Skip to main content
Log in

The impact of protein supplementation on cognitive performance in frail elderly

  • Original Contribution
  • Published:
European Journal of Nutrition Aims and scope Submit manuscript

Abstract

Purpose

Maintenance of cognitive abilities is important for elderly to stay independent. With the aging of the population, the call for modifiable factors is emerging. Dietary protein might improve cognitive performance; however, this has hardly been studied. Therefore, we studied the impact of 24-week dietary protein supplementation on cognitive performance in pre-frail and frail elderly people.

Methods

Pre-frail and frail elderly subjects, according to the Fried criteria, randomly received a protein drink containing 15 g protein or a placebo drink twice a day. Cognitive performance was measured at baseline and after 24 weeks by means of a sensitive neuropsychological test battery. In addition, reaction time was assessed after both 12 and 24 weeks of intervention. Domain scores were calculated for the domains episodic memory, attention and working memory, information processing speed, and executive functioning. Analyses of covariance were used to determine differences between groups. Linear mixed models were used to determine differences in reaction time over time and per treatment.

Results

In total, 65 subjects (79 ± 8 years) with a median Mini-Mental State Examination score of 28 (interquartile range 26–30) were included. Reaction time improved more in the protein group (68 ms) than in the placebo group (18 ms, P = 0.03). Dietary protein had no significant effect on any of the cognitive domain scores.

Conclusions

Protein supplementation might improve reaction time performance in pre-frail and frail elderly, but did not improve other cognitive functions.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Similar content being viewed by others

References

  1. World Health Organization and Alzheimer’s Disease International (2012) Dementia, a public health priority

  2. McSweeny AJ, Grant I, Heaton RK, Prigatano GP, Adams KM (1985) Relationship of neuropsychological status to everyday functioning in healthy and chronically ill persons. J Clin Exp Neuropsychol 7(3):281–291. doi:10.1080/01688638508401260

    Article  CAS  Google Scholar 

  3. Tucker DM, Penland JG, Sandstead HH, Milne DB, Heck DG, Klevay LM (1990) Nutrition status and brain function in aging. Am J Clin Nutr 52(1):93–102

    CAS  Google Scholar 

  4. Sofi F, Valecchi D, Bacci D, Abbate R, Gensini GF, Casini A, Macchi C (2011) Physical activity and risk of cognitive decline: a meta-analysis of prospective studies. J Intern Med 269(1):107–117. doi:10.1111/j.1365-2796.2010.02281.x

    Article  CAS  Google Scholar 

  5. Van Dyk K, Sano M (2007) The impact of nutrition on cognition in the elderly. Neurochem Res 32(4–5):893–904. doi:10.1007/s11064-006-9241-5

    Article  CAS  Google Scholar 

  6. Chernoff R (2004) Protein and older adults. J Am Coll Nutr 23(6 Suppl):627S–630S

    Article  CAS  Google Scholar 

  7. Jakobsen LH, Kondrup J, Zellner M, Tetens I, Roth E (2011) Effect of a high protein meat diet on muscle and cognitive functions: a randomised controlled dietary intervention trial in healthy men. Clin Nutr 30(3):303–311. doi:10.1016/j.clnu.2010.12.010

    Article  CAS  Google Scholar 

  8. Rodriguez NR, Garlick PJ (2008) Introduction to protein summit 2007: exploring the impact of high-quality protein on optimal health. Am J Clin Nutr 87(5):1551S–1553S

    CAS  Google Scholar 

  9. Castaneda C, Charnley JM, Evans WJ, Crim MC (1995) Elderly women accommodate to a low-protein diet with losses of body cell mass, muscle function, and immune response. Am J Clin Nutr 62(1):30–39

    CAS  Google Scholar 

  10. Beasley JM, LaCroix AZ, Neuhouser ML, Huang Y, Tinker L, Woods N, Michael Y, Curb JD, Prentice RL (2010) Protein intake and incident frailty in the women’s health initiative observational study. J Am Geriatr Soc 58(6):1063–1071. doi:10.1111/j.1532-5415.2010.02866.x

    Article  Google Scholar 

  11. Goodwin JS, Goodwin JM, Garry PJ (1983) Association between nutritional status and cognitive functioning in a healthy elderly population. JAMA, J Am Med Assoc 249(21):2917–2921

    Article  CAS  Google Scholar 

  12. La Rue A, Koehler KM, Wayne SJ, Chiulli SJ, Haaland KY, Garry PJ (1997) Nutritional status and cognitive functioning in a normally aging sample: a 6-y reassessment. Am J Clin Nutr 65(1):20–29

    Google Scholar 

  13. Roberts RO, Roberts LA, Geda YE, Cha RH, Pankratz VS, O’Connor HM, Knopman DS, Petersen RC (2012) Relative intake of macronutrients impacts risk of mild cognitive impairment or dementia. JAD 32(2):329–339. doi:10.3233/JAD-2012-120862

    CAS  Google Scholar 

  14. Fischer K, Colombani PC, Langhans W, Wenk C (2002) Carbohydrate to protein ratio in food and cognitive performance in the morning. Physiol Behav 75(3):411–423

    Article  CAS  Google Scholar 

  15. Kaplan RJ, Greenwood CE, Winocur G, Wolever TM (2001) Dietary protein, carbohydrate, and fat enhance memory performance in the healthy elderly. Am J Clin Nutr 74(5):687–693

    CAS  Google Scholar 

  16. Walker TB, Smith J, Herrera M, Lebegue B, Pinchak A, Fischer J (2010) The influence of 8 weeks of whey-protein and leucine supplementation on physical and cognitive performance. Int J Sport Nutr Exerc Metab 20(5):409–417

    CAS  Google Scholar 

  17. Banderet LE, Lieberman HR (1989) Treatment with tyrosine, a neurotransmitter precursor, reduces environmental stress in humans. Brain Res Bull 22(4):759–762

    Article  CAS  Google Scholar 

  18. Fernstrom JD, Fernstrom MH (2007) Tyrosine, phenylalanine, and catecholamine synthesis and function in the brain. J Nutr 137 (6 Suppl 1):1539S–1547S; discussion 1548S

    Google Scholar 

  19. Lieberman HR, Corkin S, Spring BJ, Wurtman RJ, Growdon JH (1985) The effects of dietary neurotransmitter precursors on human behavior. Am J Clin Nutr 42(2):366–370

    CAS  Google Scholar 

  20. Lieberman HR, Spring BJ, Garfield GS (1986) The behavioral effects of food constituents: strategies used in studies of amino acids, protein, carbohydrate and caffeine. Nutr Rev 44(Suppl):61–70

    Google Scholar 

  21. Scarna A, McTavish SF, Cowen PJ, Goodwin GM, Rogers RD (2005) The effects of a branched chain amino acid mixture supplemented with tryptophan on biochemical indices of neurotransmitter function and decision-making. Psychopharmacology 179(4):761–768. doi:10.1007/s00213-004-2105-2

    Article  CAS  Google Scholar 

  22. Booij L, Merens W, Markus CR, Van der Does AJ (2006) Diet rich in alpha-lactalbumin improves memory in unmedicated recovered depressed patients and matched controls. J psychopharmacol 20(4):526–535. doi:10.1177/0269881105057466

    Article  CAS  Google Scholar 

  23. Markus CR, Olivier B, de Haan EH (2002) Whey protein rich in alpha-lactalbumin increases the ratio of plasma tryptophan to the sum of the other large neutral amino acids and improves cognitive performance in stress-vulnerable subjects. Am J C Nutr 75(6):1051–1056

    CAS  Google Scholar 

  24. McEntee WJ, Crook TH (1991) Serotonin, memory, and the aging brain. Psychopharmacology 103(2):143–149

    Article  CAS  Google Scholar 

  25. Colcombe S, Kramer AF (2003) Fitness effects on the cognitive function of older adults: a meta-analytic study. Psychol Sci 14(2):125–130

    Article  Google Scholar 

  26. Buchman AS, Boyle PA, Wilson RS, Tang Y, Bennett DA (2007) Frailty is associated with incident Alzheimer’s disease and cognitive decline in the elderly. Psychosom Med 69(5):483–489. doi:10.1097/psy.0b013e318068de1d

    Article  Google Scholar 

  27. Auyeung TW, Lee JS, Kwok T, Woo J (2011) Physical frailty predicts future cognitive decline: a four-year prospective study in 2737 cognitively normal older adults. J Nutr Health Aging 15(8):690–694

    Article  CAS  Google Scholar 

  28. Gillette Guyonnet S, Abellan Van Kan G, Andrieu S, Aquino JP, Arbus C, Becq JP, Berr C, Bismuth S, Chamontin B, Dantoine T, Dartigues JF, Dubois B, Fraysse B, Hergueta T, Hanaire H, Jeandel C, Lagleyre S, Lala F, Nourhashemi F, Ousset PJ, Portet F, Ritz P, Robert P, Rolland Y, Sanz C, Soto M, Touchon J, Vellas B (2008) Prevention of progression to dementia in the elderly: rationale and proposal for a health-promoting memory consultation (an IANA Task Force). J Nutr Health Aging 12(8):520–529

    Article  CAS  Google Scholar 

  29. Abellan van Kan G, Rolland Y, Bergman H, Morley JE, Kritchevsky SB, Vellas B (2008) The I.A.N.A Task Force on frailty assessment of older people in clinical practice. J Nutr Health Aging 12 (1):29–37

  30. Evans WJ, Paolisso G, Abbatecola AM, Corsonello A, Bustacchini S, Strollo F, Lattanzio F (2010) Frailty and muscle metabolism dysregulation in the elderly. Biogerontology 11(5):527–536. doi:10.1007/s10522-010-9297-0

    Article  CAS  Google Scholar 

  31. Tieland M, van de Rest O, Dirks ML, van der Zwaluw N, Mensink M, van Loon LJ, de Groot LC (2012) Protein supplementation improves physical performance in frail elderly people: a randomized, double-blind, placebo-controlled trial. J Am Med Dir Assoc 13(8):720–726. doi:10.1016/j.jamda.2012.07.005

    Article  Google Scholar 

  32. Fried LP, Tangen CM, Walston J, Newman AB, Hirsch C, Gottdiener J, Seeman T, Tracy R, Kop WJ, Burke G, McBurnie MA, Cardiovascular Health Study Collaborative Research G (2001) Frailty in older adults: evidence for a phenotype. The journals of gerontology Series A, Biological sciences and medical sciences 56(3):M146–M156

    Article  CAS  Google Scholar 

  33. Alberti KG, Zimmet PZ (1998) Definition, diagnosis and classification of diabetes mellitus and its complications. Part 1: diagnosis and classification of diabetes mellitus provisional report of a WHO consultation. Diabetic medicine : J Br Diabet Assoc 15 (7):539–553. doi:10.1002/(SICI)1096-9136(199807)15:7<539::AID-DIA668>3.0.CO;2-S

  34. Mandayam S, Mitch WE (2006) Dietary protein restriction benefits patients with chronic kidney disease. Nephrology 11(1):53–57. doi:10.1111/j.1440-1797.2006.00528.x

    Article  CAS  Google Scholar 

  35. Folstein MF, Folstein SE, McHugh PR (1975) “Mini-mental state”. A practical method for grading the cognitive state of patients for the clinician. J Psychiatr Res 12(3):189–198

    Article  CAS  Google Scholar 

  36. Brand N, Jolles J (1985) Learning and retrieval rate of words presented auditorily and visually. J Gen Psychol 112(2):201–210. doi:10.1080/00221309.1985.9711004

    Article  CAS  Google Scholar 

  37. Wechsler D (1981) Manual for the adult intelligence scale-revised. Psychological Corporation, New York

    Google Scholar 

  38. Reitan R (1958) Validity of the Trail Making Test as an indicator of organic brain damage. Percept Mot Skills 8:271–276

    Article  Google Scholar 

  39. Stroop J (1935) Studies of interference in serial verbal reactions. J Exp Psychol 18:643–662

    Article  Google Scholar 

  40. Lezak MD (2004) Neurospychological assessment. Oxford University Press, New York

    Google Scholar 

  41. Adam JJ, Jakob R, Bovend’eerdt TJ, Van Gerven PW (2011) Spared within-hands but impaired between-hands response preparation in aging. J Gerontol B Psychol Sci Soc Sci. doi:10.1093/geronb/gbr105

    Google Scholar 

  42. Miller J (1982) Discrete versus continuous stage models of human information processing: in search of partial output. J Exp Psychol Hum Percept Perform 8(2):273–296

    Article  CAS  Google Scholar 

  43. Voedingsstoffenbestand S (2006) NEVO-tabel: Nederlands Voedingsstoffenbestand

  44. Hausdorff JM, Yogev G, Springer S, Simon ES, Giladi N (2005) Walking is more like catching than tapping: gait in the elderly as a complex cognitive task. Exp Brain Res 164(4):541–548. doi:10.1007/s00221-005-2280-3

    Article  Google Scholar 

  45. Mungas D (1991) In-office mental status testing: a practical guide. Geriatrics 46 (7):54–58, 63, 66

    Google Scholar 

  46. Kallus KW, Schmitt JA, Benton D (2005) Attention, psychomotor functions and age. Eur J Nutr 44(8):465–484. doi:10.1007/s00394-005-0584-5

    Article  Google Scholar 

  47. Vellas B, Andrieu S, Sampaio C, Wilcock G, European Task Force G (2007) Disease-modifying trials in Alzheimer’s disease: a European task force consensus. Lancet neurol 6(1):56–62. doi:10.1016/S1474-4422(06)70677-9

    Article  Google Scholar 

  48. van Iersel MB, Kessels RP, Bloem BR, Verbeek AL, Olde Rikkert MG (2008) Executive functions are associated with gait and balance in community-living elderly people. J Gerontol A Biol Sci Med Sci 63(12):1344–1349

    Article  Google Scholar 

  49. Bourre JM (2006) Effects of nutrients (in food) on the structure and function of the nervous system: update on dietary requirements for brain. Part 2: macronutrients. J Nutr Health Aging 10(5):386–399

    CAS  Google Scholar 

  50. Fernstrom JD (2012) Large neutral amino acids: dietary effects on brain neurochemistry and function. Amino Acids. doi:10.1007/s00726-012-1330-y

    Google Scholar 

  51. Cools R (2006) Dopaminergic modulation of cognitive function-implications for L-DOPA treatment in Parkinson’s disease. Neurosci Biobehav Rev 30(1):1–23. doi:10.1016/j.neubiorev.2005.03.024

    Article  CAS  Google Scholar 

  52. Novak V, Hajjar I (2010) The relationship between blood pressure and cognitive function. Nat Rev Cardiol 7(12):686–698. doi:10.1038/nrcardio.2010.161

    Google Scholar 

  53. Altorf-van der Kuil W, Engberink MF, Vedder MM, Boer JM, Verschuren WM, Geleijnse JM (2012) Sources of dietary protein in relation to blood pressure in a general Dutch population. PLoS ONE 7(2):e30582. doi:10.1371/journal.pone.0030582

    Article  Google Scholar 

  54. Gokce N (2004) l-arginine and hypertension. J Nutr 134 (10 Suppl):2807S–2811S; discussion 2818S–2819S

Download references

Acknowledgments

We gratefully acknowledge all participants in the ProMuscle study. Furthermore, we want to thank all colleagues, with special thanks to Marlou Dirks, and students who worked in this study for their help and input. The authors’ contributions were as follows: study design: OvdR, MT, GJH, LJCvL, and LCPGMdG; data collection: NLvdZ, MT; data analyses and writing article: NLvdZ, OvdR; and expertise of reaction time test: JA. GJH is an employee at the Dutch Dairy Association (NZO), but he had no interference with data collection and data analysis. All authors provided critical revision of the manuscript. This project was financed by Top Institute Food and Nutrition and Dutch Dairy Organization (NZO). None of the authors had any personal or financial conflict of interest.

Conflict of interest

The authors declared no conflict of interest.

Author information

Authors and Affiliations

Authors

Corresponding author

Correspondence to Nikita L. van der Zwaluw.

Additional information

This trial was registered at clinicaltrials.gov as NCT01109628.

Rights and permissions

Reprints and permissions

About this article

Cite this article

van der Zwaluw, N.L., van de Rest, O., Tieland, M. et al. The impact of protein supplementation on cognitive performance in frail elderly. Eur J Nutr 53, 803–812 (2014). https://doi.org/10.1007/s00394-013-0584-9

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s00394-013-0584-9

Keywords

Navigation