, complex I, complex IV, SOD2, Cat1, GPx-1) were quantified.Results: The results show that a modified, low antioxidant diet increased ATP levels in the brain of aged mice, while cognitive functions remained largely unaffected. A HF diet also showed significant effects on ATP levels and gene expression levels of relevant antioxidant markers, while the WSD had marginal effects on mitochondrial function and bioenergetics in the brain.Discussion: Our results indicate that standard- and special diets have an impact on cognition and mitochondrial function in the brain. Thus, appropriate caution is warranted when selecting a suitable diet for preclinical studies in mice.
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Affiliation(s)
- Martina Reutzel
- Institute of Nutritional Sciences, Laboratory for Nutrition in Prevention and Therapy, Justus-Liebig-University of Giessen, Biomedical Research Center Seltersberg (BFS), Giessen, Germany
| | - Rekha Grewal
- Institute of Nutritional Sciences, Laboratory for Nutrition in Prevention and Therapy, Justus-Liebig-University of Giessen, Biomedical Research Center Seltersberg (BFS), Giessen, Germany
| | - Carsten Esselun
- Institute of Nutritional Sciences, Laboratory for Nutrition in Prevention and Therapy, Justus-Liebig-University of Giessen, Biomedical Research Center Seltersberg (BFS), Giessen, Germany
| | - Sebastian Friedrich Petry
- Clinical Research Unit, Centre of Internal Medicine, Justus Liebig University Giessen, Giessen, Germany
| | - Thomas Linn
- Clinical Research Unit, Centre of Internal Medicine, Justus Liebig University Giessen, Giessen, Germany
| | - Annette Brandt
- Department of Nutritional Sciences, Molecular Nutritional Science, University of Vienna, Vienna, Austria
| | - Ina Bergheim
- Department of Nutritional Sciences, Molecular Nutritional Science, University of Vienna, Vienna, Austria
| | - Gunter P Eckert
- Institute of Nutritional Sciences, Laboratory for Nutrition in Prevention and Therapy, Justus-Liebig-University of Giessen, Biomedical Research Center Seltersberg (BFS), Giessen, Germany
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Preventing dementia? Interventional approaches in mild cognitive impairment. Neurosci Biobehav Rev 2021; 122:143-164. [PMID: 33440197 DOI: 10.1016/j.neubiorev.2020.12.022] [Citation(s) in RCA: 39] [Impact Index Per Article: 13.0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/28/2020] [Revised: 10/13/2020] [Accepted: 12/19/2020] [Indexed: 12/19/2022]
Abstract
Mild cognitive impairment (MCI) is defined as an intermediate state between normal cognitive aging and dementia. It describes a status of the subjective impression of cognitive decline and objectively detectible memory impairment beyond normal age-related changes. Activities of daily living are not affected. As the population ages, there is a growing need for early, proactive programs that can delay the consequences of dementia and improve the well-being of people with MCI and their caregivers. Various forms and approaches of intervention for older people with MCI have been suggested to delay cognitive decline. Pharmacological as well as non-pharmacological approaches (cognitive, physiological, nutritional supplementation, electric stimulation, psychosocial therapeutic) and multicomponent interventions have been proposed. Interventional approaches in MCI from 2009 to April 2019 concerning the cognitive performance are presented in this review.
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Mielech A, Puścion-Jakubik A, Markiewicz-Żukowska R, Socha K. Vitamins in Alzheimer's Disease-Review of the Latest Reports. Nutrients 2020; 12:nu12113458. [PMID: 33187212 PMCID: PMC7696081 DOI: 10.3390/nu12113458] [Citation(s) in RCA: 17] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/03/2020] [Revised: 11/08/2020] [Accepted: 11/09/2020] [Indexed: 12/11/2022] Open
Abstract
Alzheimer's disease (AD) is the most common form of dementia, and the aging of the population means that the number of cases is successively increasing. The cause of the disease has not been established, but it is suggested that many factors affect it, including nutritional aspects. As part of the work, the PubMed database has been searched, beginning from 2005, for terms related to key nutritional aspects. A diet rich in antioxidant vitamins can improve the cognitive functions of patients. Thanks to an adequate intake of B vitamins, homocysteine levels are reduced, which indirectly protects against the development of the disease. A properly balanced diet, as well as the use of appropriate supplementation, can contribute to improving the clinical condition of patients with AD.
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Zhao N, Meng J, Jiang W, Xu W, Liu C, Wang F. Study on the relationships between molecular weights of chondroitin sulfate oligosaccharides and Aβ-induced oxidative stress and the related mechanisms. Glycobiology 2020; 31:492-507. [PMID: 33043980 DOI: 10.1093/glycob/cwaa096] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/31/2020] [Revised: 09/21/2020] [Accepted: 10/01/2020] [Indexed: 12/13/2022] Open
Abstract
In the present study, we studied anti-Alzheimer's disease (AD) activities of chondroitin sulfate (CS) oligosaccharides with different molecular weights. CS from shark cartilage was degraded by a recombinant CS endolyase, chondroitinase ABC I (CHSase ABC I), and CS disaccharide (DP2), tetrasaccharide (DP4), hexasaccharide (DP6), octasaccharide (DP8), decasaccharide (DP10) and dodecasaccharide (DP12) were obtained by separation with gel filtration. Anti-AD activities of CS oligosaccharides were assessed using Aβ-injured SH-SY5Y cells and BV2 cells. It was shown that CS oligosaccharides could block Aβ-induced oxidative stress, mitochondrial dysfunction and activation of intrinsic apoptotic pathway for SH-SY5Y cells. Furthermore, these activities increased with the increase of molecular weights. For Aβ-injured BV2 cells, CS oligosaccharides inhibited oxidative stress, the production of proinflammatory cytokines and the activation of toll-like receptor pathway, and CS DP2 had the best activity among them. In conclusion, CS oligosaccharides suppressed Aβ-induced oxidative stress and relevant injury in vitro, and these effects had different relationships with the molecular weights of CS oligosaccharides for different cell lines, which might be caused by different mechanisms.
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Affiliation(s)
- Na Zhao
- Key Laboratory of Chemical Biology (Ministry of Education), Institute of Biochemical and Biotechnological Drug, School of Pharmaceutical Sciences, Cheeloo College of Medicine, Shandong University, No. 44 West Wenhua Road, Jinan 250012, China
| | - Jie Meng
- School of Basic Medical Science, Cheeloo College of Medicine, Shandong University, No. 44 West Wenhua Road, Jinan 250012, China
| | - Wenjie Jiang
- Key Laboratory of Chemical Biology (Ministry of Education), Institute of Biochemical and Biotechnological Drug, School of Pharmaceutical Sciences, Cheeloo College of Medicine, Shandong University, No. 44 West Wenhua Road, Jinan 250012, China
| | - Wenjia Xu
- Key Laboratory of Chemical Biology (Ministry of Education), Institute of Biochemical and Biotechnological Drug, School of Pharmaceutical Sciences, Cheeloo College of Medicine, Shandong University, No. 44 West Wenhua Road, Jinan 250012, China
| | - Chunhui Liu
- Key Laboratory of Chemical Biology (Ministry of Education), Institute of Biochemical and Biotechnological Drug, School of Pharmaceutical Sciences, Cheeloo College of Medicine, Shandong University, No. 44 West Wenhua Road, Jinan 250012, China
| | - Fengshan Wang
- Key Laboratory of Chemical Biology (Ministry of Education), Institute of Biochemical and Biotechnological Drug, School of Pharmaceutical Sciences, Cheeloo College of Medicine, Shandong University, No. 44 West Wenhua Road, Jinan 250012, China.,Laboratory of Carbohydrate Chemistry and Glycobiology, National Glycoengineering Research Center, Shandong University, No. 44 West Wenhua Road, Jinan 250012, China
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14
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Suh SW, Kim HS, Han JH, Bae JB, Oh DJ, Han JW, Kim KW. Efficacy of Vitamins on Cognitive Function of Non-Demented People: A Systematic Review and Meta-Analysis. Nutrients 2020; 12:E1168. [PMID: 32331312 PMCID: PMC7231132 DOI: 10.3390/nu12041168] [Citation(s) in RCA: 25] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/09/2020] [Revised: 04/12/2020] [Accepted: 04/14/2020] [Indexed: 12/19/2022] Open
Abstract
Previous evidence has suggested that vitamins might be beneficial for cognition. This systematic review aimed to investigate the efficacy of B vitamins, antioxidant vitamins, and vitamin D on the cognitive function of non-demented middle-aged or older people. Randomized or quasi-randomized controlled trials of individuals aged 40 years or older were included. PubMed/MEDLINE, EMBASE, CINAHL, PsycINFO, Cochrane Library databases, and other grey literature sources were searched up to November 2019. Their methodological quality was evaluated using the Cochrane Risk of Bias tool. Twenty-three studies on B vitamins (n = 22-1053; comprising folate, B6, and B12), nine on antioxidant vitamins (n = 185-20,469), and six on vitamin D (n = 55-4122) were included. Taking B vitamins for over 3 months was beneficial for global cognition (standardized mean difference (SMD) -0.18, 95% CI -0.30 to -0.06) and episodic memory (SMD -0.09, 95% CI -0.15 to -0.04). However, antioxidant vitamins (SMD -0.02, 95% CI -0.08 to 0.03) and vitamin D (SMD -0.06, 95% CI -0.36 to 0.23) were not. Antioxidant vitamins were beneficial for global cognition in sensitivity analyses using final measurement data as mean difference estimates (SMD, -0.04, 95% CI -0.08 to -0.01). Taking B vitamins and possibly antioxidant vitamins may be beneficial for the cognitive function of non-demented people.
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Affiliation(s)
- Seung Wan Suh
- Department of Psychiatry, College of Medicine, Hallym University, Kangdong Sacred Heart Hospital, Seoul 05355, Korea
| | - Hye Sung Kim
- Department of Neuropsychiatry, Seoul National University Bundang Hospital, Seongnam 13620, Korea
| | - Ji Hyun Han
- Department of Neuropsychiatry, Seoul National University Bundang Hospital, Seongnam 13620, Korea
| | - Jong Bin Bae
- Department of Neuropsychiatry, Seoul National University Bundang Hospital, Seongnam 13620, Korea
| | - Dae Jong Oh
- Department of Neuropsychiatry, Seoul National University Bundang Hospital, Seongnam 13620, Korea
| | - Ji Won Han
- Department of Neuropsychiatry, Seoul National University Bundang Hospital, Seongnam 13620, Korea
| | - Ki Woong Kim
- Department of Neuropsychiatry, Seoul National University Bundang Hospital, Seongnam 13620, Korea
- Department of Psychiatry, College of Medicine, Seoul National University, Seoul 03080, Korea
- Department of Brain and Cognitive Sciences, College of Natural Sciences, Seoul National University, Seoul 08826, Korea
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Vlachos GS, Scarmeas N. Dietary interventions in mild cognitive impairment and dementia. DIALOGUES IN CLINICAL NEUROSCIENCE 2020. [PMID: 31607782 PMCID: PMC6780358 DOI: 10.31887/dcns.2019.21.1/nscarmeas] [Citation(s) in RCA: 26] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
Dietary intervention is an enticing approach in the fight against cognitive impairment. Nutritional supplements and dietetic counseling are relatively easy and benign interventions, but research has not yet yielded irrefutable evidence as to their clinical utility. Heterogeneity in the results of available clinical studies, as well as methodological and practical issues, does not allow replication and generalization of findings. The paper at hand reviews only randomized clinical trials of single nutrients, multi-nutrient formulations and dietary counseling in mild cognitive impairment and dementia of the Alzheimer's type focusing on both cognitive and functional outcomes. Thus far, folate, vitamin E, Ω-3 fatty acids, and certain multi-nutrient formulations have shown some preliminary promising results; larger, well-designed trials are needed to confirm these findings before nutritional elements can be incorporated in recommended clinical guidelines.
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Affiliation(s)
- George S Vlachos
- 1st Department of Neurology, Aiginition Hospital, National and Kapodistrian University of Athens Medical School, Greece
| | - Nikolaos Scarmeas
- 1st Department of Neurology, Aiginition Hospital, National and Kapodistrian University of Athens Medical School, Greece; Taub Institute for Research in Alzheimer's Disease and the Aging Brain, The Gertrude H. Sergievsky Center, Department of Neurology, Columbia University, New York, USA
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16
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A summary of the evidence and evaluation of the effectiveness of nonpharmacological interventions for mild cognitive impairment. FRONTIERS OF NURSING 2019. [DOI: 10.2478/fon-2019-0038] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
Abstract
Abstract
Objective
To summarize and evaluate the evidence of guidelines and systematic reviews (SRs) of nonpharmacological interventions for mild cognitive impairment (MCI) to support the development of future guidelines and clinical decisions for MCI patients.
Methods
Scottish Intercollegiate Guideline Network (SIGN), National Institute for Health and Clinical Excellence (NICE), American Academy of Neurology (AAN), Registered Nurses Association of Ontario (RNAO), Web of Science, PubMed, Cochrane Library, CNAHL, VIP, China National Knowledge Infrastructure (CNKI), and Wanfang Database were searched for relevant publications, including guidelines and SRs, from January 2014 to March 2019. Two authors independently screened articles, extracted data, and assessed the publications for adherence to the inclusion criteria. Appraisal of Guidelines for Research and Evaluation (AGREE II) was used to assess the quality of the guidelines, and Assessment of Multiple Systematic Reviews (AMSTAR 2) was used to assess the quality of SRs. In addition, the Grading of Recommendations Assessment, Development and Evaluation (GRADE) approach was used to evaluate the quality of outcomes.
Results
Thirty-two articles were retrieved, including 1 guideline and 31 SRs. Fourteen SRs of physical exercise for MCI, six articles describing cognitive interventions, four articles describing acupuncture, and seven articles assessing dietary interventions (including four articles employing a Mediterranean diet, one article using vitamin B supplementation, and two articles assessing the effects of tea, coffee, and caffeine) were included. The quality of the articles was very low for 4 (13%), low for 10 (32%), and moderate for 17 (55%).
Conclusions
Based on the evidence available to date, nonpharmacological interventions may improve the current cognitive function of persons with MCI. In particular, physical exercise, cognitive interventions, and acupuncture exerted promising effects. However, due to the limited number and quality of the included publications, additional high-quality reviews are needed to further confirm.
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Larsen EL, Weimann A, Poulsen HE. Interventions targeted at oxidatively generated modifications of nucleic acids focused on urine and plasma markers. Free Radic Biol Med 2019; 145:256-283. [PMID: 31563634 DOI: 10.1016/j.freeradbiomed.2019.09.030] [Citation(s) in RCA: 22] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/07/2019] [Revised: 09/16/2019] [Accepted: 09/25/2019] [Indexed: 12/21/2022]
Abstract
Oxidative stress is associated with the development and progression of numerous diseases. However, targeting oxidative stress has not been established in the clinical management of any disease. Several methods and markers are available to measure oxidative stress, including direct measurement of free radicals, antioxidants, redox balance, and oxidative modifications of cellular macromolecules. Oxidatively generated nucleic acid modifications have attracted much interest due to the pre-mutagenic oxidative modification of DNA into 8-oxo-7,8-dihydro-2'-deoxyguanosine (8-oxodG), associated with cancer development. During the last decade, the perception of RNA has changed from that of a 'silent messenger' to an 'active contributor', and, parallelly oxidatively generated RNA modifications measured as 8-oxo-7,8-dihydro-guanosine (8-oxoGuo), has been demonstrated as a prognostic factor for all-caused and cardiovascular related mortality in patients with type 2 diabetes. Several attempts have been made to modify the amount of oxidative nucleic acid modifications. Thus, this review aims to introduce researchers to the measurement of oxidatively generated nucleic acid modifications as well as critically review previous attempts and provide future directions for targeting oxidatively generated nucleic acid modifications.
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Affiliation(s)
- Emil List Larsen
- Department of Clinical Pharmacology, Bispebjerg-Frederiksberg Hospital, Copenhagen, Denmark.
| | - Allan Weimann
- Department of Clinical Pharmacology, Bispebjerg-Frederiksberg Hospital, Copenhagen, Denmark
| | - Henrik Enghusen Poulsen
- Department of Clinical Pharmacology, Bispebjerg-Frederiksberg Hospital, Copenhagen, Denmark; Department of Clinical Medicine, University of Copenhagen, Copenhagen, Denmark
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18
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Browne D, McGuinness B, Woodside JV, McKay GJ. Vitamin E and Alzheimer's disease: what do we know so far? Clin Interv Aging 2019; 14:1303-1317. [PMID: 31409980 PMCID: PMC6645610 DOI: 10.2147/cia.s186760] [Citation(s) in RCA: 59] [Impact Index Per Article: 11.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/10/2019] [Accepted: 07/04/2019] [Indexed: 02/06/2023] Open
Abstract
Vitamin E has been proposed as a potential clinical intervention for Alzheimer's disease (AD) given the plausibility of its various biological functions in influencing the neurodegenerative processes associated with the condition. The tocopherol and tocotrienol isoforms of vitamin E have multiple properties including potent antioxidant and anti-inflammatory characteristics, in addition to influences on immune function, cellular signalling and lowering cholesterol. Several of these roles offer a theoretical rationale for providing benefit for the treatment of AD-associated pathology. Diminished circulating concentrations of vitamin E have been demonstrated in individuals with AD. Reduced plasma levels have furthermore been associated with an increased risk of AD development while intake, particularly from dietary sources, may limit or reduce the rate of disease progression. This benefit may be linked to synergistic actions between vitamin E isoforms and other micronutrients. Nevertheless, randomised trials have found limited and inconsistent evidence of vitamin E supplementation as an effective clinical intervention. Thus, despite a strong rationale in support of a beneficial role for vitamin E for the treatment of AD, the evidence remains inconclusive. Several factors may partly explain this discrepancy and represent the difficulties of translating complex laboratory evidence and dietary interactions into clinical interventions. Methodological design limitations of existing randomised trials and restrictions to supplementation with a single vitamin E isoform may also limit the influence of effect. Moreover, several factors influence individual responsiveness to vitamin E intake and recent findings suggest variation in the underlying genetic architecture attenuates vitamin E biological availability and activity which likely contributes to the variation in clinical responsiveness and the failure of randomised trials to date. Importantly, the clinical safety of vitamin E remains controversial and warrants further investigation.
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Affiliation(s)
- Declan Browne
- Centre for Public Health, Queen’s University Belfast, Belfast, UK
| | | | - Jayne V Woodside
- Centre for Public Health, Queen’s University Belfast, Belfast, UK
| | - Gareth J McKay
- Centre for Public Health, Queen’s University Belfast, Belfast, UK
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Liang JH, Shen WT, Li JY, Qu XY, Li J, Jia RX, Wang YQ, Wang S, Wu RK, Zhang HB, Hang L, Xu Y, Lin L. The optimal treatment for improving cognitive function in elder people with mild cognitive impairment incorporating Bayesian network meta-analysis and systematic review. Ageing Res Rev 2019; 51:85-96. [PMID: 30682429 DOI: 10.1016/j.arr.2019.01.009] [Citation(s) in RCA: 22] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/07/2018] [Revised: 12/16/2018] [Accepted: 01/09/2019] [Indexed: 11/26/2022]
Abstract
It's widely acknowledged that, as a neurodegenerative aging disease representing an intermediate stage between cognitive intactness and Alzheimer's disease (AD), Mild cognitive impairment (MCI) poses an excessive burden on patients' well-being, family members, health-care providers as well as the whole society. This study focuses on three cognitive interventions proposed by Clare and Woods, which are, Cognitive stimulation (CS), Cognitive training (CT) and Cognitive rehabilitation (CR). Our Network meta-analysis (NMA) aims to compar them with one another to determine the optimal cognitive intervention for elderly adults with MCI in improving their cognitive function. We applied extensive strategies to preliminary literature retrieval to identify relevant randomized controlled trials (RCTs) which scrupulously compared any two of the three cognitive interventions with one another or any one of the three with a control group as the placebo or non-active group in treating elder patients with MCI in accordance with Petersen's criteria. Our NMA of cognitive interventions for patients diagnosed with MCI appraised the relative effectiveness of cognitive interventions across trials simultaneously. Our study attempts to summarize available data to suggest that CS (Mean difference [MD] = 0.95, 95% confidence interval [CI]:0.27, 1.70) and CT (MD = 0.70, [CI]:0.11,1.30) were significantly beneficial to MCI patients for improving their cognition status while CR (MD = 0.59, [CI]:-0.30,1.50) scored lowest. Our study suggested CS was most likely to be the best intervention for improving the cognitive function of MCI patients.
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20
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Rutjes AWS, Denton DA, Di Nisio M, Chong L, Abraham RP, Al‐Assaf AS, Anderson JL, Malik MA, Vernooij RWM, Martínez G, Tabet N, McCleery J. Vitamin and mineral supplementation for maintaining cognitive function in cognitively healthy people in mid and late life. Cochrane Database Syst Rev 2018; 12:CD011906. [PMID: 30556597 PMCID: PMC6353240 DOI: 10.1002/14651858.cd011906.pub2] [Citation(s) in RCA: 60] [Impact Index Per Article: 10.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
BACKGROUND Vitamins and minerals play multiple functions within the central nervous system which may help to maintain brain health and optimal cognitive functioning. Supplementation of the diet with various vitamins and minerals has been suggested as a means of maintaining cognitive function, or even of preventing dementia, in later life. OBJECTIVES To evaluate the effects of vitamin and mineral supplementation on cognitive function in cognitively healthy people aged 40 years or more. SEARCH METHODS We searched ALOIS, the Cochrane Dementia and Cognitive Improvement Group's (CDCIG) specialised register, as well as MEDLINE, Embase, PsycINFO, CINAHL, ClinicalTrials.gov and the WHO Portal/ICTRP from inception to 26th January 2018. SELECTION CRITERIA We included randomised controlled trials that evaluated the cognitive effects on people aged 40 years or more of any vitamin or mineral supplements taken by mouth for at least three months. DATA COLLECTION AND ANALYSIS Study selection, data extraction, and quality assessments were done in duplicate. Vitamins were considered broadly in the categories of B vitamins, antioxidant vitamins, and combinations of both. Minerals were considered separately, where possible. If interventions and outcomes were considered sufficiently similar, then data were pooled. In order to separate short-term cognitive effects from possible longer-term effects on the trajectory of cognitive decline, data were pooled for various treatment durations from 3 months to 12 months and up to 10 years or more. MAIN RESULTS In total, we included 28 studies with more than 83,000 participants. There were some general limitations of the evidence. Most participants were enrolled in studies which were not designed primarily to assess cognition. These studies often had no baseline cognitive assessment and used only brief cognitive assessments at follow-up. Very few studies assessed the incidence of dementia. Most study reports did not mention adverse events or made only very general statements about them. Only 10 studies had a mean follow-up > 5 years. Only two studies had participants whose mean age was < 60 years at baseline. The risk of bias in the included studies was generally low, other than a risk of attrition bias for longer-term outcomes. We considered the certainty of the evidence behind almost all results to be moderate or low.We included 14 studies with 27,882 participants which compared folic acid, vitamin B12, vitamin B6, or a combination of these to placebo. The majority of participants were aged over 60 years and had a history of cardio- or cerebrovascular disease. We found that giving B vitamin supplements to cognitively healthy adults, mainly in their 60s and 70s, probably has little or no effect on global cognitive function at any time point up to 5 years (SMD values from -0.03 to 0.06) and may also have no effect at 5-10 years (SMD -0.01). There were very sparse data on adverse effects or on incidence of cognitive impairment or dementia.We included 8 studies with 47,840 participants in which the active intervention was one or more of the antioxidant vitamins: ß-carotene, vitamin C or vitamin E. Results were mixed. For overall cognitive function, there was low-certainty evidence of benefit associated with ß-carotene after a mean of 18 years of treatment (MD 0.18 TICS points, 95% CI 0.01 to 0.35) and of vitamin C after 5 years to 10 years (MD 0.46 TICS points, 95% CI 0.14 to 0.78), but not at earlier time points. From two studies which reported on dementia incidence, there was low-certainty evidence of no effect of an antioxidant vitamin combination or of vitamin E, either alone or combined with selenium. One of the included studies had been designed to look for effects on the incidence of prostate cancer; it found a statistically significant increase in prostate cancer diagnoses among men taking vitamin E.One trial with 4143 participants compared vitamin D3 (400 IU/day) and calcium supplements to placebo. We found low- to moderate-certainty evidence of no effect of vitamin D3 and calcium supplements at any time-point up to 10 years on overall cognitive function (MD after a mean of 7.8 years -0.1 MMSE points, 95% CI -0.81 to 0.61) or the incidence of dementia (HR 0.94, 95% CI 0.72 to 1.24). A pilot study with 60 participants used a higher dose of vitamin D3 (4000 IU on alternate days) and found preliminary evidence that this dose probably has no effect on cognitive function over six months.We included data from one trial of zinc and copper supplementation with 1072 participants. There was moderate-certainty evidence of little or no effect on overall cognitive function (MD 0.6 MMSE points, 95% CI -0.19 to 1.39) or on the incidence of cognitive impairment after 5 years to 10 years. A second smaller trial provided no usable data, but reported no cognitive effects of six months of supplementation with zinc gluconate.From one study with 3711 participants, there was low-certainty evidence of no effect of approximately five years of selenium supplementation on the incidence of dementia (HR 0.83, 95% CI 0.61 to 1.13).Finally, we included three trials of complex supplements (combinations of B vitamins, antioxidant vitamins, and minerals) with 6306 participants. From the one trial which assessed overall cognitive function, there was low-certainty evidence of little or no effect on the TICS (MD after a mean of 8.5 years 0.12, 95% CI -0.14 to 0.38). AUTHORS' CONCLUSIONS We did not find evidence that any vitamin or mineral supplementation strategy for cognitively healthy adults in mid or late life has a meaningful effect on cognitive decline or dementia, although the evidence does not permit definitive conclusions. There were very few data on supplementation starting in midlife (< 60 years); studies designed to assess cognitive outcomes tended to be too short to assess maintenance of cognitive function; longer studies often had other primary outcomes and used cognitive measures which may have lacked sensitivity. The only positive signals of effect came from studies of long-term supplementation with antioxidant vitamins. These may be the most promising for further research.
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Affiliation(s)
- Anne WS Rutjes
- University of BernInstitute of Social and Preventive Medicine (ISPM)Mittelstrasse 43BernBernSwitzerland3012
- University of BernInstitute of Primary Health Care (BIHAM)Mittelstrasse 43BernBernSwitzerland3012
| | - David A Denton
- Sussex Partnership NHS Foundation TrustSpecialist Older People's ServicesUckfield Community HosptialFramfield RoadUckfieldUKTN22 5AW
| | - Marcello Di Nisio
- University "G. D'Annunzio" of Chieti‐PescaraDepartment of Medicine and Ageing SciencesVia dei Vestini 31Chieti ScaloItaly66013
| | | | - Rajesh P Abraham
- Surrey and Borders Partnership NHS Foundation TrustCommunity Mental Health Team for Older People:Waverley11‐13 Ockford RoadGuildfordUKGU7 1QU
| | - Aalya S Al‐Assaf
- Newcastle UniversityNIHR Innovation ObservatorySuite A, 4th Floor, Time CentralGallowgateNewcastle Upon TyneUKNE1 4BF
| | - John L Anderson
- Brighton and Sussex Medical School, University of BrightonDepartment of Medical EducationWatson BuildingFalmerUKBN1 9PH
| | - Muzaffar A Malik
- Brighton and Sussex Medical School, University of BrightonDepartment of Medical Education (Postgraduate)Room 341, Mayfield HouseFalmerUKBN1 9PH
| | - Robin WM Vernooij
- Iberoamerican Cochrane CentreC/ Sant Antoni Maria Claret 167BarcelonaBarcelonaSpain08025
| | - Gabriel Martínez
- Universidad de AntofagastaFaculty of Medicine and DentistryAvenida Argentina 2000AntofagastaChile127001
| | - Naji Tabet
- Brighton and Sussex Medical SchoolCentre for Dementia StudiesMayfield House, University of BrightonFalmerBrightonUKBN1 9PH
| | - Jenny McCleery
- Oxford Health NHS Foundation TrustElms CentreOxford RoadBanburyOxfordshireUKOX16 9AL
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Solfrizzi V, Agosti P, Lozupone M, Custodero C, Schilardi A, Valiani V, Santamato A, Sardone R, Dibello V, Di Lena L, Stallone R, Ranieri M, Bellomo A, Greco A, Daniele A, Seripa D, Sabbà C, Logroscino G, Panza F. Nutritional interventions and cognitive-related outcomes in patients with late-life cognitive disorders: A systematic review. Neurosci Biobehav Rev 2018; 95:480-498. [PMID: 30395922 DOI: 10.1016/j.neubiorev.2018.10.022] [Citation(s) in RCA: 23] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/03/2018] [Revised: 10/27/2018] [Accepted: 10/29/2018] [Indexed: 12/30/2022]
Abstract
There have been a large number of observational studies on the impact of nutrition on neuroprotection, however, there was a lack of evidence from randomized clinical trials (RCTs). In the present systematic review, from the 32 included RCTs published in the last four years (2014-2017) in patients aged 60 years and older with different late-life cognitive disorders, nutritional intervention through medical food/nutraceutical supplementation and multidomain approach improved magnetic resonance imaging findings and other cognitive-related biomarkers, but without clear effect on cognition in mild Alzheimer's disease (AD) and mild cognitive impairment (MCI). Antioxidant-rich foods (nuts, grapes, cherries) and fatty acid supplementation, mainly n-3 polyunsaturated fatty acids (PUFA), improved specific cognitive domains and cognitive-related outcomes in MCI, mild-to-moderate dementia, and AD. Antioxidant vitamin and trace element supplementations improved only cognitive-related outcomes and biomarkers, high-dose B vitamin supplementation in AD and MCI patients improved cognitive outcomes in the subjects with a high baseline plasma n-3 PUFA, while folic acid supplementation had positive impact on specific cognitive domains in those with high homocysteine.
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Affiliation(s)
- Vincenzo Solfrizzi
- Geriatric Medicine-Memory Unit and Rare Disease Centre, University of Bari 'Aldo Moro', Bari, Italy.
| | - Pasquale Agosti
- Geriatric Medicine-Memory Unit and Rare Disease Centre, University of Bari 'Aldo Moro', Bari, Italy
| | - Madia Lozupone
- Neurodegenerative Disease Unit, Department of Basic Medicine, Neuroscience, and Sense Organs, University of Bari Aldo Moro, Bari, Italy
| | - Carlo Custodero
- Geriatric Medicine-Memory Unit and Rare Disease Centre, University of Bari 'Aldo Moro', Bari, Italy
| | - Andrea Schilardi
- Geriatric Medicine-Memory Unit and Rare Disease Centre, University of Bari 'Aldo Moro', Bari, Italy
| | - Vincenzo Valiani
- Geriatric Medicine-Memory Unit and Rare Disease Centre, University of Bari 'Aldo Moro', Bari, Italy
| | - Andrea Santamato
- Physical Medicine and Rehabilitation Section, "OORR Hospital", University of Foggia, Foggia, Italy
| | - Rodolfo Sardone
- National Institute of Gastroenterology "Saverio de Bellis", Research Hospital, Castellana Grotte, Bari, Italy; Interdisciplinary Department of Medicine (DIM), Section of Dentistry, University of Bari AldoMoro, Bari, Italy
| | - Vittorio Dibello
- Psychiatric Unit, Department of Clinical and Experimental Medicine, University of Foggia, Foggia, Italy
| | - Luca Di Lena
- National Institute of Gastroenterology "Saverio de Bellis", Research Hospital, Castellana Grotte, Bari, Italy; Interdisciplinary Department of Medicine (DIM), Section of Dentistry, University of Bari AldoMoro, Bari, Italy
| | - Roberta Stallone
- National Institute of Gastroenterology "Saverio de Bellis", Research Hospital, Castellana Grotte, Bari, Italy; Interdisciplinary Department of Medicine (DIM), Section of Dentistry, University of Bari AldoMoro, Bari, Italy
| | - Maurizio Ranieri
- Physical Medicine and Rehabilitation Section, "OORR Hospital", University of Foggia, Foggia, Italy
| | - Antonello Bellomo
- Psychiatric Unit, Department of Clinical and Experimental Medicine, University of Foggia, Foggia, Italy
| | - Antonio Greco
- Geriatric Unit, Fondazione IRCCS "Casa Sollievo della Sofferenza", San Giovanni Rotondo, Foggia, Italy
| | - Antonio Daniele
- Institute of Neurology, Catholic University of Sacred Heart, Rome, Italy; Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy
| | - Davide Seripa
- Geriatric Unit, Fondazione IRCCS "Casa Sollievo della Sofferenza", San Giovanni Rotondo, Foggia, Italy
| | - Carlo Sabbà
- Geriatric Medicine-Memory Unit and Rare Disease Centre, University of Bari 'Aldo Moro', Bari, Italy
| | - Giancarlo Logroscino
- Neurodegenerative Disease Unit, Department of Basic Medicine, Neuroscience, and Sense Organs, University of Bari Aldo Moro, Bari, Italy; Department of Clinical Research in Neurology, Center for Neurodegenerative Diseases and the Aging Brain, University of Bari "Aldo Moro", "Pia Fondazione Cardinale G. Panico", Tricase, Lecce, Italy
| | - Francesco Panza
- Neurodegenerative Disease Unit, Department of Basic Medicine, Neuroscience, and Sense Organs, University of Bari Aldo Moro, Bari, Italy; Geriatric Unit, Fondazione IRCCS "Casa Sollievo della Sofferenza", San Giovanni Rotondo, Foggia, Italy; Department of Clinical Research in Neurology, Center for Neurodegenerative Diseases and the Aging Brain, University of Bari "Aldo Moro", "Pia Fondazione Cardinale G. Panico", Tricase, Lecce, Italy.
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McCleery J, Abraham RP, Denton DA, Rutjes AWS, Chong L, Al‐Assaf AS, Griffith DJ, Rafeeq S, Yaman H, Malik MA, Di Nisio M, Martínez G, Vernooij RWM, Tabet N. Vitamin and mineral supplementation for preventing dementia or delaying cognitive decline in people with mild cognitive impairment. Cochrane Database Syst Rev 2018; 11:CD011905. [PMID: 30383288 PMCID: PMC6378925 DOI: 10.1002/14651858.cd011905.pub2] [Citation(s) in RCA: 59] [Impact Index Per Article: 9.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
BACKGROUND Vitamins and minerals have many functions in the nervous system which are important for brain health. It has been suggested that various different vitamin and mineral supplements might be useful in maintaining cognitive function and delaying the onset of dementia. In this review, we sought to examine the evidence for this in people who already had mild cognitive impairment (MCI). OBJECTIVES To evaluate the effects of vitamin and mineral supplementation on cognitive function and the incidence of dementia in people with mild cognitive impairment. SEARCH METHODS We searched ALOIS, the Cochrane Dementia and Cognitive Improvement Group's (CDCIG) specialised register, as well as MEDLINE, Embase, PsycINFO, CENTRAL, CINAHL, LILACs, Web of Science Core Collection, ClinicalTrials.gov, and the WHO Portal/ICTRP, from inception to 25 January 2018. SELECTION CRITERIA We included randomised or quasi-randomised, placebo-controlled trials which evaluated orally administered vitamin or mineral supplements in participants with a diagnosis of mild cognitive impairment and which assessed the incidence of dementia or cognitive outcomes, or both. We were interested in studies applicable to the general population of older people and therefore excluded studies in which participants had severe vitamin or mineral deficiencies. DATA COLLECTION AND ANALYSIS We sought data on our primary outcomes of dementia incidence and overall cognitive function and on secondary outcomes of episodic memory, executive function, speed of processing, quality of life, functional performance, clinical global impression, adverse events, and mortality. We conducted data collection and analysis according to standard Cochrane systematic review methods. We assessed the risk of bias of included studies using the Cochrane 'Risk of bias' assessment tool. We grouped vitamins and minerals according to their putative mechanism of action and, where we considered it to be clinically appropriate, we pooled data using random-effects methods. We used GRADE methods to assess the overall quality of evidence for each comparison and outcome. MAIN RESULTS We included five trials with 879 participants which investigated B vitamin supplements. In four trials, the intervention was a combination of vitamins B6, B12, and folic acid; in one, it was folic acid only. Doses varied. We considered there to be some risks of performance and attrition bias and of selective outcome reporting among these trials. Our primary efficacy outcomes were the incidence of dementia and scores on measures of overall cognitive function. None of the trials reported the incidence of dementia and the evidence on overall cognitive function was of very low-quality. There was probably little or no effect of B vitamins taken for six to 24 months on episodic memory, executive function, speed of processing, or quality of life. The evidence on our other secondary clinical outcomes, including harms, was very sparse or very low-quality. There was evidence from one study that there may be a slower rate of brain atrophy over two years in participants taking B vitamins. The same study reported subgroup analyses based on the level of serum homocysteine (tHcy) at baseline and found evidence that B vitamins may improve episodic memory in those with tHcy above the median at baseline.We included one trial (n = 516) of vitamin E supplementation. Vitamin E was given as 1000 IU of alpha-tocopherol twice daily. We considered this trial to be at risk of attrition and selective reporting bias. There was probably no effect of vitamin E on the probability of progression from MCI to Alzheimer's dementia over three years (HR 1.02; 95% CI 0.74 to 1.41; n = 516; 1 study, moderate-quality evidence). There was also no evidence of an effect at intermediate time points. The available data did not allow us to conduct analyses, but the authors reported no significant effect of three years of supplementation with vitamin E on overall cognitive function, episodic memory, speed of processing, clinical global impression, functional performance, adverse events, or mortality (five deaths in each group). We considered this to be low-quality evidence.We included one trial (n = 256) of combined vitamin E and vitamin C supplementation and one trial (n = 26) of supplementation with chromium picolinate. In both cases, there was a single eligible cognitive outcome, but we considered the evidence to be very low-quality and so could not be sure of any effects. AUTHORS' CONCLUSIONS The evidence on vitamin and mineral supplements as treatments for MCI is very limited. Three years of treatment with high-dose vitamin E probably does not reduce the risk of progression to dementia, but we have no data on this outcome for other supplements. Only B vitamins have been assessed in more than one RCT. There is no evidence for beneficial effects on cognition of supplementation with B vitamins for six to 24 months. Evidence from a single study of a reduced rate of brain atrophy in participants taking vitamin B and a beneficial effect of vitamin B on episodic memory in those with higher tHcy at baseline warrants attempted replication.
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Affiliation(s)
- Jenny McCleery
- Oxford Health NHS Foundation TrustElms CentreOxford RoadBanburyOxfordshireUKOX16 9AL
| | - Rajesh P Abraham
- Surrey and Borders Partnership NHS Foundation TrustCommunity Mental Health Team for Older People:Waverley11‐13 Ockford RoadGuildfordUKGU7 1QU
| | - David A Denton
- Sussex Partnership NHS Foundation TrustSpecialist Older People's ServicesUckfield Community HosptialFramfield RoadUckfieldUKTN22 5AW
| | - Anne WS Rutjes
- Fondazione "Università G. D'Annunzio"Centre for Systematic ReviewsVia dei Vestini 31ChietiChietiItaly66100
- University of BernInstitute of Social and Preventive Medicine (ISPM)Mittelstrasse 43BernBernSwitzerland3012
| | | | - Aalya S Al‐Assaf
- Newcastle UniversityNIHR Innovation ObservatorySuite A, 4th Floor, Time CentralGallowgateNewcastle Upon TyneUKNE1 4BF
| | - Daniel J Griffith
- Queen Elizabeth Hospital Birmingham, University Hospitals Birmingham NHS Foundation TrustDepartment of Nutrition and DieteticsMindelsohn WayEdgbastonBirminghamWest MidlandsUKB15 2GW
| | - Shireen Rafeeq
- Central Park Medical CollegeCommunity MedicineCentral Park Housing Scheme, Ferozepur Road, Kahna NauLahorePunjabPakistan53100
| | - Hakan Yaman
- Faculty of Medicine, Akdeniz UniversityDepartment of Family MedicineAntalyaTurkey07059
| | - Muzaffar A Malik
- Brighton and Sussex Medical School, University of BrightonDepartment of Medical Education (Postgraduate)Room 341, Mayfield HouseFalmerUKBN1 9PH
| | - Marcello Di Nisio
- University "G. D'Annunzio" of Chieti‐PescaraDepartment of Medicine and Ageing SciencesVia dei Vestini 31Chieti ScaloItaly66013
| | - Gabriel Martínez
- Universidad de AntofagastaFaculty of Medicine and DentistryAvenida Argentina 2000AntofagastaChile127001
- Iberoamerican Cochrane CentreSant Antoni Maria Claret 167BarcelonaSpain08025
| | - Robin WM Vernooij
- Iberoamerican Cochrane CentreSant Antoni Maria Claret 167BarcelonaSpain08025
| | - Naji Tabet
- Brighton and Sussex Medical SchoolCentre for Dementia StudiesMayfield House, University of BrightonFalmerBrightonUKBN1 9PH
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Prinzi G, Santoro A, Lamonaca P, Cardaci V, Fini M, Russo P. Cognitive Impairment in Chronic Obstructive Pulmonary Disease (COPD): Possible Utility of Marine Bioactive Compounds. Mar Drugs 2018; 16:md16090313. [PMID: 30181485 PMCID: PMC6163567 DOI: 10.3390/md16090313] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/16/2018] [Revised: 08/30/2018] [Accepted: 08/30/2018] [Indexed: 12/23/2022] Open
Abstract
Chronic obstructive pulmonary disease (COPD) is characterized by long-term airflow limitation. Early-onset COPD in non-smoker subjects is ≥60 years and in the elderly is often associated with different comorbidities. Cognitive impairment is one of the most common feature in patients with COPD, and is associated with COPD severity and comorbidities. Cognitive impairment in COPD enhances the assistance requirement in different aspects of daily living, treatment adherence, and effectual self-management.This review describes various bioactive compounds of natural marine sources that modulate different targets shared by both COPD and cognitive impairment and hypothesizes a possible link between these two syndromes.
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Affiliation(s)
- Giulia Prinzi
- Clinical and Molecular Epidemiology, IRCSS San Raffaele Pisana, Via di Valcannuta 247, I-00166 Rome, Italy.
| | - Alessia Santoro
- Clinical and Molecular Epidemiology, IRCSS San Raffaele Pisana, Via di Valcannuta 247, I-00166 Rome, Italy.
| | - Palma Lamonaca
- Clinical and Molecular Epidemiology, IRCSS San Raffaele Pisana, Via di Valcannuta 247, I-00166 Rome, Italy.
| | - Vittorio Cardaci
- Unit of Pulmonary Rehabilitation, IRCCS San Raffaele Pisana, Via della Pisana 235, I-00163 Rome, Italy.
| | - Massimo Fini
- Scientific Direction, IRCSS San Raffaele Pisana, Via di Valcannuta 247, I-00166 Rome, Italy.
| | - Patrizia Russo
- Clinical and Molecular Epidemiology, IRCSS San Raffaele Pisana, Via di Valcannuta 247, I-00166 Rome, Italy.
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Herrlinger KA, Nieman KM, Sanoshy KD, Fonseca BA, Lasrado JA, Schild AL, Maki KC, Wesnes KA, Ceddia MA. Spearmint Extract Improves Working Memory in Men and Women with Age-Associated Memory Impairment. J Altern Complement Med 2018; 24:37-47. [PMID: 29314866 PMCID: PMC5779242 DOI: 10.1089/acm.2016.0379] [Citation(s) in RCA: 31] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/03/2023] Open
Abstract
OBJECTIVE The purpose of this study was to investigate the effects of supplementation with a spearmint (Mentha spicata L.) extract, high in polyphenols including rosmarinic acid, on cognitive performance, sleep, and mood in individuals with age-associated memory impairment (AAMI). DESIGN Subjects with AAMI (N = 90; 67% female; age = 59.4 ± 0.6 years) were randomly assigned (n = 30/group) to consume 900, 600, or 0 mg/day (two capsules, once daily) spearmint extract for 90 days, in this double-blind, placebo-controlled trial. Assessments were completed for cognition (days 0, 45, and 90), sleep (days 0 and 90), and mood (days 0 and 90) by using the Cognitive Drug Research (CDR) System™, Leeds Sleep Evaluation Questionnaire (LSEQ), and Profile of Mood States (POMS™), respectively. RESULTS Quality of working memory and spatial working memory accuracy improved after supplementation with 900 mg/day spearmint extract by 15% (p = 0.0469) and 9% (p = 0.0456), respectively, versus placebo. Subjects consuming 900 mg/day spearmint extract reported improvement in their ability to fall asleep, relative to subjects consuming placebo (p = 0.0046). Overall treatment effects were evident for vigor-activity (p = 0.0399), total mood disturbance (p = 0.0374), and alertness and behavior following wakefulness (p = 0.0415), with trends observed for improvements after spearmint supplementation relative to placebo. CONCLUSIONS These results suggest that the distinct spearmint extract may be a beneficial nutritional intervention for cognitive health in older subjects with AAMI.
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Affiliation(s)
| | | | | | | | | | | | - Kevin C. Maki
- Biofortis Research Services/Mérieux NutriSciences, Addison, IL
| | - Keith A. Wesnes
- Bracket, LLC, Wayne, PA
- Department of Psychology, Northumbria University, Newcastle, United Kingdom
- Centre for Human Psychopharmacology, Swinburne University, Melbourne, Australia
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Vitamin C Status Correlates with Markers of Metabolic and Cognitive Health in 50-Year-Olds: Findings of the CHALICE Cohort Study. Nutrients 2017; 9:nu9080831. [PMID: 28771190 PMCID: PMC5579624 DOI: 10.3390/nu9080831] [Citation(s) in RCA: 59] [Impact Index Per Article: 8.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/14/2017] [Revised: 07/27/2017] [Accepted: 07/31/2017] [Indexed: 12/20/2022] Open
Abstract
A cohort of 50-year-olds from Canterbury, New Zealand (N = 404), representative of midlife adults, undertook comprehensive health and dietary assessments. Fasting plasma vitamin C concentrations (N = 369) and dietary vitamin C intake (N = 250) were determined. The mean plasma vitamin C concentration was 44.2 µmol/L (95% CI 42.4, 46.0); 62% of the cohort had inadequate plasma vitamin C concentrations (i.e., <50 µmol/L), 13% of the cohort had hypovitaminosis C (i.e., <23 µmol/L), and 2.4% had plasma vitamin C concentrations indicating deficiency (i.e., <11 µmol/L). Men had a lower mean plasma vitamin C concentration than women, and a higher percentage of vitamin C inadequacy and deficiency. A higher prevalence of hypovitaminosis C and deficiency was observed in those of lower socio-economic status and in current smokers. Adults with higher vitamin C levels exhibited lower weight, BMI and waist circumference, and better measures of metabolic health, including HbA1c, insulin and triglycerides, all risk factors for type 2 diabetes. Lower levels of mild cognitive impairment were observed in those with the highest plasma vitamin C concentrations. Plasma vitamin C showed a stronger correlation with markers of metabolic health and cognitive impairment than dietary vitamin C.
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Farina N, Llewellyn D, Isaac MGEKN, Tabet N. Vitamin E for Alzheimer's dementia and mild cognitive impairment. Cochrane Database Syst Rev 2017; 4:CD002854. [PMID: 28418065 PMCID: PMC6478142 DOI: 10.1002/14651858.cd002854.pub5] [Citation(s) in RCA: 51] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
BACKGROUND Vitamin E occurs naturally in the diet. It has several biological activities, including functioning as an antioxidant to scavenge toxic free radicals. Evidence that free radicals may contribute to the pathological processes behind cognitive impairment has led to interest in the use of vitamin E supplements to treat mild cognitive impairment (MCI) and Alzheimer's disease (AD). This is an update of a Cochrane Review first published in 2000, and previously updated in 2006 and 2012. OBJECTIVES To assess the efficacy of vitamin E in the treatment of MCI and dementia due to AD. SEARCH METHODS We searched the Specialized Register of the Cochrane Dementia and Cognitive Improvement Group (ALOIS), the Cochrane Library, MEDLINE, Embase, PsycINFO, CINAHL, LILACS as well as many trials databases and grey literature sources on 22 April 2016 using the terms: "Vitamin E", vitamin-E, alpha-tocopherol. SELECTION CRITERIA We included all double-blind, randomised trials in which treatment with any dose of vitamin E was compared with placebo in people with AD or MCI. DATA COLLECTION AND ANALYSIS We used standard methodological procedures according to the Cochrane Handbook for Systematic Reviews of Interventions. We rated the quality of the evidence using the GRADE approach. Where appropriate we attempted to contact authors to obtain missing information. MAIN RESULTS Four trials met the inclusion criteria, but we could only extract outcome data in accordance with our protocol from two trials, one in an AD population (n = 304) and one in an MCI population (n = 516). Both trials had an overall low to unclear risk of bias. It was not possible to pool data across studies owing to a lack of comparable outcome measures.In people with AD, we found no evidence of any clinically important effect of vitamin E on cognition, measured with change from baseline in the Alzheimer's Disease Assessment Scale - Cognitive subscale (ADAS-Cog) over six to 48 months (mean difference (MD) -1.81, 95% confidence interval (CI) -3.75 to 0.13, P = 0.07, 1 study, n = 272; moderate quality evidence). There was no evidence of a difference between vitamin E and placebo groups in the risk of experiencing at least one serious adverse event over six to 48 months (risk ratio (RR) 0.86, 95% CI 0.71 to 1.05, P = 0.13, 1 study, n = 304; moderate quality evidence), or in the risk of death (RR 0.84, 95% CI 0.52 to 1.34, P = 0.46, 1 study, n = 304; moderate quality evidence). People with AD receiving vitamin E showed less functional decline on the Alzheimer's Disease Cooperative Study/Activities of Daily Living Inventory than people receiving placebo at six to 48 months (mean difference (MD) 3.15, 95% CI 0.07 to 6.23, P = 0.04, 1 study, n = 280; moderate quality evidence). There was no evidence of any clinically important effect on neuropsychiatric symptoms measured with the Neuropsychiatric Inventory (MD -1.47, 95% CI -4.26 to 1.32, P = 0.30, 1 study, n = 280; moderate quality evidence).We found no evidence that vitamin E affected the probability of progression from MCI to probable dementia due to AD over 36 months (RR 1.03, 95% CI 0.79 to 1.35, P = 0.81, 1 study, n = 516; moderate quality evidence). Five deaths occurred in each of the vitamin E and placebo groups over the 36 months (RR 1.01, 95% CI 0.30 to 3.44, P = 0.99, 1 study, n = 516; moderate quality evidence). We were unable to extract data in accordance with the review protocol for other outcomes. However, the study authors found no evidence that vitamin E differed from placebo in its effect on cognitive function, global severity or activities of daily living . There was also no evidence of a difference between groups in the more commonly reported adverse events. AUTHORS' CONCLUSIONS We found no evidence that the alpha-tocopherol form of vitamin E given to people with MCI prevents progression to dementia, or that it improves cognitive function in people with MCI or dementia due to AD. However, there is moderate quality evidence from a single study that it may slow functional decline in AD. Vitamin E was not associated with an increased risk of serious adverse events or mortality in the trials in this review. These conclusions have changed since the previous update, however they are still based on small numbers of trials and participants and further research is quite likely to affect the results.
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Affiliation(s)
- Nicolas Farina
- Brighton and Sussex Medical SchoolCentre for Dementia StudiesBrightonUKBN1 9QH
| | - David Llewellyn
- University of ExeterMedical SchoolExeterUK+44 (0) 1392 726018
| | | | - Naji Tabet
- Brighton and Sussex Medical SchoolCentre for Dementia StudiesBrightonUKBN1 9QH
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Abstract
BACKGROUND Vitamin E occurs naturally in the diet. It has several biological activities, including functioning as an antioxidant to scavenge toxic free radicals. Evidence that free radicals may contribute to the pathological processes behind cognitive impairment has led to interest in the use of vitamin E supplements to treat mild cognitive impairment (MCI) and Alzheimer's disease (AD). This is an update of a Cochrane Review first published in 2000, and previously updated in 2006 and 2012. OBJECTIVES To assess the efficacy of vitamin E in the treatment of MCI and dementia due to AD. SEARCH METHODS We searched the Specialized Register of the Cochrane Dementia and Cognitive Improvement Group (ALOIS), the Cochrane Library, MEDLINE, Embase, PsycINFO, CINAHL, LILACS as well as many trials databases and grey literature sources on 22 April 2016 using the terms: "Vitamin E", vitamin-E, alpha-tocopherol. SELECTION CRITERIA We included all double-blind, randomised trials in which treatment with any dose of vitamin E was compared with placebo in people with AD or MCI. DATA COLLECTION AND ANALYSIS We used standard methodological procedures according to the Cochrane Handbook for Systematic Reviews of Interventions. We rated the quality of the evidence using the GRADE approach. Where appropriate we attempted to contact authors to obtain missing information. MAIN RESULTS Four trials met the inclusion criteria, but we could only extract outcome data in accordance with our protocol from two trials, one in an AD population (n = 304) and one in an MCI population (n = 516). Both trials had an overall low to unclear risk of bias. It was not possible to pool data across studies owing to a lack of comparable outcome measures.In people with AD, we found no evidence of any clinically important effect of vitamin E on cognition, measured with change from baseline in the Alzheimer's Disease Assessment Scale - Cognitive subscale (ADAS-Cog) over six to 48 months (mean difference (MD) -1.81, 95% confidence interval (CI) -3.75 to 0.13, P = 0.07, 1 study, n = 272; moderate quality evidence). There was no evidence of a difference between vitamin E and placebo groups in the risk of experiencing at least one serious adverse event over six to 48 months (risk ratio (RR) 0.86, 95% CI 0.71 to 1.05, P = 0.13, 1 study, n = 304; moderate quality evidence), or in the risk of death (RR 0.84, 95% CI 0.52 to 1.34, P = 0.46, 1 study, n = 304; moderate quality evidence). People with AD receiving vitamin E showed less functional decline on the Alzheimer's Disease Cooperative Study/Activities of Daily Living Inventory than people receiving placebo at six to 48 months (mean difference (MD) 3.15, 95% CI 0.07 to 6.23, P = 0.04, 1 study, n = 280; moderate quality evidence). There was no evidence of any clinically important effect on neuropsychiatric symptoms measured with the Neuropsychiatric Inventory (MD -1.47, 95% CI -4.26 to 1.32, P = 0.30, 1 study, n = 280; moderate quality evidence).We found no evidence that vitamin E affected the probability of progression from MCI to probable dementia due to AD over 36 months (RR 1.03, 95% CI 0.79 to 1.35, P = 0.81, 1 study, n = 516; moderate quality evidence). Five deaths occurred in each of the vitamin E and placebo groups over the 36 months (RR 1.01, 95% CI 0.30 to 3.44, P = 0.99, 1 study, n = 516; moderate quality evidence). We were unable to extract data in accordance with the review protocol for other outcomes. However, the study authors found no evidence that vitamin E differed from placebo in its effect on cognitive function, global severity or activities of daily living . There was also no evidence of a difference between groups in the more commonly reported adverse events. AUTHORS' CONCLUSIONS We found no evidence that the alpha-tocopherol form of vitamin E given to people with MCI prevents progression to dementia, or that it improves cognitive function in people with MCI or dementia due to AD. However, there is moderate quality evidence from a single study that it may slow functional decline in AD. Vitamin E was not associated with an increased risk of serious adverse events or mortality in the trials in this review. These conclusions have changed since the previous update, however they are still based on small numbers of trials and participants and further research is quite likely to affect the results.
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Affiliation(s)
- Nicolas Farina
- Brighton and Sussex Medical SchoolCentre for Dementia StudiesBrightonUKBN1 9QH
| | - David Llewellyn
- University of ExeterMedical SchoolExeterUK+44 (0) 1392 726018
| | | | - Naji Tabet
- Brighton and Sussex Medical SchoolCentre for Dementia StudiesBrightonUKBN1 9QH
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Barekatain M, Alavirad M, Tavakoli M, Emsaki G, Maracy MR. Cognitive rehabilitation in patients with nonamnestic mild cognitive impairment. JOURNAL OF RESEARCH IN MEDICAL SCIENCES 2016; 21:101. [PMID: 28250778 PMCID: PMC5322687 DOI: 10.4103/1735-1995.193173] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 05/12/2016] [Revised: 06/22/2016] [Accepted: 07/18/2016] [Indexed: 11/15/2022]
Abstract
Background: The nonamnesic type of mild cognitive impairment (na-MCI) is predementia state with subtle decline incognitive domains except memory. Although cognitive rehabilitation (CR) has been investigated in amnesic type of MCI, we could not find any trial that rehabilitated na-MCI exclusively. We studied the effectiveness of CR on na-MCI. Materials and Methods: This study was a blinded, randomized clinical trial. Individuals with age of 60 years or more, complete self-directedness and diagnosis of na-MCI, based on Neuropsychiatry Unit Cognitive assessment tool, were selected. The 51 patients were randomly assigned into three groups: CR, lifestyle (LS) modification, and the control group (CG). Neuropsychological tests for executive functioning were assessed at the baseline, after the interventions, and 6 months later. Results: The mean score of the “design fluency” test increased significantly in CR, compared to LS and CG (P = 0.007). In “five-point” test, mean score increased significantly in CR (P = 0.03). There was higher mean score of Behavioral Rating Inventory of Executive Function for adults in CR (P = 0.01). Conclusion: Consideration of the MCI subtypes allows us to target specific cognitive domains, such as information processing, for better CR outcome. CR may result in better performance of executive functioning of daily living.
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Affiliation(s)
- Majid Barekatain
- Department of Psychiatry, Behavioral Sciences Research Center, School of Medicine, Isfahan University of Medical Sciences, Isfahan, Iran
| | - Maryam Alavirad
- Department of Psychiatry, Isfahan University of Medical Sciences, Isfahan, Iran
| | - Mahgol Tavakoli
- Department of Psychology, School of Educational Sciences and Psychology, University of Isfahan, Isfahan, Iran
| | - Golita Emsaki
- Department of Psychology, School of Educational Sciences and Psychology, University of Isfahan, Isfahan, Iran
| | - Mohammad Reza Maracy
- Department of Epidemiology and Biostatistics, School of Public Health, Isfahan University of Medical Sciences, Isfahan, Iran
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Rautiainen S, Manson JE, Lichtenstein AH, Sesso HD. Dietary supplements and disease prevention - a global overview. Nat Rev Endocrinol 2016; 12:407-20. [PMID: 27150288 DOI: 10.1038/nrendo.2016.54] [Citation(s) in RCA: 125] [Impact Index Per Article: 15.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
Dietary supplements are widely used and offer the potential to improve health if appropriately targeted to those in need. Inadequate nutrition and micronutrient deficiencies are prevalent conditions that adversely affect global health. Although improvements in diet quality are essential to address these issues, dietary supplements and/or food fortification could help meet requirements for individuals at risk of deficiencies. For example, supplementation with vitamin A and iron in developing countries, where women of reproductive age, infants and children often have deficiencies; with folic acid among women of reproductive age and during pregnancy; with vitamin D among infants and children; and with calcium and vitamin D to ensure bone health among adults aged ≥65 years. Intense debate surrounds the benefits of individual high-dose micronutrient supplementation among well-nourished individuals because the alleged beneficial effects on chronic diseases are not consistently supported. Daily low-dose multivitamin supplementation has been linked to reductions in the incidence of cancer and cataracts, especially among men. Baseline nutrition is an important consideration in supplementation that is likely to modify its effects. Here, we provide a detailed summary of dietary supplements and health outcomes in both developing and developed countries to help guide decisions about dietary supplement recommendations.
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Affiliation(s)
- Susanne Rautiainen
- Division of Preventive Medicine, Department of Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts 02215, USA
- Institute of Environmental Medicine, Karolinska Institutet, 171 77 Stockholm, Sweden
| | - JoAnn E Manson
- Division of Preventive Medicine, Department of Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts 02215, USA
- Department of Epidemiology, Harvard T.H. Chan School of Public Health, Boston, Massachusetts 02215, USA
| | - Alice H Lichtenstein
- Jean Mayer USDA Human Nutrition Research Center on Aging, Tufts University, Boston, Massachusetts 02111, USA
| | - Howard D Sesso
- Division of Preventive Medicine, Department of Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts 02215, USA
- Department of Epidemiology, Harvard T.H. Chan School of Public Health, Boston, Massachusetts 02215, USA
- Division of Aging, Department of Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts 02215, USA
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Malekahmadi M, Naeini AA, Shab-Bidar S, Feizi A, Djazayery A. Development, validity, and reliability of a food frequency questionnaire for antioxidants in elderly Iranian people. JOURNAL OF RESEARCH IN MEDICAL SCIENCES : THE OFFICIAL JOURNAL OF ISFAHAN UNIVERSITY OF MEDICAL SCIENCES 2016; 21:14. [PMID: 27904560 PMCID: PMC5122246 DOI: 10.4103/1735-1995.178753] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 09/30/2015] [Revised: 11/02/2015] [Accepted: 01/20/2016] [Indexed: 11/04/2022]
Abstract
BACKGROUND The food frequency questionnaire (FFQ), as a way to assess the dietary intake in comparison with other methods, is easier to analyze and takes less time and is less costly. Our aim in this study was to develop and validate an FFQ for estimating the intakes of selected antioxidants in elderly Iranian people. MATERIALS AND METHODS A total of 185 elderly people were randomly selected. Three-day food records were completed by the subjects and collected every 2 months and dietary intake levels of zinc, selenium, carotenes and vitamins C and E were estimated. Based on the food records data, geographic location, and age, an FFQ was designed to estimate antioxidant intakes during 1 year. In addition, for controlling energy intake, 2-day food records were also collected with the food frequency questionnaire. To assess the reliability, 40 individuals were asked to complete the FFQ twice with an interval of 3 months in between. RESULTS Intraclass correlation coefficient (ICC) between the two FFQs for antioxidant C, antioxidant E, carotene, selenium, and zinc were 0.62, 0.47, 0.51, 0.54, and 0.58, respectively (P < 0.05). In addition, Pearson correlation coefficients between the FFQ and the food records, after controlling energy for vitamin C, vitamin E, carotene, selenium, and zinc, were 0.46, 0.48, 0.38, 0.55, and 0.47 respectively (P < 0.001). CONCLUSION According to the results of this study, considering the fact that the FFQ was designed for the elderly and the special conditions (patience, memory, etc.) and vulnerability of this age group, the questionnaire is relatively valid and reliable to use.
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Affiliation(s)
- Mahsa Malekahmadi
- Department of Community Nutrition, Tehran University of Medical Sciences, Tehran, Iran
| | | | - Sakineh Shab-Bidar
- Department of Community Nutrition, Tehran University of Medical Sciences, Tehran, Iran
| | - Awat Feizi
- Department of Health Sciences, Isfahan University of Medical Sciences, Isfahan, Iran
| | - Abolghasem Djazayery
- Department of Community Nutrition, Tehran University of Medical Sciences, Tehran, Iran
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Nutrients, Microglia Aging, and Brain Aging. OXIDATIVE MEDICINE AND CELLULAR LONGEVITY 2016; 2016:7498528. [PMID: 26941889 PMCID: PMC4752989 DOI: 10.1155/2016/7498528] [Citation(s) in RCA: 28] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 09/25/2015] [Revised: 12/21/2015] [Accepted: 12/31/2015] [Indexed: 02/04/2023]
Abstract
As the life expectancy continues to increase, the cognitive decline associated with Alzheimer's disease (AD) becomes a big major issue in the world. After cellular activation upon systemic inflammation, microglia, the resident immune cells in the brain, start to release proinflammatory mediators to trigger neuroinflammation. We have found that chronic systemic inflammatory challenges induce differential age-dependent microglial responses, which are in line with the impairment of learning and memory, even in middle-aged animals. We thus raise the concept of “microglia aging.” This concept is based on the fact that microglia are the key contributor to the acceleration of cognitive decline, which is the major sign of brain aging. On the other hand, inflammation induces oxidative stress and DNA damage, which leads to the overproduction of reactive oxygen species by the numerous types of cells, including macrophages and microglia. Oxidative stress-damaged cells successively produce larger amounts of inflammatory mediators to promote microglia aging. Nutrients are necessary for maintaining general health, including the health of brain. The intake of antioxidant nutrients reduces both systemic inflammation and neuroinflammation and thus reduces cognitive decline during aging. We herein review our microglia aging concept and discuss systemic inflammation and microglia aging. We propose that a nutritional approach to controlling microglia aging will open a new window for healthy brain aging.
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Pottie K, Rahal R, Jaramillo A, Birtwhistle R, Thombs BD, Singh H, Gorber SC, Dunfield L, Shane A, Bacchus M, Bell N, Tonelli M. Recommendations on screening for cognitive impairment in older adults. CMAJ 2015; 188:37-46. [PMID: 26622001 DOI: 10.1503/cmaj.141165] [Citation(s) in RCA: 61] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022] Open
Affiliation(s)
| | - Kevin Pottie
- Departments of Family Medicine, and of Epidemiology and Community Medicine, University of Ottawa, and Bruyère Research Institute (Pottie), Ottawa, Ont.; Public Health Agency of Canada (Rahal, Jaramillo, Connor Gorber, Dunfield, Shane), Ottawa, Ont.; Departments of Family Medicine and of Community Health and Epidemiology, and Centre for Studies in Primary Care (Birtwhistle), Queen's University, Kingston, Ont.; Department of Medicine, Lady Davis Institute, Jewish General Hospital and Faculty of Medicine, McGill University (Thombs), Montréal, Que.; Department of Internal Medicine and Community Health Sciences (Singh), University of Manitoba, Winnipeg, Man.; Department of Family Medicine (Bell), University of Alberta, Edmonton, Alta.; Department of Medicine (Bacchus, Tonelli), University of Calgary, Calgary, Alta
| | - Rana Rahal
- Departments of Family Medicine, and of Epidemiology and Community Medicine, University of Ottawa, and Bruyère Research Institute (Pottie), Ottawa, Ont.; Public Health Agency of Canada (Rahal, Jaramillo, Connor Gorber, Dunfield, Shane), Ottawa, Ont.; Departments of Family Medicine and of Community Health and Epidemiology, and Centre for Studies in Primary Care (Birtwhistle), Queen's University, Kingston, Ont.; Department of Medicine, Lady Davis Institute, Jewish General Hospital and Faculty of Medicine, McGill University (Thombs), Montréal, Que.; Department of Internal Medicine and Community Health Sciences (Singh), University of Manitoba, Winnipeg, Man.; Department of Family Medicine (Bell), University of Alberta, Edmonton, Alta.; Department of Medicine (Bacchus, Tonelli), University of Calgary, Calgary, Alta
| | - Alejandra Jaramillo
- Departments of Family Medicine, and of Epidemiology and Community Medicine, University of Ottawa, and Bruyère Research Institute (Pottie), Ottawa, Ont.; Public Health Agency of Canada (Rahal, Jaramillo, Connor Gorber, Dunfield, Shane), Ottawa, Ont.; Departments of Family Medicine and of Community Health and Epidemiology, and Centre for Studies in Primary Care (Birtwhistle), Queen's University, Kingston, Ont.; Department of Medicine, Lady Davis Institute, Jewish General Hospital and Faculty of Medicine, McGill University (Thombs), Montréal, Que.; Department of Internal Medicine and Community Health Sciences (Singh), University of Manitoba, Winnipeg, Man.; Department of Family Medicine (Bell), University of Alberta, Edmonton, Alta.; Department of Medicine (Bacchus, Tonelli), University of Calgary, Calgary, Alta
| | - Richard Birtwhistle
- Departments of Family Medicine, and of Epidemiology and Community Medicine, University of Ottawa, and Bruyère Research Institute (Pottie), Ottawa, Ont.; Public Health Agency of Canada (Rahal, Jaramillo, Connor Gorber, Dunfield, Shane), Ottawa, Ont.; Departments of Family Medicine and of Community Health and Epidemiology, and Centre for Studies in Primary Care (Birtwhistle), Queen's University, Kingston, Ont.; Department of Medicine, Lady Davis Institute, Jewish General Hospital and Faculty of Medicine, McGill University (Thombs), Montréal, Que.; Department of Internal Medicine and Community Health Sciences (Singh), University of Manitoba, Winnipeg, Man.; Department of Family Medicine (Bell), University of Alberta, Edmonton, Alta.; Department of Medicine (Bacchus, Tonelli), University of Calgary, Calgary, Alta
| | - Brett D Thombs
- Departments of Family Medicine, and of Epidemiology and Community Medicine, University of Ottawa, and Bruyère Research Institute (Pottie), Ottawa, Ont.; Public Health Agency of Canada (Rahal, Jaramillo, Connor Gorber, Dunfield, Shane), Ottawa, Ont.; Departments of Family Medicine and of Community Health and Epidemiology, and Centre for Studies in Primary Care (Birtwhistle), Queen's University, Kingston, Ont.; Department of Medicine, Lady Davis Institute, Jewish General Hospital and Faculty of Medicine, McGill University (Thombs), Montréal, Que.; Department of Internal Medicine and Community Health Sciences (Singh), University of Manitoba, Winnipeg, Man.; Department of Family Medicine (Bell), University of Alberta, Edmonton, Alta.; Department of Medicine (Bacchus, Tonelli), University of Calgary, Calgary, Alta
| | - Harminder Singh
- Departments of Family Medicine, and of Epidemiology and Community Medicine, University of Ottawa, and Bruyère Research Institute (Pottie), Ottawa, Ont.; Public Health Agency of Canada (Rahal, Jaramillo, Connor Gorber, Dunfield, Shane), Ottawa, Ont.; Departments of Family Medicine and of Community Health and Epidemiology, and Centre for Studies in Primary Care (Birtwhistle), Queen's University, Kingston, Ont.; Department of Medicine, Lady Davis Institute, Jewish General Hospital and Faculty of Medicine, McGill University (Thombs), Montréal, Que.; Department of Internal Medicine and Community Health Sciences (Singh), University of Manitoba, Winnipeg, Man.; Department of Family Medicine (Bell), University of Alberta, Edmonton, Alta.; Department of Medicine (Bacchus, Tonelli), University of Calgary, Calgary, Alta
| | - Sarah Connor Gorber
- Departments of Family Medicine, and of Epidemiology and Community Medicine, University of Ottawa, and Bruyère Research Institute (Pottie), Ottawa, Ont.; Public Health Agency of Canada (Rahal, Jaramillo, Connor Gorber, Dunfield, Shane), Ottawa, Ont.; Departments of Family Medicine and of Community Health and Epidemiology, and Centre for Studies in Primary Care (Birtwhistle), Queen's University, Kingston, Ont.; Department of Medicine, Lady Davis Institute, Jewish General Hospital and Faculty of Medicine, McGill University (Thombs), Montréal, Que.; Department of Internal Medicine and Community Health Sciences (Singh), University of Manitoba, Winnipeg, Man.; Department of Family Medicine (Bell), University of Alberta, Edmonton, Alta.; Department of Medicine (Bacchus, Tonelli), University of Calgary, Calgary, Alta
| | - Lesley Dunfield
- Departments of Family Medicine, and of Epidemiology and Community Medicine, University of Ottawa, and Bruyère Research Institute (Pottie), Ottawa, Ont.; Public Health Agency of Canada (Rahal, Jaramillo, Connor Gorber, Dunfield, Shane), Ottawa, Ont.; Departments of Family Medicine and of Community Health and Epidemiology, and Centre for Studies in Primary Care (Birtwhistle), Queen's University, Kingston, Ont.; Department of Medicine, Lady Davis Institute, Jewish General Hospital and Faculty of Medicine, McGill University (Thombs), Montréal, Que.; Department of Internal Medicine and Community Health Sciences (Singh), University of Manitoba, Winnipeg, Man.; Department of Family Medicine (Bell), University of Alberta, Edmonton, Alta.; Department of Medicine (Bacchus, Tonelli), University of Calgary, Calgary, Alta
| | - Amanda Shane
- Departments of Family Medicine, and of Epidemiology and Community Medicine, University of Ottawa, and Bruyère Research Institute (Pottie), Ottawa, Ont.; Public Health Agency of Canada (Rahal, Jaramillo, Connor Gorber, Dunfield, Shane), Ottawa, Ont.; Departments of Family Medicine and of Community Health and Epidemiology, and Centre for Studies in Primary Care (Birtwhistle), Queen's University, Kingston, Ont.; Department of Medicine, Lady Davis Institute, Jewish General Hospital and Faculty of Medicine, McGill University (Thombs), Montréal, Que.; Department of Internal Medicine and Community Health Sciences (Singh), University of Manitoba, Winnipeg, Man.; Department of Family Medicine (Bell), University of Alberta, Edmonton, Alta.; Department of Medicine (Bacchus, Tonelli), University of Calgary, Calgary, Alta
| | - Maria Bacchus
- Departments of Family Medicine, and of Epidemiology and Community Medicine, University of Ottawa, and Bruyère Research Institute (Pottie), Ottawa, Ont.; Public Health Agency of Canada (Rahal, Jaramillo, Connor Gorber, Dunfield, Shane), Ottawa, Ont.; Departments of Family Medicine and of Community Health and Epidemiology, and Centre for Studies in Primary Care (Birtwhistle), Queen's University, Kingston, Ont.; Department of Medicine, Lady Davis Institute, Jewish General Hospital and Faculty of Medicine, McGill University (Thombs), Montréal, Que.; Department of Internal Medicine and Community Health Sciences (Singh), University of Manitoba, Winnipeg, Man.; Department of Family Medicine (Bell), University of Alberta, Edmonton, Alta.; Department of Medicine (Bacchus, Tonelli), University of Calgary, Calgary, Alta
| | - Niel Bell
- Departments of Family Medicine, and of Epidemiology and Community Medicine, University of Ottawa, and Bruyère Research Institute (Pottie), Ottawa, Ont.; Public Health Agency of Canada (Rahal, Jaramillo, Connor Gorber, Dunfield, Shane), Ottawa, Ont.; Departments of Family Medicine and of Community Health and Epidemiology, and Centre for Studies in Primary Care (Birtwhistle), Queen's University, Kingston, Ont.; Department of Medicine, Lady Davis Institute, Jewish General Hospital and Faculty of Medicine, McGill University (Thombs), Montréal, Que.; Department of Internal Medicine and Community Health Sciences (Singh), University of Manitoba, Winnipeg, Man.; Department of Family Medicine (Bell), University of Alberta, Edmonton, Alta.; Department of Medicine (Bacchus, Tonelli), University of Calgary, Calgary, Alta
| | - Marcello Tonelli
- Departments of Family Medicine, and of Epidemiology and Community Medicine, University of Ottawa, and Bruyère Research Institute (Pottie), Ottawa, Ont.; Public Health Agency of Canada (Rahal, Jaramillo, Connor Gorber, Dunfield, Shane), Ottawa, Ont.; Departments of Family Medicine and of Community Health and Epidemiology, and Centre for Studies in Primary Care (Birtwhistle), Queen's University, Kingston, Ont.; Department of Medicine, Lady Davis Institute, Jewish General Hospital and Faculty of Medicine, McGill University (Thombs), Montréal, Que.; Department of Internal Medicine and Community Health Sciences (Singh), University of Manitoba, Winnipeg, Man.; Department of Family Medicine (Bell), University of Alberta, Edmonton, Alta.; Department of Medicine (Bacchus, Tonelli), University of Calgary, Calgary, Alta
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Fitzpatrick-Lewis D, Warren R, Ali MU, Sherifali D, Raina P. Treatment for mild cognitive impairment: a systematic review and meta-analysis. CMAJ Open 2015; 3:E419-27. [PMID: 26770964 PMCID: PMC4701654 DOI: 10.9778/cmajo.20150057] [Citation(s) in RCA: 46] [Impact Index Per Article: 5.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
BACKGROUND The effectiveness of treatments for mild cognitive impairment is uncertain. The aim of this review was to evaluate the effectiveness and harms of treatment for mild cognitive impairment in adults 65 years of age and older. METHODS We searched MEDLINE, Embase and Cochrane Central (December 2012-December 2014); citations from 2 systematic reviews were considered for inclusion. We included randomized controlled trials involving community-dwelling adults aged 65 years and older with a diagnosis of mild cognitive impairment. Studies reporting on cognition, function, behaviour, global status, mortality and adverse events for treatment with pharmacologic and nonpharmacologic interventions were included. RESULTS Seventeen studies were included. Cholinesterase inhibitor studies evaluating cognition (Alzheimer's Disease Assessment Scale, cognition subscale) showed no difference between intervention and control groups (mean difference [MD] -0.33, 95% CI -0.73 to 0.06]; one behavioural study showed no significant effect on cognition (Alzheimer's Disease Assessment Scale, cognition subscale) for the intervention group when compared to controls (MD -0.60, (95% CI -1.44 to 0.24), and one study on vitamin E showed no difference between intervention and control groups (MD 0.85, 95% CI -0.32 to 2.02). With the Mini-Mental State Examination, cholinesterase inhibitors showed no difference between intervention and control groups (MD 0.17, 95% CI -0.13 to 0.47); behavioural studies showed a significant difference favouring intervention (MD 1.01, 95% CI 0.25 to 1.77), and studies of dietary supplements and/or vitamins showed no difference between intervention and control groups (MD 0.20, 95% CI -0.04 to 0.43). Pharmacologic studies showed no difference in serious adverse events (risk ratio 0.98, 95% CI 0.86 to 1.10). No serious adverse events were reported for nonpharmacologic interventions. INTERPRETATION Treatment of mild cognitive impairment with cholinesterase inhibitors showed no benefit when compared with a control group. A small cognitive benefit was observed using behavioural therapies when compared with the control group. However, the clinical significance of this small benefit remains uncertain. The current evidence does not support the use of cholinesterase inhibitors for treating mild cognitive impairment, and future high-quality research using a standardized approach is needed to affirm the finding of a small benefit on cognition that was observed for behavioural interventions. REGISTRATION PROSPERO no. CRD42014015431.
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Popper CW. Single-micronutrient and broad-spectrum micronutrient approaches for treating mood disorders in youth and adults. Child Adolesc Psychiatr Clin N Am 2014; 23:591-672. [PMID: 24975626 DOI: 10.1016/j.chc.2014.04.001] [Citation(s) in RCA: 30] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
Several different vitamins and minerals appear to be effective augmenting agents for mood-modifying drugs, but are not potent monotherapies in themselves for treating psychiatric disorders. In contrast, broad-spectrum micronutrient interventions appear in early trials to be as effective as psychiatric medications with fewer adverse effects for treating mood disorders, ADHD, aggressivity, and misconduct in youth and adults. Broad-spectrum treatments also may improve stress responses, cognition, and sense of well-being in healthy adults, but have been less well studied in youth. Current clinical data justify an extensive expansion of research on micronutrient mechanisms and treatments in psychiatry.
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Affiliation(s)
- Charles W Popper
- Child and Adolescent Psychiatry, McLean Hospital, Belmont, MA, USA; Harvard Medical School, Boston, MA, USA.
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