Nutritional Intervention as a Preventive Approach for Cognitive-Related Outcomes in Cognitively Healthy Older Adults: A Systematic Review

Issue title: Alzheimer’s Disease: New Beginnings

Guest editors: G. Perry, J. Avila, P.I. Moreira, A.A. Sorensen and M. Tabaton

Article type: Research Article

Authors: Solfrizzi, Vincenzo^{a; 1; *} | Agosti, Pasquale^a | Lozupone, Madia^b | Custodero, Carlo^a | Schilardi, Andrea^a | Valiani, Vincenzo^a | Sardone, Rodolfo^c | Dibello, Vittorio^d | Di Lena, Luca^c | Lamanna, Angela^c | Stallone, Roberta^b | Bellomo, Antonello^e | Greco, Antonio^f | Daniele, Antonio^g | Seripa, Davide^f | Sabbà, Carlo^a | Logroscino, Giancarlo^{b; h} | Panza, Francesco^{b; f; h; 1; *}

Affiliations: [a] Geriatric Medicine-Memory Unit and Rare Disease Centre, University of Bari ‘Aldo Moro’, Bari, Italy | [b] Department of Basic Medicine, Neurodegenerative Disease Unit, Neuroscience, and Sense Organs, University of Bari Aldo Moro, Bari, Italy | [c] National Institute of Gastroenterology “Saverio de Bellis”, Research Hospital, Castellana Grotte Bari, Italy | [d] Department of Interdisciplinary Medicine (DIM), Section of Dentistry, University of Bari Aldo, Moro, Bari, Italy | [e] Department of Clinical and Experimental Medicine, Psychiatric Unit, University of Foggia, Foggia, Italy | [f] Department of Medical Sciences, Geriatric Unit and Laboratory of Gerontology and Geriatrics, IRCCS “Casa Sollievo della Sofferenza”, San Giovanni Rotondo, Foggia, Italy | [g] Institute of Neurology, Catholic University of Sacred Heart, Rome, Italy | [h] Department of Clinical Research in Neurology, University of Bari Aldo Moro, “Pia Fondazione Cardinale G. Panico”, Tricase, Lecce, Italy

Correspondence: [*] Correspondence to: Francesco Panza, MD, PhD, Geriatric Unit and Laboratory of Gerontology and Geriatrics, Department of Medical Sciences, IRCCS “Casa Sollievo della Sofferenza”, San Giovanni Rotondo, Foggia, Italy and Neurodegenerative Disease Unit, Department of Basic Medicine, Neuroscience, and Sense Organs, University of Bari Aldo Moro, Bari, Italy and Department of Clinical Research in Neurology, University of Bari Aldo Moro, “Pia Fondazione Cardinale G. Panico“, Tricase, Lecce, Italy. Tel.: +39 0882 410271; Fax: +39 0882 410271; E-mail: [email protected]. and Vincenzo Solfrizzi, MD, PhD, Department of Geriatric Medicine, Memory Unit and Rare Disease Center, University of Bari Aldo Moro, Policlinico, Piazza Giulio Cesare, 11, 70124 Bari, Italy. Tel.: +39 080 5473685; Fax: +39 080 5478633; E-mail: [email protected] on cognitive function. For fatty acid supplementation, mainly long-chain polyunsaturated fatty acids, there was emerging evidence suggesting an impact of this approach in improving specific cognitive domains, magnetic resonance imaging (MRI) findings, and/or cognitive-related biomarkers also in selected subgroups of older subjects, although some results were conflicting. There was convincing evidence of an impact of non-flavonoid polyphenol and flavonoid supplementations in improving specific cognitive domains and/or MRI findings. Finally, there was only low evidence suggesting efficacy of intervention with homocysteine-related and antioxidant vitamins in improving cognitive functions, dementia incidence, or cognitive-related biomarkers in cognitively healthy older subjects.

Note: [1] These authors contributed equally to this work.

Abstract: The link diet-cognitive function/dementia has been largely investigated in observational studies; however, there was a lack of evidence from randomized clinical trials (RCTs) on the prevention of late-life cognitive disorders though dietary intervention in cognitively healthy older adults. In the present article, we systematically reviewed RCTs published in the last four years (2014–2017) exploring nutritional intervention efficacy in preventing the onset of late-life cognitive disorders and dementia in cognitively healthy subjects aged 60 years and older using different levels of investigation (i.e., dietary pattern changes/medical food/nutraceutical supplementation/multidomain approach and dietary macro- and micronutrient approaches) as well as possible underlying mechanisms of nutritional prevention. From the 35 included RCTs, there was moderate evidence that intervention through dietary pattern changes, medical food/nutraceutical supplementation, and multidomain approach improved specific cognitive domains or cognitive-related blood biomarkers. There was high evidence that protein supplementation improved specific cognitive domains or functional status in prefrail older adults without effect

Keywords: Alzheimer’s disease, dementia, dietary pattern, healthy diet, macronutrients, medical food, Mediterranean diet, micronutrients, mild cognitive impairment, nutraceuticals, prevention

DOI: 10.3233/JAD-179940

Journal: Journal of Alzheimer's Disease, vol. 64, no. s1, pp. S229-S254, 2018