Diet, cognition, and Alzheimer's disease: food for thought

Mens Sana in Corpore Sano: Does the Glycemic Index Have a Role to Play?

Although diet interventions are mostly related to metabolic disorders, nowadays they are used in a wide variety of pathologies. From diabetes and obesity to cardiovascular diseases, to cancer or neurological disorders and stroke, nutritional recommendations are applied to almost all diseases. Among such disorders, metabolic disturbances and brain function and/or diseases have recently been shown to be linked. Indeed, numerous neurological functions are often associated with perturbations of whole-body energy homeostasis. In this regard, specific diets are used in various neurological conditions, such as epilepsy, stroke, or seizure recovery. In addition, Alzheimer’s disease and Autism Spectrum Disorders are also considered to be putatively improved by diet interventions. Glycemic index diets are a novel developed indicator expected to anticipate the changes in blood glucose induced by specific foods and how they can affect various physiological functions. Several results have provided indications of the efficiency of low-glycemic index diets in weight management and insulin sensitivity, but also cognitive function, epilepsy treatment, stroke, and neurodegenerative diseases. Overall, studies involving the glycemic index can provide new insights into the relationship between energy homeostasis regulation and brain function or related disorders. Therefore, in this review, we will summarize the main evidence on glycemic index involvement in brain mechanisms of energy homeostasis regulation.

A Personalized Voice-Based Diet Assistant for Caregivers of Alzheimer Disease and Related Dementias: System Development and Validation

BACKGROUND

The world's aging population is increasing, with an expected increase in the prevalence of Alzheimer disease and related dementias (ADRD). Proper nutrition and good eating behavior show promise for preventing and slowing the progression of ADRD and consequently improving patients with ADRD's health status and quality of life. Most ADRD care is provided by informal caregivers, so assisting caregivers to manage patients with ADRD's diet is important.

OBJECTIVE

This study aims to design, develop, and test an artificial intelligence-powered voice assistant to help informal caregivers manage the daily diet of patients with ADRD and learn food and nutrition-related knowledge.

METHODS

The voice assistant is being implemented in several steps: construction of a comprehensive knowledge base with ontologies that define ADRD diet care and user profiles, and is extended with external knowledge graphs; management of conversation between users and the voice assistant; personalized ADRD diet services provided through a semantics-based knowledge graph search and reasoning engine; and system evaluation in use cases with additional qualitative evaluations.

RESULTS

A prototype voice assistant was evaluated in the lab using various use cases. Preliminary qualitative test results demonstrate reasonable rates of dialogue success and recommendation correctness.

CONCLUSIONS

The voice assistant provides a natural, interactive interface for users, and it does not require the user to have a technical background, which may facilitate senior caregivers' use in their daily care tasks. This study suggests the feasibility of using the intelligent voice assistant to help caregivers manage patients with ADRD's diet.

Healthy brain, healthy life: a review of diet and exercise interventions to promote brain health and reduce Alzheimer's disease risk

With the world's population aging at a rapid rate, the prevalence of Alzheimer's disease (AD) has significantly increased. These statistics are alarming given recent evidence that a third of dementia cases may be preventable. The role of lifestyle factors, such as diet and exercise, can directly alter the risk of disease development. However, an understanding of the effectiveness of dietary patterns and exercise strategies to reduce AD risk or improve brain function is not fully understood. The aim of this review is to discuss the effects of diet and exercise on AD risk. Key components of the Western and Mediterranean diets are discussed in relation to AD progression, as well as how physical activity promotes brain health. Components of the Western diet (saturated fatty acids and simple carbohydrates) are detrimental to the brain, impair cognition, and increase AD pathologies. While components of the Mediterranean diet (polyunsaturated fatty acids, polyphenols, and antioxidants) are considered to be neuroprotective. Exercise can significantly reduce the risk of AD; however, specific exercise recommendations for older adults are limited and optimal intensity, duration, and type remains unknown. This review highlights important modifiable risk factors for AD and points out potential avenues for future research. Novelty Diet and exercise are modifiable factors that can improve brain health and reduce the risk of AD. Polyunsaturated fatty acids, polyphenols, and antioxidants are neuroprotective. Exercise reduces neuroinflammation, improves brain insulin sensitivity, and increases brain derived neurotrophic factor.

NHANES 2011-2014 Reveals Cognition of US Older Adults may Benefit from Better Adaptation to the Mediterranean Diet

Although the Mediterranean diet (MedD) has gained interest for potential Alzheimer’s disease (AD) prevention, it is unknown how well US older adults follow a MedD. We used two National Health and Nutrition Examination Survey (NHANES) cycles (2011–2014) to conduct our primary aim of reporting population estimates of MedD adherence among older adults (60+ years) in the US (n = 3068). The mean MedD adherence score for US older adults was 5.3 ± 2.1 (maximum possible = 18), indicating that older adults in the US do not adhere to a MedD. There were various differences in MedD scores across demographic characteristics. We also assessed the cross-sectional relationship between MedD adherence and cognitive performance using survey-weighted ordinary least squares regression and binary logistic regression models adjusted for 11 covariates. Compared to the lowest MedD adherence tertile, the highest tertile had a lower odds ratio of low cognitive performance on three of five cognitive measures (p < 0.05 for each). Sensitivity analyses within participants without subjective memory complaints over the past year revealed similar results on the same three cognitive measures. We conclude that MedD interventions are a departure from usual dietary intake of older adults in the US and are a reasonable approach for AD prevention trials.

Alternate Healthy Eating Index is Positively Associated with Cognitive Function Among Middle-Aged and Older Hispanics/Latinos in the HCHS/SOL

BACKGROUND

Diet quality may be an important area of focus for promoting cognitive health; however, the association between diet quality and cognitive function among Hispanics/Latinos remains largely unexamined. We hypothesized that a healthier diet quality will be associated with better cognitive function in middle-aged and older Hispanics/Latinos.

OBJECTIVE

The objective of this study was to examine associations between the Alternate Healthy Eating Index (AHEI-2010), a measure of diet quality, and cognitive function in middle-aged and older Hispanics/Latinos.

METHODS

Data from the Hispanic Community Health Study/Study of Latinos (HCHS/SOL) Visit 1 (2008-2011) were used (n = 8461; ages 45-74 y). Cognitive function was assessed with tests of verbal learning and memory, verbal fluency, and processing speed; a global cognition score was derived by summing the z scores of individual tests. Dietary intake was assessed via two 24-h recalls. Total AHEI-2010 score was categorized into quintiles (higher quintiles indicating healthier diet). Linear regression models were used to examine associations between AHEI-2010 quintiles and cognitive function adjusting for sociodemographic characteristics, daily energy intake, type 2 diabetes, smoking, and depressive symptoms.

RESULTS

Compared with the lowest quintile, in the second to fourth AHEI-2010 quintiles, global cognition scores were significantly higher by 0.28, 0.52, and 0.48 units (P-trend = 0.042). In the second to fifth AHEI-2010 quintiles, verbal learning scores were significantly higher by 0.60, 0.62, 0.92, and 0.88 units, and verbal memory scores were higher by 0.33, 0.40, 0.52, and 0.46 units (P-trend = 0.020 and 0.007, respectively). No associations were observed between the AHEI-2010 and verbal fluency or processing speed (P-trend = 0.49 and 0.84, respectively). Among AHEI-2010 components, adequate consumption of vegetables, alcohol, and whole fruits were each associated with better cognitive function.

CONCLUSIONS

An overall healthier diet quality was associated with better global cognition, verbal learning, and verbal memory in middle-aged and older Hispanics/Latinos.

Targeted Nutritional Intervention for Patients with Mild Cognitive Impairment: The Cognitive impAiRmEnt Study (CARES) Trial 1

Omega-3 fatty acids (ω-3FAs), carotenoids, and vitamin E are important constituents of a healthy diet. While they are present in brain tissue, studies have shown that these key nutrients are depleted in individuals with mild cognitive impairment (MCI) in comparison to cognitively healthy individuals. Therefore, it is likely that these individuals will benefit from targeted nutritional intervention, given that poor nutrition is one of the many modifiable risk factors for MCI. Evidence to date suggests that these nutritional compounds can work independently to optimize the neurocognitive environment, primarily due to their antioxidant and anti-inflammatory properties. To date, however, no interventional studies have examined the potential synergistic effects of a combination of ω-3FAs, carotenoids and vitamin E on the cognitive function of patients with MCI. Individuals with clinically confirmed MCI consumed an ω-3FA plus carotenoid plus vitamin E formulation or placebo for 12 months. Cognitive performance was determined from tasks that assessed global cognition and episodic memory. Ω-3FAs, carotenoids, and vitamin E were measured in blood. Carotenoid concentrations were also measured in tissue (skin and retina). Individuals consuming the active intervention (n = 6; median [IQR] age 73.5 [69.5–80.5] years; 50% female) exhibited statistically significant improvements (p < 0.05, for all) in tissue carotenoid concentrations, and carotenoid and ω-3FA concentrations in blood. Trends in improvements in episodic memory and global cognition were also observed in this group. In contrast, the placebo group (n = 7; median [IQR] 72 (69.5–75.5) years; 89% female) remained unchanged or worsened for all measurements (p > 0.05). Despite a small sample size, this exploratory study is the first of its kind to identify trends in improved cognitive performance in individuals with MCI following supplementation with ω-3FAs, carotenoids, and vitamin E.

Brain Injury-Mediated Neuroinflammatory Response and Alzheimer's Disease

Traumatic brain injury (TBI) is a major health problem in the United States, which affects about 1.7 million people each year. Glial cells, T-cells, and mast cells perform specific protective functions in different regions of the brain for the recovery of cognitive and motor functions after central nervous system (CNS) injuries including TBI. Chronic neuroinflammatory responses resulting in neuronal death and the accompanying stress following brain injury predisposes or accelerates the onset and progression of Alzheimer's disease (AD) in high-risk individuals. About 5.7 million Americans are currently living with AD. Immediately following brain injury, mast cells respond by releasing prestored and preactivated mediators and recruit immune cells to the CNS. Blood-brain barrier (BBB), tight junction and adherens junction proteins, neurovascular and gliovascular microstructural rearrangements, and dysfunction associated with increased trafficking of inflammatory mediators and inflammatory cells from the periphery across the BBB leads to increase in the chronic neuroinflammatory reactions following brain injury. In this review, we advance the hypothesis that neuroinflammatory responses resulting from mast cell activation along with the accompanying risk factors such as age, gender, food habits, emotional status, stress, allergic tendency, chronic inflammatory diseases, and certain drugs can accelerate brain injury-associated neuroinflammation, neurodegeneration, and AD pathogenesis.

Diet, inflammation and the gut microbiome: Mechanisms for obesity-associated cognitive impairment

Poor diet and obesity are associated with cognitive impairment throughout adulthood, and increased dementia risk in aging. Here we review the current literature interrogating the mechanisms by which diets high in fat, or fat and sugar lead to cognitive impairment, focusing on changes to gut microbiome composition, inflammatory signalling and blood-brain barrier integrity. Preclinical studies indicate weight gain is not necessary for diet-induced cognitive impairment. Rather, gut microbiome composition, and systemic and central inflammatory processes appear to contribute to diet-induced cognitive impairment. While both obese humans and rodents exhibit reduced blood-brain barrier integrity, cognitive impairments precede these changes, suggesting other mechanisms may underly diet-induced cognitive changes. Other potential candidates include hormone, glucoregulatory and cardiovascular changes. Poor diet and obesity act through multiple mechanisms to affect cognitive health and the challenge for future research is to identify key processes that can be reversed to improve cognition and quality of life.

Lipophilic Antioxidants and Cognitive Function in the Elderly

Objective:

To determine the relationship between blood serum lipophilic antioxidant levels and cognitive function (CF) in older adults aged 60 and above guided by the oxidative stress theory of aging.

Methods:

Cross-sectional data from the National Health and Nutrition Examination Survey (n = 291) for older adults aged 60 and above were examined using Pearson correlation coefficient and multiple linear regression to determine whether blood serum antioxidant status predicted CF while controlling for age, sex, race, hypertension, smoking status, and body mass index.

Results:

Alpha-tocopherol, retinyl palmitate, trans-lycopene, and retinyl stearate were all significantly correlated with CF. After controlling for covariates, α-tocopherol and retinyl palmitate were associated with CF. Age, sex, and current smoking status were significant predictors of CF.

Conclusions:

The benefits of antioxidants in CF may be a part of nutritional recommendations which include α-tocopherol and retinyl palmitate for delay of CI, and subsequently a better quality of life.

Nutrition interventions for healthy ageing across the lifespan: a conference report

Thanks to advances in modern medicine over the past century, the world’s population has experienced a marked increase in longevity. However, disparities exist that lead to groups with both shorter lifespan and significantly diminished health, especially in the aged. Unequal access to proper nutrition, healthcare services, and information to make informed health and nutrition decisions all contribute to these concerns. This in turn has hastened the ageing process in some and adversely affected others’ ability to age healthfully. Many in developing as well as developed societies are plagued with the dichotomy of simultaneous calorie excess and nutrient inadequacy. This has resulted in mental and physical deterioration, increased non-communicable disease rates, lost productivity and quality of life, and increased medical costs. While adequate nutrition is fundamental to good health, it remains unclear what impact various dietary interventions may have on improving healthspan and quality of life with age. With a rapidly ageing global population, there is an urgent need for innovative approaches to health promotion as individual’s age. Successful research, education, and interventions should include the development of both qualitative and quantitative biomarkers and other tools which can measure improvements in physiological integrity throughout life. Data-driven health policy shifts should be aimed at reducing the socio-economic inequalities that lead to premature ageing. A framework for progress has been proposed and published by the World Health Organization in its Global Strategy and Action Plan on Ageing and Health. This symposium focused on the impact of nutrition on this framework, stressing the need to better understand an individual’s balance of intrinsic capacity and functional abilities at various life stages, and the impact this balance has on their mental and physical health in the environments they inhabit.

Adherence to Dietary Patterns and Risk of Incident Dementia: Findings from the Atherosclerosis Risk in Communities Study

BACKGROUND

Previous studies have suggested that adherence to healthy dietary patterns during late life may be associated with improved cognition. However, few studies have examined the association between healthy dietary patterns during midlife and incident dementia.

OBJECTIVE

Our study aimed to determine the association between adherence to healthy dietary patterns at midlife and incident dementia.

METHODS

We included 13,630 adults from the Atherosclerosis Risk in Communities (ARIC) Study in our prospective analysis. We used food frequency questionnaire responses to calculate four dietary scores: Healthy Eating Index-2015 (HEI-2015), Alternative Healthy Eating Index-2010 (AHEI-2010), alternate Mediterranean (aMed) diet, and Dietary Approaches to Stop Hypertension (DASH). Participants were followed until the end of 2017 for incident dementia. Cox regression models adjusted for covariates were used to estimate risk of incident dementia by quintile of dietary scores.

RESULTS

Over a median of 27 years, there were 2,352 cases of incident dementia documented. Compared with participants in quintile 1 of HEI-2015, participants in quintile 5 (healthiest) had a 14% lower risk of incident dementia (hazard ratio, HR: 0.86, 95% confidence interval, CI: 0.74-0.99). There were no significant associations of incident dementia with the AHEI-2010, aMed, or DASH scores. There were no significant interactions by sex, age, race, education, physical activity, hypertension, or obesity.

CONCLUSION

Adherence to the HEI-2015, but not the other dietary scores, during midlife was associated with lower risk of incident dementia. Further research is needed to elucidate whether timing of a healthy diet may influence dementia risk.

Pathways of Prevention: A Scoping Review of Dietary and Exercise Interventions for Neurocognition

Alzheimer's disease and related dementias (ADRD) represent an increasingly urgent public health concern, with an increasing number of baby boomers now at risk. Due to a lack of efficacious therapies among symptomatic older adults, an increasing emphasis has been placed on preventive measures that can curb or even prevent ADRD development among middle-aged adults. Lifestyle modification using aerobic exercise and dietary modification represents one of the primary treatment modalities used to mitigate ADRD risk, with an increasing number of trials demonstrating that exercise and dietary change, individually and together, improve neurocognitive performance among middle-aged and older adults. Despite several optimistic findings, examination of treatment changes across lifestyle interventions reveals a variable pattern of improvements, with large individual differences across trials. The present review attempts to synthesize available literature linking lifestyle modification to neurocognitive changes, outline putative mechanisms of treatment improvement, and discuss discrepant trial findings. In addition, previous mechanistic assumptions linking lifestyle to neurocognition are discussed, with a focus on potential solutions to improve our understanding of individual neurocognitive differences in response to lifestyle modification. Specific recommendations include integration of contemporary causal inference approaches for analyzing parallel mechanistic pathways and treatment-exposure interactions. Methodological recommendations include trial multiphase optimization strategy (MOST) design approaches that leverage individual differences for improved treatment outcomes.

Common risk factors for major noncommunicable disease, a systematic overview of reviews and commentary: the implied potential for targeted risk reduction

Noncommunicable disease now contributes to the World Health Organization top 10 causes of death in low-, middle- and high-income countries. Particular examples include stroke, coronary heart disease, dementia and certain cancers. Research linking clinical and lifestyle risk factors to increased risk of noncommunicable disease is now well established with examples of confirmed risk factors, including smoking, physical inactivity, obesity and hypertension. However, despite a need to target our resources to achieve risk reduction, relatively little work has examined the overlap between the risk factors for these main noncommunicable diseases. Our high-level review draws together the evidence in this area. Using a systematic overview of reviews, we demonstrate the likely commonality of established risk factors having an impact on multiple noncommunicable disease outcomes. For example, systematic reviews of the evidence on physical inactivity and poor diet found each to be associated with increased risk of cancers, coronary heart disease, stroke, diabetes mellitus and dementia. We highlight the potential for targeted risk reduction to simultaneously impact multiple noncommunicable disease areas. These relationships now need to be further quantified to allow the most effective development of public health interventions in this area.

A Systematic Review and Meta-Analysis of B Vitamin Supplementation on Depressive Symptoms, Anxiety, and Stress: Effects on Healthy and 'At-Risk' Individuals

A systematic review and meta-analysis was undertaken to examine and quantify the effects of B vitamin supplementation on mood in both healthy and 'at-risk' populations. A systematic search identified all available randomised controlled trials (RCTs) of daily supplementation with ≥3 B group vitamins with an intervention period of at least four weeks. Random effects models for a standardized mean difference were used to test for overall effect. Heterogeneity was tested using the I² statistic. Eighteen articles (16 trials, 2015 participants) were included, of which 12 were eligible for meta-analysis. Eleven of the 18 articles reported a positive effect for B vitamins over a placebo for overall mood or a facet of mood. Of the eight studies in 'at-risk' cohorts, five found a significant benefit to mood. Regarding individual facets of mood, B vitamin supplementation benefited stress (n = 958, SMD = 0.23, 95% CI = 0.02, 0.45, p = 0.03). A benefit to depressive symptoms did not reach significance (n = 568, SMD = 0.15, 95% CI = -0.01, 0.32, p = 0.07), and there was no effect on anxiety (n = 562, SMD = 0.03, 95% CI = -0.13, 0.20, p = 0.71). The review provides evidence for the benefit of B vitamin supplementation in healthy and at-risk populations for stress, but not for depressive symptoms or anxiety. B vitamin supplementation may particularly benefit populations who are at risk due to (1) poor nutrient status or (2) poor mood status.

Can krill oil be of use for counteracting neuroinflammatory processes induced by high fat diet and aging?

Most neurodegenerative diseases, such as Alzheimer's and Parkinson's disease, demonstrate preceding or on-going inflammatory processes. Therefore, discovering effective means of counteracting detrimental inflammatory mediators in the brain could help alter aging-related disease onset and progression. Fish oil and marine-derived omega-3, long-chain polyunsaturated fatty acids (LC n-3) have shown promising anti-inflammatory effects both systemically and centrally. More specifically, krill oil (KO), extracted from small Antarctic crustaceans, is an alternative type of LC n-3 with reported health benefits including improvement of spatial memory and learning, memory loss, systemic inflammation and depression symptoms. Similar to the more widely studied fish oil, KO contains the long chain fatty acids eicosapentaenoic acid (EPA) and docosahexaenoic acid (DHA) which are essential for basic brain functions. Moreover, the phospholipid bound nature of fatty acids found in KO improves bioavailability and efficiency of absorption, thus supporting the belief that KO may offer a superior method of dietary n-3 delivery. Finally, KO contains astaxanthin, an antioxidant capable of reducing potentially excessive oxidative stress and inflammation within the brain. This review will discuss the potential benefits of KO over other marine-based LC n-3 on brain inflammation and cognitive function in the context of high fat diets and aging.

Effects of Moxibustion and Moxa Smoke on Behavior Changes and Energy Metabolism in APP/PS1 Mice

OBJECTIVE

To investigate the antiaging effects of moxibustion and moxa smoke on APP/PS1 mice and to illustrate the mechanism of moxibustion improving Alzheimer's disease (AD).

METHODS

36 male APP/PS1 mice were randomly assigned into three groups (n = 12), including a model control group, a moxibustion group, and a moxa smoke group. In addition, 12 C57BL/6 normal mice served as a normal (negative) control group. Mice in the moxibustion group received moxibustion intervention using Guanyuan (RN4) acupoint. Mice in the moxa smoke group received moxa smoke exposure with the same frequency as the moxibustion group. Behavioral tests were implemented in the 9th week, 3 days after the completion of the intervention. Tricarboxylic acid cycle and fatty acid metabolomics assessments of the mice were determined after behavioral tests.

RESULTS

In this study, relative to normal mice, we found that AD mice showed altered tricarboxylic and fatty acid metabolism and showed behavioral changes consistent with the onset of AD. However, both the moxibustion and moxa smoke interventions were able to mitigate these effects to some degree in AD mice.

CONCLUSIONS

The data suggest that tricarboxylic acid cycle and unsaturated fatty acid metabolomics changes may be a target of AD, and the beneficial effects of moxibustion on cognitive behaviors may be mediated by the energy metabolism system.

Gene-by-environment interactions in Alzheimer's disease and Parkinson's disease

Diseases such as Alzheimer's disease (AD) and Parkinson's disease (PD) arise from complex interactions of genetic and environmental factors, with genetic variants regulating individual responses to environmental exposures (i.e. gene-by-environment interactions). Identifying gene-by-environment interactions will be critical to fully understanding disease mechanisms and developing personalized therapeutics, though these interactions are still poorly understood and largely under-studied. Candidate gene approaches have shown that known disease risk variants often regulate response to environmental factors. However, recent improvements in exposome- and genome-wide association and interaction studies in humans and mice are enabling discovery of novel genetic variants and pathways that predict response to a variety of environmental factors. Here, we highlight recent approaches and ongoing developments in human and rodent studies to identify genetic modulators of environmental factors using AD and PD as exemplars. Identifying gene-by-environment interactions in disease will be critical to developing personalized intervention strategies and will pave the way for precision medicine.

Nutritional Intervention to Prevent Alzheimer's Disease: Potential Benefits of Xanthophyll Carotenoids and Omega-3 Fatty Acids Combined

BACKGROUND

A growing body of scientific evidence suggests that enrichment of certain nutritional compounds in the brain may reduce the risk of Alzheimer's disease (AD).

OBJECTIVE

To investigate the impact of supplemental xanthophyll carotenoids plus omega-3 fatty acids on disease progression in patients with AD.

METHODS

Three trial experiments were performed. In Trials 1 and 2 (performed on patients with AD over an 18-month period), 12 patients (AD status at baseline: 4 mild and 8 moderate) were supplemented with a xanthophyll carotenoid only formulation (Formulation 1; lutein:meso-zeaxanthin:zeaxanthin 10:10:2 mg/day) and 13 patients (AD status at baseline: 2 mild, 10 moderate, and 1 severe) were supplemented with a xanthophyll carotenoid and fish oil combination (Formulation 2; lutein:meso-zeaxanthin:zeaxanthin 10:10:2 mg/day plus 1 g/day of fish oil containing 430 mg docohexaenoic acid [DHA] and 90 mg eicopentaenoic acid [EPA]), respectively. In Trial 3, 15 subjects free of AD (the control group) were supplemented for 6 months with Formulation 1. Blood xanthophyll carotenoid response was measured in all trials by HPLC. Omega-3 fatty acids were profiled by direct infusion mass spectrometry.

RESULTS

Xanthophyll carotenoid concentration increases were significantly greater for Formulation 2 compared to Formulation 1 (p < 0.05), and progression of AD was less for this group (p = 0.003), with carers reporting functional benefits in memory, sight, and mood.

CONCLUSION

This preliminary report suggests positive outcomes for patients with AD who consumed a combination of xanthophyll carotenoids plus fish oil, but further study is required to confirm this important observation.

The Nutritional Components of Beer and Its Relationship with Neurodegeneration and Alzheimer's Disease

The prevalence of degenerative diseases has risen in western countries. Growing evidence suggests that demenia and other cognition affectations are associated with ambient factors including specific nutrients, food ingredients or specific dietary patterns. Mediterranean diet adherence has been associated with various health benefits and decreased risk of many diseases, including neurodegenerative disorders. Beer, as part of this protective diet, contains compounds such as silicon and hops that could play a major role in preventing brain disorders. In this review, different topics regarding Mediterranean diet, beer and the consumption of their main compounds and their relation to neurological health have been addressed. Taking into account published results from our group and other studies, the hypothesis linking aluminum intoxication with dementia and/or Alzheimer’s disease and the potential role of regular beer has also been considered. Beer, in spite of its alcohol content, may have some health benefits; nonetheless, its consumption is not adequate for all subjects. Thus, this review analyzed some promising results of non-alcoholic beer on several mechanisms engaged in neurodegeneration such as inflammation, oxidation, and cholinesterase activity, and their contribution to the behavioral modifications induced by aluminum intoxication. The review ends by giving conclusions and suggesting future topics of research related to moderate beer consumption and/or the consumption of its major compounds as a potential instrument for protecting against neurodegenerative disease progression and the need to develop nutrigenetic and nutrigenomic studies in aged people and animal models.

Dietary intake and cognitive function: evidence from the Bogalusa Heart Study

BACKGROUND

Dementia and late-life cognitive decline are leading causes of death and disability in the United States. Prevention of these diseases, by maintaining brain health throughout the life course, is essential. Diet and lifestyle changes are the chief strategies aimed at primary prevention for many of the risk factors of cognitive decline.

OBJECTIVE

The aim of this study was to examine the potential impact of dietary factors on cognitive function.

METHODS

This prospective cohort study followed 516 young adults through midlife. The Youth/Adolescent Questionnaire was used to collect habitual nutrition data (mean age: 32.03 ± 5.96 y) at baseline. Scores from a neurocognitive battery were used to assess cognitive function (mean age: 49.03 ± 4.86 y) at follow-up and were transformed to z scores. Separate multivariable-adjusted linear regression models were fitted. The trend across quintiles for each dietary variable was assessed.

RESULTS

Vitamin B-6, whole grains, processed meats, and foods fried at home all displayed significant linear trends in their relation with cognitive function. Dietary intake of vitamin B-6 and whole grains was directly associated with better cognitive function after adjustment for age, race, sex, and total calorie intake (β coefficient from linear regression and SE: 1.755 ± 0.621, P = 0.005, and 0.001 ± 0.000, P = 0.018, respectively). Processed meat and foods fried at home consistently displayed inverse associations with cognitive function across crude and adjusted models (linear trend P values were 0.05 and <0.0001, respectively).

CONCLUSIONS

Our findings suggest that dietary consumption in young adulthood may affect cognitive function in midlife. Strong associations between dietary intake and cognition were observed in our analysis, but as with all observational studies, the possibility of residual confounding cannot be excluded.

Non-Alcoholic Fatty Liver Disease, and the Underlying Altered Fatty Acid Metabolism, Reveals Brain Hypoperfusion and Contributes to the Cognitive Decline in APP/PS1 Mice

Non-alcoholic fatty liver disease (NAFLD), the leading cause of chronic liver disease, is associated with cognitive decline in middle-aged adults, but the mechanisms underlying this association are not clear. We hypothesized that NAFLD would unveil the appearance of brain hypoperfusion in association with altered plasma and brain lipid metabolism. To test our hypothesis, amyloid precursor protein/presenilin-1 (APP/PS1) transgenic mice were fed a standard diet or a high-fat, cholesterol and cholate diet, inducing NAFLD without obesity and hyperglycemia. The diet-induced NAFLD disturbed monounsaturated and polyunsaturated fatty acid (MUFAs, PUFAs) metabolism in the plasma, liver, and brain, and particularly reduced n-3 PUFAs levels. These alterations in lipid homeostasis were associated in the brain with an increased expression of Tnfα, Cox2, p21, and Nox2, reminiscent of brain inflammation, senescence, and oxidative stress. In addition, compared to wild-type (WT) mice, while brain perfusion was similar in APP/PS1 mice fed with a chow diet, NAFLD in APP/PS1 mice reveals cerebral hypoperfusion and furthered cognitive decline. NAFLD reduced plasma β₄₀- and β₄₂-amyloid levels and altered hepatic but not brain expression of genes involved in β-amyloid peptide production and clearance. Altogether, our results suggest that in a mouse model of Alzheimer disease (AD) diet-induced NAFLD contributes to the development and progression of brain abnormalities through unbalanced brain MUFAs and PUFAs metabolism and cerebral hypoperfusion, irrespective of brain amyloid pathology that may ultimately contribute to the pathogenesis of AD.

Dietary Long-Chain Fatty Acids and Cognitive Performance in Older Australian Adults

Convincing evidence exists for the positive effect of an improvement in diet quality on age-related cognitive decline, in part due to dietary fatty acid intake. A cross-sectional analysis of data from the Hunter Community Study (HCS) (n = 2750) was conducted comparing dietary data from a validated Food Frequency Questionnaire (FFQ) with validated cognitive performance measures, Audio Recorded Cognitive Screen (ARCS) and Mini Mental State Examination (MMSE). Adjusted linear regression analysis found statistically significant associations between dietary intake of total n-6 fatty acids (FA), but no other FAs, and better cognitive performance as measured by the ARCS (RC = 0.0043; p = 0.0004; R² = 0.0084). Multivariate regression analyses of n-6 FA intakes in quartiles showed that, compared with the lowest quartile (179.8–1150.3 mg), those in the highest quartile (2315.0–7449.4 mg) had a total ARCS score 2.1 units greater (RC = 10.60466; p = 0.006; R² = 0.0081). Furthermore, when n-6 FA intake was tested against each of the ARCS domains, statistically significant associations were observed for the Fluency (RC = 0.0011432; p = 0.007; R² = 0.0057), Visual (RC = 0.0009889; p = 0.034; R² = 0.0050), Language (RC = 0.0010651; p = 0.047; R² = 0.0068) and Attention (RC = 0.0011605; p = 0.017; R² = 0.0099) domains, yet there was no association with Memory (RC = −0.000064; p = 0.889; R² = 0.0083). No statistically significant associations were observed between FA intakes and MMSE. A higher intake of total n-6 FA, but not other types of FA, was associated with better cognitive performance among a representative sample of older aged Australian adults.

The Role of Nutrition for the Aging Population: Implications for Cognition and Alzheimer's Disease

Improved life expectancy worldwide has resulted in a significant increase in age-related diseases. Dementia is one of the fastest growing age-related diseases, with 75 million adults globally projected to develop the condition by 2030. Alzheimer's disease (AD) is the most common form of dementia and represents the most significant stage of cognitive decline. With no cure identified to date for AD, focus is being placed on preventative strategies to slow progression, minimize the burden of neurological disease, and promote healthy aging. Accumulating evidence suggests that nutrition (e.g., via fruit, vegetables, fish) is important for optimizing cognition and reducing risk of AD. This review examines the role of nutrition on cognition and AD, with specific emphasis on the Mediterranean diet (MeDi) and key nutritional components of the MeDi, namely xanthophyll carotenoids and omega-3 fatty acids. Given their selective presence in the brain and their ability to attenuate proposed mechanisms involved in AD pathogenesis (namely oxidative damage and inflammation), these nutritional compounds offer potential for optimizing cognition and reducing the risk of AD.

Consumption of β-glucans to spice up T cell treatment of tumors: a review

INTRODUCTION

Adoptive T-cell treatments of solid cancers have evolved into a robust therapy with objective response rates surpassing those of standardized treatments. Unfortunately, only a limited fraction of patients shows durable responses, which is considered to be due to a T cell-suppressive tumor microenvironment (TME). Here we argue that naturally occurring β-glucans can enable reversion of such T cell suppression by engaging innate immune cells and enhancing numbers and function of lymphocyte effectors.

AREAS COVERED

This review summarizes timely reports with respect to absorption, trafficking and immune stimulatory effects of β-glucans, particularly in relation to innate immune cells. Furthermore, we list effects toward well-being and immune functions in healthy subjects as well as cancer patients treated with orally administered β-glucans, extended with effects of β-glucan treatments in mouse cancer models.

EXPERT OPINION

Beta-glucans, when present in food and following uptake in the proximal gut, stimulate immune cells present in gut-associated lymphoid tissue and initiate highly conserved pro-inflammatory pathways. When tested in mouse cancer models, β-glucans result in better control of tumor growth and shift the TME toward a T cell-sensitive environment. Along these lines, we advocate that intake of β-glucans provides an accessible and immune-potentiating adjuvant when combined with adoptive T-cell treatments of cancer.

Modulating Effect of Diet on Alzheimer's Disease

As life expectancy is growing, neurodegenerative disorders, such as Alzheimer's disease, are increasing. This disease is characterised by the accumulation of intracellular neurofibrillary tangles formed by hyperphosphorylated tau protein, senile plaques composed of an extracellular deposit of β-amyloid peptide (Aβ), and neuronal loss. This is accompanied by deficient mitochondrial function, increased oxidative stress, altered inflammatory response, and autophagy process impairment. The present study gathers scientific evidence that demonstrates that specific nutrients exert a direct effect on both Aβ production and Tau processing and their elimination by autophagy activation. Likewise, certain nutrients can modulate the inflammatory response and the oxidative stress related to the disease. However, the extent to which these effects come with beneficial clinical outcomes remains unclear. Even so, several studies have shown the benefits of the Mediterranean diet on Alzheimer's disease, due to its richness in many of these compounds, to which can be attributed their neuroprotective properties due to the pleiotropic effect they show on the aforementioned processes. These indications highlight the potential role of adequate dietary recommendations for clinical management of both Alzheimer's diagnosed patients and those in risk of developing it, emphasising once again the importance of diet on health.

Comparative studies of DHA-enriched phosphatidylcholine and recombination of DHA-ethyl ester with egg phosphatidylcholine on ameliorating memory and cognitive deficiency in SAMP8 mice

DHA-PLs (DHA-PC) could not be substituted by recombination of commercial fish oil with DHA-free PC in alleviating age-related memory loss and cognitive deficiency in SAMP8 mice.

How stress mediators can cumulatively contribute to Alzheimer's disease An allostatic load approach

Allostatic load is defined as the frequent activation of the neuroendocrine, immunological, metabolic and cardiovascular systems, which makes individuals more susceptible to stress-related health problems. According to this model, physiological dysregulations start to emerge decades before diseases manifest. Consequently, stress research has shifted its attention to anticipating the degree of this dysregulation to better understand the impact of stress hormones and other biomarkers on disease progression. In view of the growing number of studies that demonstrate the influence of modifiable risk factors on cognitive decline, in addition to the effects of chronic stress mediators, the objective of the present review was to present an overview of the development of cognitive changes based on studies on stress and its mediators.

Association of Nutritional Status with Cognitive Stage in the Elderly Korean Population: The Korean Brain Aging Study for the Early Diagnosis and Prediction of Alzheimer's Disease

Background and Purpose

Epidemiological studies have suggested the presence of strong correlations among diet, lifestyle, and dementia onset. However, these studies have unfortunately had major limitations due to their inability to fully control the various potential confounders affecting the nutritional status. The purpose of the current study was to determine the nutritional status of participants in the Korean Brain Aging Study for the Early Diagnosis and Prediction of Alzheimer's Disease (KBASE) and to identify clinical risk factors for being at risk of malnutrition or being malnourished.

Methods

Baseline data from 212 participants [119 cognitively unimpaired (CU), 56 with mild cognitive impairment (MCI), and 37 with dementia] included in the KBASE database were analyzed. All participants underwent a comprehensive cognitive test and MRI at baseline. The presence of malnutrition at baseline was measured by the Mini Nutritional Assessment score. We examined the cross-sectional relationships of clinical findings with nutritional status using multiple logistic regression applied to variables for which p<0.2 in the univariate analysis. Differences in cortical thickness according to the nutritional status were also investigated.

Results

After adjustment for demographic, nutritional, and neuropsychological factors, participants with dementia had a significantly higher odds ratio (OR) for being at risk of malnutrition or being malnourished than CU participants [OR=5.98, 95% CI=1.20–32.97] whereas participants with MCI did not (OR=0.62, 95% CI=0.20–1.83). Cortical thinning in the at-risk/malnutrition group was observed in the left temporal area.

Conclusions

Dementia was found to be an independent predictor for the risk of malnutrition compared with CU participants. Our findings further suggest that cortical thinning in left temporal regions is related to the nutritional status.

Migration and cognitive function: a conceptual framework for Global Health Research

BACKGROUND

Migration is a fundamental demographic process that has been observed globally. It is suggested that migration is an issue of global health importance that can have an immediate and lasting impact on an individual's health and well-being. There is now an increasing body of evidence linking migration with cognitive function in older adults. In this paper, we synthesized the current evidence to develop a general conceptual framework to understand the factors contributing to the association between migration and cognitive function.

METHODS

A comprehensive review of the literature was conducted on the associations between migration and cognition among middle-aged and older adults.

RESULTS

Five potential mechanisms were identified from the literature: 1) socioeconomic status-including education, occupation, and income; 2) psychosocial factors-including social networks, social support, social stressors, and discrimination; 3) behavioral factors-including smoking, drinking, and health service utilization; 4) physical and psychological health status-including chronic conditions, physical function, and depression; and 5) environmental factors-including both physical and social environment. Several underlying factors were also identified-including early-life conditions, gender, and genetic factors.

CONCLUSIONS

The factors linking migration and cognitive function are multidimensional and complex. This conceptual framework highlights potential implications for global health policies and planning on healthy aging and migrant health. Additional studies are needed to further examine these mechanisms to extend and refine our general conceptual framework.

Effects of Long-Term Treatment with a Blend of Highly Purified Olive Secoiridoids on Cognition and Brain ATP Levels in Aged NMRI Mice

Aging represents a major risk factor for developing neurodegenerative diseases such as Alzheimer's disease (AD). As components of the Mediterranean diet, olive polyphenols may play a crucial role in the prevention of AD. Since mitochondrial dysfunction acts as a final pathway in both brain aging and AD, respectively, the effects of a mixture of highly purified olive secoiridoids were tested on cognition and ATP levels in a commonly used mouse model for brain aging. Over 6 months, female NMRI mice (12 months of age) were fed with a blend containing highly purified olive secoiridoids (POS) including oleuropein, hydroxytyrosol and oleurosid standardized for 50 mg oleuropein/kg diet (equivalent to 13.75 mg POS/kg b.w.) or the study diet without POS as control. Mice aged 3 months served as young controls. Behavioral tests showed deficits in cognition in aged mice. Levels of ATP and mRNA levels of NADH-reductase, cytochrome-c-oxidase, and citrate synthase were significantly reduced in the brains of aged mice indicating mitochondrial dysfunction. Moreover, gene expression of Sirt1, CREB, Gap43, and GPx-1 was significantly reduced in the brain tissue of aged mice. POS-fed mice showed improved spatial working memory. Furthermore, POS restored brain ATP levels in aged mice which were significantly increased. Our results show that a diet rich in purified olive polyphenols has positive long-term effects on cognition and energy metabolism in the brain of aged mice.

Cognitive Health Promotion Program for Community-Dwelling Seniors: Who Are We Reaching?

This exploratory study examines the reach of Jog Your Mind, a multifactorial community-based program promoting cognitive vitality among seniors with no known cognitive impairment. The aim was to determine whether the program successfully reached its target population and to compare the characteristics of participants (sociodemographic, health, lifestyle, attitudes, and cognitive profile) with the general population of seniors. Twenty-three community organizations recruited 294 community-dwelling seniors willing to participate in the program. Descriptive analyses revealed that the participants were mostly Canadian-born educated women living alone. Participants' health profile and lifestyle behaviors were fairly similar to those of seniors in Québec and Canada. A large proportion of the participants were concerned about their memory. These results suggest that the program did not attract many hard-to-reach members of the population and reached seniors who may have had some cognitive challenges. Cues to action for improving the reach of cognitive health promotion programs are discussed.

Perceived control and cognition in adulthood: The mediating role of physical activity

The cognitive benefits of a greater sense of control are well-established; however, only recently have the mechanisms involved in this relationship been explored. Because of its well-established cognitive benefits and positive relationship to perceived control, physical activity has been suggested as a potential mediator. However, with age, not only does cognition tend to decline, but so does one's perception of control and their level of physical activity. Therefore, it is important to understand the relationship between these variables from a life span perspective. The goal of the current study was to expand on past work that investigated physical activity as a mediator between perceived control and change in cognition across 4 years to a multi-decade perspective that examines these variables as they change from midlife to older adulthood. To do so, we used longitudinal data across 20 years from the Midlife in the United States Study. Our results show that perceiving more control over one's life predicted less decline in cognition 20 years later, and this relationship was mediated by an increase in physical activity. We consider limitations and future directions to further our understanding of the role of physical activity in the relationship between perceived control and cognitive aging. (PsycINFO Database Record

Essential Dietary Bioactive Lipids in Neuroinflammatory Diseases

SIGNIFICANCE

Under physiological conditions, neurons and glia are in a healthy, redox-balanced environment; when injury perturbs this equilibrium, a neuroinflammatory state is established by activated microglia that triggers pro-inflammatory responses and alters the oxidant/antioxidant balance, thus leading to neuronal loss and neurodegeneration. In neurodegenerative diseases (such as Alzheimer's disease, Parkinson's disease, amyothrophic lateral sclerosis, and multiple sclerosis), the brain is in a constitutively self-sustaining cycle of inflammation and oxidative stress that prompts and amplifies brain damage. Recent Advances: Recently, an increasing amount of scientific data highlight the ability of specific nutrients to cross the blood-brain barrier, and to modulate inflammatory and oxidative pathways. Therefore, nutritional approaches may contribute to restore the lost equilibrium among factors accounting for neurodegeneration.

CRITICAL ISSUES

Herein, we critically examine how essential lipids (including fatty acids, liposoluble vitamins and phytosterols) might contribute to accelerate or prevent the onset and progression of such pathologies. In particular, we highlight that experimental and clinical findings, although promising, are still inadequate to draw definitive conclusions.

FUTURE DIRECTIONS

More research is warranted in order to establish the real impact of lipid intake on brain health, especially when redox balance and inflammatory responses have been already compromised. In the future, it would be hoped to gain a detailed knowledge of chemical modifications and dynamic properties of such nutrients, before planning to exploit them as potential therapeutics. Antioxid. Redox Signal. 29, 37-60.

Prospective Associations between Single Foods, Alzheimer's Dementia and Memory Decline in the Elderly

Background: Evidence whether single &ldquo;cognitive health&rdquo; foods could prevent cognitive decline is limited. We investigated whether dietary intake of red wine, white wine, coffee, green tea, olive oil, fresh fish, fruits and vegetables, red meat and sausages, assessed by a single-food-questionnaire, would be associated with either incident Alzheimer&rsquo;s dementia (AD) or verbal memory decline. Methods: Participants aged 75+ of the German Study on Aging, Cognition and Dementia in Primary Care Patients (AgeCoDe) cohort were regularly followed over 10 years (n = 2622; n = 418 incident AD cases). Multivariable-adjusted joint modeling of repeated-measures and survival analysis was used, taking gender and Apolipoprotein E4 (APOE &epsilon;4) genotype into account as possible effect modifiers. Results: Only higher red wine intake was associated with a lower incidence of AD (HR = 0.92; P = 0.045). Interestingly, this was true only for men (HR = 0.82; P < 0.001), while in women higher red wine intake was associated with a higher incidence of AD (HR = 1.15; P = 0.044), and higher white wine intake with a more pronounced memory decline over time (HR = &minus;0.13; P = 0.052). Conclusion: We found no evidence for these single foods to be protective against cognitive decline, with the exception of red wine, which reduced the risk for AD only in men. Women could be more susceptible to detrimental effects of alcohol.

Neuro-nutrients as anti-alzheimer's disease agents: A critical review

Alzheimer's disease (AD) is characterized by a massive neuronal death causing memory loss, cognitive impairment and behavioral alteration that ultimately lead to dementia and death. AD is a multi-factorial pathology controlled by molecular events such as oxidative stress, protein aggregation, mitochondrial dysfunction and neuro inflammation. Nowadays, there is no efficient disease-modifying treatment for AD and epidemiological studies have suggested that diet and nutrition have a significant impact on the development of this disorder. Indeed, some nutrients can protect all kind of cells, including neurons. As prevention is better than cure, life style improvement, with a special emphasis on diet, should seriously be considered as an anti-AD track and intake of nutrients promoting neuronal health is the need of the hour. Diets rich in unsaturated fatty acids, polyphenols and vitamins have been shown to protect against AD, whereas saturated fatty acids-containing diets deprived of polyphenols promote the development of the disease. Thus, Mediterranean diets, mainly composed of fruits, vegetables and omega-3 fatty acids, stand as valuable, mild and preventive anti-AD agents. This review focuses on our current knowledge in the field and how one can fight this devastating neurodegenerative disorder through the simple proper modification of our life style.

Inflammation in CNS neurodegenerative diseases

Neurodegenerative diseases, the leading cause of morbidity and disability, are gaining increased attention as they impose a considerable socioeconomic impact, due in part to the ageing community. Neuronal damage is a pathological hallmark of Alzheimer's and Parkinson's diseases, amyotrophic lateral sclerosis, Huntington's disease, spinocerebellar ataxia and multiple sclerosis, although such damage is also observed following neurotropic viral infections, stroke, genetic white matter diseases and paraneoplastic disorders. Despite the different aetiologies, for example, infections, genetic mutations, trauma and protein aggregations, neuronal damage is frequently associated with chronic activation of an innate immune response in the CNS. The growing awareness that the immune system is inextricably involved in shaping the brain during development as well as mediating damage, but also regeneration and repair, has stimulated therapeutic approaches to modulate the immune system in neurodegenerative diseases. Here, we review the current understanding of how astrocytes and microglia, as well as neurons and oligodendrocytes, shape the neuroimmune response during development, and how aberrant responses that arise due to genetic or environmental triggers may predispose the CNS to neurodegenerative diseases. We discuss the known interactions between the peripheral immune system and the brain, and review the current concepts on how immune cells enter and leave the CNS. A better understanding of neuroimmune interactions during development and disease will be key to further manipulating these responses and the development of effective therapies to improve quality of life, and reduce the impact of neuroinflammatory and degenerative diseases.

The Neuroprotective Effects of Thymoquinone: A Review

Thymoquinone (TQ), one of the main components active of Nigella sativa, exhibited very useful biomedical effects such as anti-inflammatory, antioxidant, antimicrobial, antiparasitic, anticancer, hypoglycemic, antihypertensive, and antiasthmatic effects. There are several studies about pharmacological activities of TQ but its neuroprotection effects are not fully described. The literature search has indicated many studies pertaining to the effects of TQ in neurological problems such as epilepsy, parkinsonism, anxiety, and improvement of learning and memory, and so on. In addition, TQ protected brain cells from various injuries due to its antioxidant, anti-inflammatory, and apoptotic effects in cell line and experimental animal models. The present study has been designed to review the scientific literature about the pharmacological activities of TQ to the neurological diseases. This study purposed that although experimental studies indicated the beneficial effects of TQ against nervous system problems, better designed clinical trials in humans are needed to confirm these effects.

Occlusal force is correlated with cognitive function directly as well as indirectly via food intake in community-dwelling older Japanese: From the SONIC study

BACKGROUND

Growing evidence suggests that oral health may be an important factor associated with cognitive function in aged populations. However, many previous studies on this topic used insensitive oral indicators or did not include certain essential covariates. Thus, we examined the association between occlusal force and cognitive function in a large sample of older adults, controlling for dietary intake, vascular risk factors, inflammatory biomarkers, depression, and genetic factors.

METHODS

In this cross-sectional study of older community-dwelling Japanese adults, we examined data collected from 994 persons aged 70 years and 968 persons aged 80 years. Cognitive function was measured using the Japanese version of the Montreal Cognitive Assessment (MoCA-J). Oral status and function were evaluated according to the number of remaining teeth, periodontal pocket depth, and maximal occlusal force. Associations between MoCA-J scores and occlusal force were investigated via bivariate and multivariate analyses.

RESULTS

Education level, financial status, depression score, and intake of green and yellow vegetables, as well as number of teeth and occlusal force, were significantly correlated with MoCA-J scores in both age groups. Among individuals aged 80 years, CRP and periodontal status were weakly but significantly associated with MoCA-J score. After controlling for all significant variables via bivariate analyses, the correlation between maximal occlusal force and cognitive function persisted. A path analysis confirmed the hypothesis that cognitive function is associated with occlusal force directly as well as indirectly via food intake.

CONCLUSIONS

After controlling for possible factors, maximal occlusal force was positively associated with cognitive function directly as well as indirectly through dietary intake.

A high-glycemic diet is associated with cerebral amyloid burden in cognitively normal older adults

Background: Little is known about the relation between dietary intake and cerebral amyloid accumulation in aging.Objective: We assessed the association of dietary glycemic measures with cerebral amyloid burden and cognitive performance in cognitively normal older adults.Design: We performed cross-sectional analyses relating dietary glycemic measures [adherence to a high-glycemic-load diet (HGLDiet) pattern, intakes of sugar and carbohydrates, and glycemic load] with cerebral amyloid burden (measured by florbetapir F-18 positron emission tomography) and cognitive performance in 128 cognitively normal older adults who provided eligibility screening data for the University of Kansas's Alzheimer's Prevention through Exercise (APEX) Study. The study began in November 2013 and is currently ongoing.Results: Amyloid was elevated in 26% (n = 33) of participants. HGLDiet pattern adherence (P = 0.01), sugar intake (P = 0.03), and carbohydrate intake (P = 0.05) were significantly higher in participants with elevated amyloid burden. The HGLDiet pattern was positively associated with amyloid burden both globally and in all regions of interest independently of age, sex, and education (all P ≤ 0.001). Individual dietary glycemic measures (sugar intake, carbohydrate intake, and glycemic load) were also positively associated with global amyloid load and nearly all regions of interest independently of age, sex, and educational level (P ≤ 0.05). Cognitive performance was associated only with daily sugar intake, with higher sugar consumption associated with poorer global cognitive performance (global composite measure and Mini-Mental State Examination) and performance on subtests of Digit Symbol, Trail Making Test B, and Block Design, controlling for age, sex, and education.Conclusion: A high-glycemic diet was associated with greater cerebral amyloid burden, which suggests diet as a potential modifiable behavior for cerebral amyloid accumulation and subsequent Alzheimer disease risk. This trial was registered at clinicaltrials.gov as NCT02000583.

What is the best combination treatment with transarterial chemoembolization of unresectable hepatocellular carcinoma? a systematic review and network meta-analysis

OBJECTIVE

To assess the comparative efficacy and safety of combination treatment with transarterial chemoembolization (TACE) for patients with unresectable hepatocellular carcinoma (HCC) through a systematic review and network meta-analysis and to identify what is the best combination treatment with TACE.

MATERIALS AND METHODS

A network meta-analysis was used to identify evidence from relevant randomized controlled trials. We searched databases for publications up to June 2017. The prespecified primary efficacy outcomes were treatment response and 6-month to 3-year overall survival (OS), while the secondary efficacy outcomes were 1- and 2-year disease-free survival (DFS); safety outcomes were advance effects of combination treatment. We conducted pairwise meta-analyses using a random-effects model and then performed random-effects network meta-analyses.

RESULTS

A total of 48 trials were eligible (50 analyses), involving 5627 patients and 19 treatment arms. In comparison with other types of combination therapy arms, network meta-analysis disclosed that TACE + three-dimensional conformal radiotherapy, TACE + percutaneous ethanol injection, TACE + percutaneous microwave coagulation therapy, TACE + percutaneous acetic acid injection, and TACE + sorafenib were the more effective methods in treatment response, 6-month to 3-year OS, and 1-2 year DFS; the adverse effects of TACE + sorafenib were serious. The study was registered with PROSPERO, number CRD42017071102.

CONCLUSIONS

When considering the efficacy, combination therapy with TACE seemed to offer clear advantages for patients with unresectable HCC. TACE + Three-dimensional conformal radiotherapy, TACE + Percutaneous ethanol injection, TACE + Percutaneous microwave coagulation therapy, and TACE + Percutaneous acetic acid injection are likely the best options to consider in the application of combination treatment.

Comparing the long-term efficacy of standard and combined minimally invasive procedures for unresectable HCC: a mixed treatment comparison

A small proportion of hepatocellular carcinoma (HCC) patients are suitable for surgical resections and various minimally invasive procedures have been introduced as alternatives to surgical resections. However, the relative efficacy of minimally invasive procedures remains to be studied in the current literature. Several popular minimally invasive procedures (monotherapy or combined therapies) were selected for comparison and their relative long-term efficacy were determined by using the statistics of hazard ratio (HR) which evaluates the survival status of HCC patients in one, two, three and four years, respectively. Evidence were obtained from the current literature and synthesized by using the approach of conventional pairwise meta-analysis and network meta-analysis (NMA). Moreover, selected minimally invasive procedures were ranked according to their surface under the cumulative ranking curve (SUCRA) which was produced by NMA in conjunction with the Markov Chain Monte Carlo (MCMC) sampling method. HCC patients treated by combined minimally invasive procedures, particularly transcatheter arterial chemoembolization (TACE) + high intensity focused ultrasound (HIFU), TACE + radiofrequency ablation (RFA), TACE + radiotherapy (RT) and TACE + Sorafenib (SOR) exhibited a significant decrease in the HR compared to those with standard TACE (HR < 1). The combined minimally invasive procedure of TACE + HIFU appears to be the most preferable therapy. PEI seems to be less favorable than other minimally invasive procedures. Combined minimally invasive procedures may be more preferable than standard minimally invasive procedures. Percutaneous ethanol injection (PEI) may not provide adequate efficacy compared to other minimally invasive procedures for unresectable HCC patients.

Effectiveness of omega-3 fatty acid supplementation in patients with Alzheimer disease: A systematic review and meta-analysis

INTRODUCTION

Alzheimer disease (AD) is a neurodegenerative disease characterised by progressive dementia associated with global cognitive dysfunction.

METHODS

We conducted a systematic review and meta-analysis of clinical trials evaluating omega-3 supplementation in patients with AD.

OBJECTIVE

To determine if there is scientific evidence of the effectiveness of omega-3 supplementation in improving cognitive function in patients with AD.

SEARCH STRATEGY

We included only randomised controlled trials (RCTs) from the following databases: Medline, Cochrane Central, Cinahl, and LILACS. An electronic search was also conducted using Google Scholar.

STUDY SELECTION

Six articles met the eligibility criteria. The risk of bias was assessed following the Cochrane method.

CONCLUSION

There is no consistent evidence to support the effectiveness of omega-3 supplementation in improving cognitive function in AD patients in the short and medium term.

Inhibitory Effect of Lycopene on Amyloid-β-Induced Apoptosis in Neuronal Cells

Alzheimer′s disease (AD) is a fatal neurodegenerative disease. Brain amyloid-β deposition is a crucial feature of AD, causing neuronal cell death by inducing oxidative damage. Reactive oxygen species (ROS) activate NF-κB, which induces expression of Nucling. Nucling is a pro-apoptotic factor recruiting the apoptosome complex. Lycopene is an antioxidant protecting from oxidative stress-induced cell damage. We investigated whether lycopene inhibits amyloid-β-stimulated apoptosis through reducing ROS and inhibiting mitochondrial dysfunction and NF-κB-mediated Nucling expression in neuronal SH-SY5Y cells. We prepared cells transfected with siRNA for Nucling or nontargeting control siRNA to determine the role of Nucling in amyloid-β-induced apoptosis. The amyloid-β increased intracellular and mitochondrial ROS levels, apoptotic indices (p53, Bax/Bcl-2 ratio, caspase-3 cleavage), NF-kB activation and Nucling expression, while cell viability, mitochondrial membrane potential, and oxygen consumption rate decreased in SH-SY5Y cells. Lycopene inhibited these amyloid-β-induced alterations. However, amyloid-β did not induce apoptosis, determined by cell viability and apoptotic indices (p53, Bax/Bcl-2 ratio, caspase-3 cleavage), in the cells transfected with siRNA for Nucling. Lycopene inhibited apoptosis by reducing ROS, and by inhibiting mitochondrial dysfunction and NF-κB-target gene Nucling expression in neuronal cells. Lycopene may be beneficial for preventing oxidative stress-mediated neuronal death in patients with neurodegeneration.