Nutrition state of science and dementia prevention: recommendations of the Nutrition for Dementia Prevention Working Group

Hussein N Yassine¹, Cécilia Samieri¹, Gill Livingston¹, Kimberly Glass¹, Maude Wagner¹, Christy Tangney¹, Brenda L Plassman¹, M Arfan Ikram¹, Robin M Voigt¹, Yian Gu¹, Sid O'Bryant¹, Anne Marie Minihane¹, Suzanne Craft¹, Howard A Fink¹, Suzanne Judd¹, Sandrine Andrieu¹, Gene L Bowman¹, Edo Richard¹, Benedict Albensi¹, Emily Meyers¹, Serly Khosravian¹, Michele Solis¹, Maria Carrillo¹, Heather Snyder¹, Francine Grodstein¹, Nikolaos Scarmeas¹, Lon S Schneider¹

Affiliations

Affiliation

¹ Department of Medicine (H N Yassine MD) and Department of Neurology (H N Yassine, Prof L S Schneider MD MS), Department of Psychiatry and Neuroscience (Prof L S Schneider), and Department of Gerontology (Prof L S Schneider), Keck School of Medicine and Department of Medicine (S Khosravian BA), University of Southern California, Los Angeles, CA, USA; Bordeaux population health U1219, National Institute of Health and Medical Research (INSERM)-University of Bordeaux, Bordeaux, France (C Samieri PhD); Division of Psychiatry, University College London, London, UK (G Livingston MD); Camden and Islington NHS Foundation Trust, London, UK (G Livingston); Channing Division of Network Medicine, Brigham and Women's Hospital, Boston MA, USA (K Glass PhD); Department of Medicine, Harvard Medical School (K Glass) and Department of Biostatistics, Harvard Chan School of Public Health (K Glass), Harvard University, Boston MA, USA; Rush Alzheimer's Disease Center (M Wagner PhD, F Grodstein ScD), Departments of Clinical Nutrition and Preventive Medicine (C Tangney PhD), Rush Center for Microbiome and Chronobiology Research (R M Voigt PhD), Department of Internal Medicine (R M Voigt), and Department of Anatomy and Cell Biology (R M Voigt), Rush University Medical Center (M Wagner) and Department of Neurological Sciences (M Wagner), Rush Medical College, Rush University, Chicago IL, USA; Department of Psychiatry and Behavioral Sciences, Duke University, Durham NC, USA (B L Plassman PhD); Department of Epidemiology, Erasmus MC University Medical Center, Rotterdam, Netherlands (M A Ikram MD PhD); Department of Neurology and Department of Epidemiology, Taub Institute, Sergievsky Center, Columbia University Irving Medical Center (Y Gu MD PhD), and Department of Neurology (N Scarmeas MD), Colombia University, New York, NY, USA; University of North Texas Health Science Center, University of North Texas, Fort Worth, Texas TX, USA (S O'Bryant PhD); Norwich Medical School (A M Minihane PhD) and Norwich Institute of Healthy Ageing (A M Minihane), University of East Anglia, Norwich, UK; Department of Internal Medicine-Geriatrics, Wake Forest University School of Medicine, Wake Forest University, Wake Forest, NC, USA (S Craft PhD); Geriatric Research Education and Clinical Center, Minneapolis VA Health Care System, Minneapolis, MN, USA (H A Fink MD MPH); Biostatistics School of Public Health, University of Alabama at Birmingham, Birmingham AL, USA (S Judd PhD MPH); Aging Research team, Centre for Epidemiology and Research in Population Health, INSERM (S Andrieu MD PhD) and Department of Clinical Epidemiology and Public Health, University of Toulouse Hospital, University of Toulouse III-Paul Sabatier, Toulouse, France (S Andrieu); NIA-Layton Aging and Alzheimer's Disease Research Center, Department of Neurology, Oregon Health and Science University, Portland OR, USA (G L Bowman ND MPH); Helfgott Research Institute, National University of Natural Medicine, Portland OR, USA (G L Bowman); Department of Neurology, Donders Institute from Brain, Behavior and Cognition, Radboud University Medical Centre, Nijmegen, Netherlands (E Richard MD PhD); Department of Public and Occupational Health, Amsterdam University Medical Centre, University of Amsterdam, Amsterdam, Netherlands (E Richard); Department of Pharmaceutical Sciences, College of Pharmacy, Nova Southeastern University, Davie FL, USA (B Albensi PhD); St Boniface Hospital Research Center, Winnipeg MB, Canada (B Albensi); Department of Pharmacology and Therapeutics, University of Manitoba, Winnipeg MB, Canada (B Albensi); Alzheimer's Association, Chicago, IL, USA (E Meyers PhD, M Solis PhD, M Carrillo PhD, H Snyder PhD); Department of Neurology, Aiginitio Hospital, Medical School, National and Kapodistrian University of Athens, Athens, Greece (N Scarmeas).

PMID: 35821792
PMCID: PMC9273104
DOI: 10.1016/s2666-7568(22)00120-9

Nutrition state of science and dementia prevention: recommendations of the Nutrition for Dementia Prevention Working Group

Hussein N Yassine et al. Lancet Healthy Longev. 2022 Jul.

. 2022 Jul;3(7):e501-e512.

doi: 10.1016/s2666-7568(22)00120-9. Epub 2022 Jul 4.

Authors

Affiliation

¹ Department of Medicine (H N Yassine MD) and Department of Neurology (H N Yassine, Prof L S Schneider MD MS), Department of Psychiatry and Neuroscience (Prof L S Schneider), and Department of Gerontology (Prof L S Schneider), Keck School of Medicine and Department of Medicine (S Khosravian BA), University of Southern California, Los Angeles, CA, USA; Bordeaux population health U1219, National Institute of Health and Medical Research (INSERM)-University of Bordeaux, Bordeaux, France (C Samieri PhD); Division of Psychiatry, University College London, London, UK (G Livingston MD); Camden and Islington NHS Foundation Trust, London, UK (G Livingston); Channing Division of Network Medicine, Brigham and Women's Hospital, Boston MA, USA (K Glass PhD); Department of Medicine, Harvard Medical School (K Glass) and Department of Biostatistics, Harvard Chan School of Public Health (K Glass), Harvard University, Boston MA, USA; Rush Alzheimer's Disease Center (M Wagner PhD, F Grodstein ScD), Departments of Clinical Nutrition and Preventive Medicine (C Tangney PhD), Rush Center for Microbiome and Chronobiology Research (R M Voigt PhD), Department of Internal Medicine (R M Voigt), and Department of Anatomy and Cell Biology (R M Voigt), Rush University Medical Center (M Wagner) and Department of Neurological Sciences (M Wagner), Rush Medical College, Rush University, Chicago IL, USA; Department of Psychiatry and Behavioral Sciences, Duke University, Durham NC, USA (B L Plassman PhD); Department of Epidemiology, Erasmus MC University Medical Center, Rotterdam, Netherlands (M A Ikram MD PhD); Department of Neurology and Department of Epidemiology, Taub Institute, Sergievsky Center, Columbia University Irving Medical Center (Y Gu MD PhD), and Department of Neurology (N Scarmeas MD), Colombia University, New York, NY, USA; University of North Texas Health Science Center, University of North Texas, Fort Worth, Texas TX, USA (S O'Bryant PhD); Norwich Medical School (A M Minihane PhD) and Norwich Institute of Healthy Ageing (A M Minihane), University of East Anglia, Norwich, UK; Department of Internal Medicine-Geriatrics, Wake Forest University School of Medicine, Wake Forest University, Wake Forest, NC, USA (S Craft PhD); Geriatric Research Education and Clinical Center, Minneapolis VA Health Care System, Minneapolis, MN, USA (H A Fink MD MPH); Biostatistics School of Public Health, University of Alabama at Birmingham, Birmingham AL, USA (S Judd PhD MPH); Aging Research team, Centre for Epidemiology and Research in Population Health, INSERM (S Andrieu MD PhD) and Department of Clinical Epidemiology and Public Health, University of Toulouse Hospital, University of Toulouse III-Paul Sabatier, Toulouse, France (S Andrieu); NIA-Layton Aging and Alzheimer's Disease Research Center, Department of Neurology, Oregon Health and Science University, Portland OR, USA (G L Bowman ND MPH); Helfgott Research Institute, National University of Natural Medicine, Portland OR, USA (G L Bowman); Department of Neurology, Donders Institute from Brain, Behavior and Cognition, Radboud University Medical Centre, Nijmegen, Netherlands (E Richard MD PhD); Department of Public and Occupational Health, Amsterdam University Medical Centre, University of Amsterdam, Amsterdam, Netherlands (E Richard); Department of Pharmaceutical Sciences, College of Pharmacy, Nova Southeastern University, Davie FL, USA (B Albensi PhD); St Boniface Hospital Research Center, Winnipeg MB, Canada (B Albensi); Department of Pharmacology and Therapeutics, University of Manitoba, Winnipeg MB, Canada (B Albensi); Alzheimer's Association, Chicago, IL, USA (E Meyers PhD, M Solis PhD, M Carrillo PhD, H Snyder PhD); Department of Neurology, Aiginitio Hospital, Medical School, National and Kapodistrian University of Athens, Athens, Greece (N Scarmeas).

PMID: 35821792
PMCID: PMC9273104
DOI: 10.1016/s2666-7568(22)00120-9

Abstract

Observational studies suggest that nutritional factors have a potential cognitive benefit. However, systematic reviews of randomised trials of dietary and nutritional supplements have reported largely null effects on cognitive outcomes and have highlighted study inconsistencies and other limitations. In this Personal View, the Nutrition for Dementia Prevention Working Group presents what we consider to be limitations in the existing nutrition clinical trials for dementia prevention. On the basis of this evidence, we propose recommendations for incorporating dietary patterns and the use of genetic, and nutrition assessment tools, biomarkers, and novel clinical trial designs to guide future trial developments. Nutrition-based research has unique challenges that could require testing both more personalised interventions in targeted risk subgroups, identified by nutritional and other biomarkers, and large-scale and pragmatic study designs for more generalisable public health interventions across diverse populations.

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Figures

**Figure 1:. Biological pathways mediating the relationship of the diet with cognition**
The effect of the diet on cognition involves complex interactions that include behavioural, genetic, systemic, and brain factors. The diet can affect the brain directly or indirectly through chronic diseases (dementia risk factors). The blood-brain barrier has pleiotropic functions that include nutrient brain delivery, and a leaky blood-brain barrier in Alzheimer’s disease is associated with brain glucose hypometabolism.

**Figure 2:. Two contrasting study designs to nutrition-based interventions for dementia prevention**
Two contrasting approaches to nutrition-based clinical trials are shown. The first column shows intensive and personalised interventions guided by biomarkers that capture brain functions. In the second column, interventions are tailored to a population level in groups at risk of dementia and uses pragmatic outcomes. Although certain trials will have to share elements from both approaches, clear study designs that match the intensity of the intervention with the outcome proposed promises to maximise the chances of finding effective therapies.

See this image and copyright information in PMC

References

1. Livingston G, Huntley J, Sommerlad A, et al. Dementia prevention, intervention, and care: 2020 report of the Lancet Commission. Lancet 2020; 396: 413–46. - PMC - PubMed
1. Samieri C, Perier MC, Gaye B, et al. Association of cardiovascular health level in older age with cognitive decline and incident dementia. JAMA 2018; 320: 657–64. - PMC - PubMed
1. Sabia S, Fayosse A, Dumurgier J, et al. Association of ideal cardiovascular health at age 50 with incidence of dementia: 25 year follow-up of Whitehall II cohort study. BMJ 2019; 366: l4414. - PMC - PubMed
1. Scarmeas N, Anastasiou CA, Yannakoulia M. Nutrition and prevention of cognitive impairment. Lancet Neurol 2018; 17: 1006–15. - PubMed
1. Ngandu T, Lehtisalo J, Solomon A, et al. A 2 year multidomain intervention of diet, exercise, cognitive training, and vascular risk monitoring versus control to prevent cognitive decline in at-risk elderly people (FINGER): a randomised controlled trial. Lancet 2015; 385: 2255–63. - PubMed

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Nutrition state of science and dementia prevention: recommendations of the Nutrition for Dementia Prevention Working Group

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Nutrition state of science and dementia prevention: recommendations of the Nutrition for Dementia Prevention Working Group

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