Glucose enhancement of performance on memory tests in young and aged humans

Energetically efficient learning in neuronal networks

Human and animal experiments have shown that acquiring and storing information can require substantial amounts of metabolic energy. However, computational models of neural plasticity only seldom take this cost into account, and might thereby miss an important constraint on biological learning. This review explores various ways to reduce energy requirements for learning in neural networks. By comparing the resulting learning rules to cognitive and neurophysiological observations, we discuss how energy efficiency might have shaped biological learning.

Associations between circulating cardiovascular disease risk factors and cognitive performance in cognitively healthy older adults from the NuAge study

Introduction

Cardiovascular disease risk factors (CVRFs) contribute to the development of cognitive impairment and dementia.

Methods

This study examined the associations between circulating CVRF biomarkers and cognition in 386 cognitively healthy older adults (mean age = 78 ± 4 years, 53% females) selected from the Quebec Longitudinal Study on Nutrition and Successful Aging (NuAge). Memory, executive function, and processing speed were assessed at baseline and 2-year follow-up. CVRF biomarkers included total cholesterol, high-density lipoprotein cholesterol (HDL-C), low-density lipoprotein-cholesterol (LDL-C), triglycerides, glucose, insulin, high sensitivity C-reactive protein (hs-CRP), homocysteine, protein carbonyls, and cortisol. Linear mixed models were used to determine associations between individual CVRF biomarkers and cognition at both time points.

Results

HDL-C was most consistently associated with cognition with higher values related to better performance across several domains. Overall, stronger and more consistent relationships between CVRF biomarkers and cognition were observed in females relative to males.

Discussion

Findings suggest that increases in the majority of circulating CVRFs are not associated with worse cognition in cognitively healthy older adults.

Hypometabolism, Alzheimer's Disease, and Possible Therapeutic Targets: An Overview

The brain is a highly dynamic organ that requires a constant energy source to function normally. This energy is mostly supplied by glucose, a simple sugar that serves as the brain's principal fuel source. Glucose transport across the blood-brain barrier (BBB) is primarily controlled via sodium-independent facilitated glucose transport, such as by glucose transporter 1 (GLUT1) and 3 (GLUT3). However, other glucose transporters, including GLUT4 and the sodium-dependent transporters SGLT1 and SGLT6, have been reported in vitro and in vivo. When the BBB endothelial layer is crossed, neurons and astrocytes can absorb the glucose using their GLUT1 and GLUT3 transporters. Glucose then enters the glycolytic pathway and is metabolized into adenosine triphosphate (ATP), which supplies the energy to support cellular functions. The transport and metabolism of glucose in the brain are impacted by several medical conditions, which can cause neurological and neuropsychiatric symptoms. Alzheimer's disease (AD), Parkinson's disease (PD), epilepsy, traumatic brain injury (TBI), schizophrenia, etc., are a few of the most prevalent disorders, characterized by a decline in brain metabolism or hypometabolism early in the course of the disease. Indeed, AD is considered a metabolic disorder related to decreased brain glucose metabolism, involving brain insulin resistance and age-dependent mitochondrial dysfunction. Although the conventional view is that reduced cerebral metabolism is an effect of neuronal loss and consequent brain atrophy, a growing body of evidence points to the opposite, where hypometabolism is prodromal or at least precedes the onset of brain atrophy and the manifestation of clinical symptoms. The underlying processes responsible for these glucose transport and metabolic abnormalities are complicated and remain poorly understood. This review article provides a comprehensive overview of the current understanding of hypometabolism in AD and potential therapeutic targets.

Sex Differences in Cognition Across Aging

Sex and gender differences are seen in cognitive disturbances in a variety of neurological and psychiatry diseases. Men are more likely to have cognitive symptoms in schizophrenia whereas women are more likely to have more severe cognitive symptoms with major depressive disorder and Alzheimer's disease. Thus, it is important to understand sex and gender differences in underlying cognitive abilities with and without disease. Sex differences are noted in performance across various cognitive domains - with males typically outperforming females in spatial tasks and females typically outperforming males in verbal tasks. Furthermore, there are striking sex differences in brain networks that are activated during cognitive tasks and in learning strategies. Although rarely studied, there are also sex differences in the trajectory of cognitive aging. It is important to pay attention to these sex differences as they inform researchers of potential differences in resilience to age-related cognitive decline and underlying mechanisms for both healthy and pathological cognitive aging, depending on sex. We review literature on the progressive neurodegenerative disorder, Alzheimer's disease, as an example of pathological cognitive aging in which human females show greater lifetime risk, neuropathology, and cognitive impairment, compared to human males. Not surprisingly, the relationships between sex and cognition, cognitive aging, and Alzheimer's disease are nuanced and multifaceted. As such, this chapter will end with a discussion of lifestyle factors, like education and diet, as modifiable factors that can alter cognitive aging by sex. Understanding how cognition changes across age and contributing factors, like sex differences, will be essential to improving care for older adults.

Effect of glucose and sucrose on cognition in healthy humans: a systematic review and meta-analysis of interventional studies

CONTEXT

Evidence suggests that plasma glucose levels may influence cognitive performance, but this has not been systematically reviewed and quantified.

OBJECTIVE

The aim of this review was to investigate the potential effects of glucose and sucrose, compared with placebo, on cognition in healthy humans.

DATA SOURCES

The electronic databases PubMed and Web of Science were searched up to December 2019. Reference lists of selected articles were checked manually.

STUDY SELECTION

Randomized controlled trials or crossover trials that compared glucose or sucrose with placebo for effects on cognition were eligible.

DATA EXTRACTION

Potentially eligible articles were selected independently by 2 authors. Risk of bias was assessed through the Cochrane Collaboration tool. Standardized mean differences (SMDs) were obtained from random-effects meta-analyses for a subsample of studies that reported the same outcomes.

RESULTS

Thirty-seven trials were identified, of which 35 investigated the effect of glucose consumption compared with placebo on cognition. Two studies found no effect of glucose on cognition, while the others found mixed results. Only 3 of the 37 studies investigated the effects of sucrose intake, reporting mixed results. Meta-analyses revealed a significantly positive effect of glucose compared with control, but only when a verbal performance test (immediate word recall) was used in parallel-design studies (SMD = 0.61; 95%CI, 0.20-1.02; I2 = 0%). Twenty-four studies were classified as having high risk of bias for the selection procedure.

CONCLUSIONS

A limited body of evidence shows a beneficial effect of glucose in individuals performing immediate verbal tasks. High-quality trials with standardized cognitive measurements are needed to better establish the effect of glucose or sucrose on cognition.

SYSTEMATIC REVIEW REGISTRATION

PROSPERO registration number CRD42019122939.

Western diet, obesity and bariatric surgery sequentially modulated anxiety, eating patterns and brain responses to sucrose in adult Yucatan minipigs

Palatable sweet/fatty foods overconsumption is a major risk factor for obesity and eating disorders, also having an impact on neuro-behavioural hedonic and cognitive components comparable to what is described for substance abuse. We hypothesized that Yucatan minipigs would show hedonic, cognitive, and affective neuro-behavioral shifts when subjected to western diet (WD) exposure without weight gain, after the onset of obesity, and finally after weight loss induced by caloric restriction with (RYGB) or without (Sham) gastric bypass. Eating behavior, cognitive and affective abilities were assessed with a spatial discrimination task (holeboard test) and two-choice feed tests. Brain responses to oral sucrose were mapped using 18F-FDG positron emission tomography. WD exposure impaired working memory and led to an “addiction-type” neuronal pattern involving hippocampal and cortical brain areas. Obesity induced anxiety-like behavior, loss of motivation, and snacking-type eating behavior. Weight loss interventions normalized the motivational and affective states but not eating behavior patterns. Brain glucose metabolism increased in gustatory (insula) and executive control (aPFC) areas after weight loss, but RYGB showed higher responses in inhibition-related areas (dorsal striatum). These results showed that diet quality, weight loss, and the type of weight loss intervention differently impacted brain responses to sucrose in the Yucatan minipig model.

Energy efficient synaptic plasticity

Many aspects of the brain’s design can be understood as the result of evolutionary drive toward metabolic efficiency. In addition to the energetic costs of neural computation and transmission, experimental evidence indicates that synaptic plasticity is metabolically demanding as well. As synaptic plasticity is crucial for learning, we examine how these metabolic costs enter in learning. We find that when synaptic plasticity rules are naively implemented, training neural networks requires extremely large amounts of energy when storing many patterns. We propose that this is avoided by precisely balancing labile forms of synaptic plasticity with more stable forms. This algorithm, termed synaptic caching, boosts energy efficiency manifold and can be used with any plasticity rule, including back-propagation. Our results yield a novel interpretation of the multiple forms of neural synaptic plasticity observed experimentally, including synaptic tagging and capture phenomena. Furthermore, our results are relevant for energy efficient neuromorphic designs.

The brain expends a lot of energy. While the organ accounts for only about 2% of a person’s bodyweight, it is responsible for about 20% of our energy use at rest. Neurons use some of this energy to communicate with each other and to process information, but much of the energy is likely used to support learning. A study in fruit flies showed that insects that learned to associate two stimuli and then had their food supply cut off, died 20% earlier than untrained flies. This is thought to be because learning used up the insects’ energy reserves.

If learning a single association requires so much energy, how does the brain manage to store vast amounts of data? Li and van Rossum offer an explanation based on a computer model of neural networks. The advantage of using such a model is that it is possible to control and measure conditions more precisely than in the living brain.

Analysing the model confirmed that learning many new associations requires large amounts of energy. This is particularly true if the memories must be stored with a high degree of accuracy, and if the neural network contains many stored memories already. The reason that learning consumes so much energy is that forming long-term memories requires neurons to produce new proteins. Using the computer model, Li and van Rossum show that neural networks can overcome this limitation by storing memories initially in a transient form that does not require protein synthesis. Doing so reduces energy requirements by as much as 10-fold.

Studies in living brains have shown that transient memories of this type do in fact exist. The current results hence offer a hypothesis as to how the brain can learn in a more energy efficient way. Energy consumption is thought to have placed constraints on brain evolution. It is also often a bottleneck in computers. By revealing how the brain encodes memories energy efficiently, the current findings could thus also inspire new engineering solutions.

Fasting enhances extinction retention and prevents the return of fear in humans

Fear is prone to return following extinction that is the basis of exposure therapy for fear-related disorders. Manipulations that enhance the extinction process can be beneficial for treatment. Animal studies have shown that fasting or caloric restriction can enhance extinction and inhibit the return of fear. The present study examined the effects of fasting on fear acquisition, extinction, and the return of fear in humans. One hundred and twenty-five male participants were randomized into a fasting group and food group and exposed to a Pavlovian fear conditioning paradigm. Changes in plasma cortisol and ghrelin levels were examined using enzyme-linked immunosorbent assays. One-night fasting had no effect on fear acquisition but enhanced fear extinction retention and prevented the return of fear, and this effect persisted for at least 6 months. This procedure was also effective for remote fear memory. Plasma ghrelin levels were elevated after fasting and had a negative relationship with the fear response in spontaneous recovery test. However, overnight fasting did not affect cortisol levels. These findings indicate that fasting enhances extinction retention and prevents the return of fear, without influencing fear memory formation. We propose that this novel procedure may open new avenues for promoting extinction-based therapies for fear-related disorders.

Mental Work Requires Physical Energy: Self-Control Is Neither Exception nor Exceptional

The brain’s reliance on glucose as a primary fuel source is well established, but psychological models of cognitive processing that take energy supply into account remain uncommon. One exception is research on self-control depletion, where debate continues over a limited-resource model. This model argues that a transient reduction in self-control after the exertion of prior self-control is caused by the depletion of brain glucose, and that self-control processes are special, perhaps unique, in this regard. This model has been argued to be physiologically implausible in several recent reviews. This paper attempts to correct some inaccuracies that have occurred during debate over the physiological plausibility of this model. We contend that not only is such limitation of cognition by constraints on glucose supply plausible, it is well established in the neuroscience literature across several cognitive domains. Conversely, we argue that there is no evidence that self-control is special in regard to its metabolic cost. Mental processes require physical energy, and the body is limited in its ability to supply the brain with sufficient energy to fuel mental processes. This article reviews current findings in brain metabolism and seeks to resolve the current conflict in the field regarding the physiological plausibility of the self-control glucose-depletion hypothesis.

The Effects of Carbohydrates, in Isolation and Combined with Caffeine, on Cognitive Performance and Mood-Current Evidence and Future Directions

This review examines the effects of carbohydrates, delivered individually and in combination with caffeine, on a range of cognitive domains and subjective mood. There is evidence for beneficial effects of glucose at a dose of 25 g on episodic memory, but exploration of dose effects has not been systematic and the effects on other cognitive domains is not known. Factors contributing to the differential sensitivity to glucose facilitation include age, task difficulty/demand, task domain, and glucoregulatory control. There is modest evidence to suggest modulating glycemic response may impact cognitive function. The evidence presented in this review identifies dose ranges of glucose and caffeine which improve cognition, but fails to find convincing consistent synergistic effects of combining caffeine and glucose. Whilst combining glucose and caffeine has been shown to facilitate cognitive performance and mood compared to placebo or glucose alone, the relative contribution of caffeine and glucose to the observed effects is difficult to ascertain, due to the paucity of studies that have appropriately compared the effects of these ingredients combined and in isolation. This review identifies a number of methodological challenges which need to be considered in the design of future hypothesis driven research in this area.

The impact of diet-based glycaemic response and glucose regulation on cognition: evidence across the lifespan

The brain has a high metabolic rate and its metabolism is almost entirely restricted to oxidative utilisation of glucose. These factors emphasise the extreme dependence of neural tissue on a stable and adequate supply of glucose. Whereas initially it was thought that only glucose deprivation (i.e. under hypoglycaemic conditions) can affect brain function, it has become apparent that low-level fluctuations in central availability can affect neural and consequently, cognitive performance. In the present paper the impact of diet-based glycaemic response and glucose regulation on cognitive processes across the lifespan will be reviewed. The data suggest that although an acute rise in blood glucose levels has some short-term improvements of cognitive function, a more stable blood glucose profile, which avoids greater peaks and troughs in circulating glucose is associated with better cognitive function and a lower risk of cognitive impairments in the longer term. Therefore, a habitual diet that secures optimal glucose delivery to the brain in the fed and fasting states should be most advantageous for the maintenance of cognitive function. Although the evidence to date is promising, it is insufficient to allow firm and evidence-based nutritional recommendations. The rise in obesity, diabetes and metabolic syndrome in recent years highlights the need for targeted dietary and lifestyle strategies to promote healthy lifestyle and brain function across the lifespan and for future generations. Consequently, there is an urgent need for hypothesis-driven, randomised controlled trials that evaluate the role of different glycaemic manipulations on cognition.

Glucose Effects on Memory and Other Neuropsychological Tests in Elderly Humans

Recent experiments indicate that peripheral glucose administration enhances memory in rodents and humans. This study examined the effects of glucose on memory and nonmemory measures of neuropsychological functioning in elderly humans. Healthy older adults were given a series of neuropsychological tests after drinking glucose- or saccharin-flavored lemonade. A repeated measures design using counter-balanced beverages and tests was used. Glucose enhanced performance on declarative memory tests but not on short-term or nonmemory neuropsychological measures. Glucose tolerance predicted performance on declarative memory tasks but not on other measures.

To work or not to work: Neural representation of cost and benefit of instrumental action

By definition, instrumental actions are performed in order to obtain certain goals. Nevertheless, the attainment of goals typically implies obstacles, and response vigor is known to reflect an integration of subjective benefit and cost. Whereas several brain regions have been associated with cost/benefit ratio decision-making, trial-by-trial fluctuations in motivation are not well understood. We review recent evidence supporting the motivational implications of signal fluctuations in the mesocorticolimbic system. As an extension of "set-point" theories of instrumental action, we propose that response vigor is determined by a rapid integration of brain signals that reflect value and cost on a trial-by-trial basis giving rise to an online estimate of utility. Critically, we posit that fluctuations in key nodes of the network can predict deviations in response vigor and that variability in instrumental behavior can be accounted for by models devised from optimal control theory, which incorporate the effortful control of noise. Notwithstanding, the post hoc analysis of signaling dynamics has caveats that can effectively be addressed in future research with the help of two novel fMRI imaging techniques. First, adaptive fMRI paradigms can be used to establish a time-order relationship, which is a prerequisite for causality, by using observed signal fluctuations as triggers for stimulus presentation. Second, real-time fMRI neurofeedback can be employed to induce predefined brain states that may facilitate benefit or cost aspects of instrumental actions. Ultimately, understanding temporal dynamics in brain networks subserving response vigor holds the promise for targeted interventions that could help to readjust the motivational balance of behavior.

Effects of glucose load on cognitive functions in elderly people

Glucose is the main fuel for the brain, and manipulation of the glucose supply may consequently affect brain function. The present review was conducted to provide an overview of studies that investigated the acute effects of glucose load on memory and other cognitive functions in elderly people. The effects of sucrose on cognition and suggested mechanisms were also explored. A total of twenty studies met the inclusion criteria. In the majority of studies, episodic memory was investigated and a beneficial role for glucose in that specific cognitive domain was suggested. Other cognitive domains, i.e., working memory, semantic memory, visual memory, information-processing speed, attention, executive function, and visual/spatial function, have been studied less frequently and evidence for a beneficial effect of glucose was equivocal. Mechanisms are suggested to be mainly related to the human body's need for glucose as a metabolic substrate for physiological mechanisms in both central and peripheral processes.

Glucose, relational memory, and the hippocampus

RATIONALE

Many studies suggest that glucose can temporarily enhance hippocampal-dependent memories. As the hippocampus plays a key role in associative learning, we examined the influence of glucose on verbal paired associate memory.

OBJECTIVE

This study examines how glucose modifies performance on a relational memory task by examining its influence on learning, subsequent forgetting and relearning.

METHODS

A selective reminding procedure was used to show high and low imagability paired associates to 80 participants, who were seen twice. On the first session, they received 25 g glucose pre-learning, 25 g glucose post-learning or placebo. On the second session, 1 week later, they received 25 g glucose or placebo. Cued-recall was evaluated after each learning trial, 1 week later to assess forgetting and after an opportunity to relearn the material forgotten.

RESULTS

Glucose did not influence paired associate acquisition. Those given glucose pre-learning tended to forget less material the following week, and independently, glucose at retrieval facilitated cued-recall. Both forms of facilitation were equally apparent on low and high imagability pairs. The benefit of glucose pre-learning was eliminated once the paired associates had been seen again, but the benefit of glucose at retrieval extended into the second relearning trial.

CONCLUSIONS

The discussion considers the cognitive processes and hippocampal basis for paired associate learning and retention and the implications for glucose's mode of action. It is proposed that glucose during encoding serves to make the delayed memories initially more available, whereas its influence during delayed retrieval makes available memories temporarily more accessible.

Fasting glucose and glucose tolerance as potential predictors of neurocognitive function among nondiabetic older adults

INTRODUCTION

Significant evidence has demonstrated that Type 2 diabetes mellitus and related precursors are associated with diminished neurocognitive function and risk of dementia among older adults. However, very little research has examined relations of glucose regulation to neurocognitive function among older adults free of these conditions. The primary aim of this investigation was to examine associations among fasting glucose, glucose tolerance, and neurocognitive function among nondiabetic older adults. The secondary aim was to examine age, gender, and education as potential effect modifiers.

METHOD

The study employed a cross-sectional, correlational study design. Participants were 172 older adults with a mean age of 64.43 years (SD = 13.09). The sample was 58% male and 87% White. Participants completed an oral glucose tolerance test as part of a larger study. Trained psychometricians administered neuropsychological tests that assessed performance in the domains of response inhibition, nonverbal memory, verbal memory, attention and working memory, visuoconstructional abilities, visuospatial abilities, psychomotor speed and executive function, and motor speed and manual dexterity. Linear multiple regressions were run to test study aims.

RESULTS

No significant main effects of fasting glucose and 2-hour glucose emerged for performance on any neurocognitive test; however, significant interactions were present. Higher fasting glucose was associated with poorer short-term verbal memory performance among men, but unexpectedly better response inhibition and long-term verbal memory performance for participants over age 70. Higher 2-hour glucose values were associated with reduced divided attention performance among participants with less than a high school education.

CONCLUSIONS

Mixed findings suggest that glucose levels may be both beneficial and deleterious to neurocognition among nondiabetic older adults. Additional studies with healthy older adults are needed to confirm this unexpected pattern of associations; however, findings have implications for the importance of maintaining healthy glucose levels in older adulthood.

Effects of a carbohydrate-electrolyte solution on cognitive performance following exercise-induced hyperthermia in humans

BACKGROUND

There is limited information on the effects of sports drinks on cognitive function after exercise in the heat. We aimed to investigate the effects of ingesting a commercially available carbohydrate-electrolyte (CHO) solution on cognitive performance following exercise-induced hyperthermia.

METHODS

Twelve participants completed three practices of cognitive tests, one full familiarisation and two experimental trials in an environmental chamber (dry bulb temperature: 30.2 ± 0.3°C, relative humidity: 70 ± 3%). The experimental trials consisted of five cognitive tests (symbol digit matching, search and memory, digit span, choice reaction time and psychomotor vigilance test) performed before and after a 75-min run on a treadmill at 70% VO2 max. One ml/kg body mass of a 6.8% CHO solution or placebo was consumed at the start, every 15 min during exercise and between cognitive tests after exercise. Core temperature, heart rate, blood glucose concentrations, subjective ratings and cognitive performance were assessed (symbol digit matching, search and memory, digit span, choice reaction time and psychomotor vigilance).

RESULTS

Participants were hyperthermic at the end of the run (placebo: 39.5 ± 0.4°C, CHO: 39.6 ± 0.5°C; Mean ± SD; p = 0.37). The change in blood glucose was higher with CHO ingestion (1.6, 0.7 to 4.5 mmol/L) (median, range) than with placebo ingestion (0.9, -0.1 to 4.7 mmol/L; p < 0.05). CHO ingestion reduced the maximum span of digits memorized, in contrast to an increase in maximum span with placebo ingestion (p < 0.05). CHO solution had no effect on other cognitive tests (p > 0.05).

CONCLUSIONS

These results suggest that CHO solution ingestion may impair short-term memory following exertional heat stress.

The Influence of Fat Co-administration on the Glucose Memory Facilitation Effect

Memory for a list of 20 words can be enhanced when learning is preceded by consumption of 25 g of glucose, compared with consumption of an equally sweet aspartame solution. The present study examined whether memory performance is also enhanced when glucose is administered in conjunction with another food constituent, in particular fat. Four groups of healthy young participants were tested under one of four conditions: (a) glucose + full-fat yoghurt; (b) glucose + fat-free yoghurt; (c) aspartame + full-fat yoghurt; (d) aspartame + fat-free yoghurt. The groups were compared on measures of blood glucose and cognitive performance. Participants receiving a glucose drink in conjunction with a fat-free yoghurt displayed higher blood glucose levels (BGL) and better performance on short- and long-delay recall of the word list compared with (a) individuals who consumed the glucose drink in conjunction with a full-fat yoghurt and (b) individuals who consumed the aspartame drink. The glycaemic data indicated that the presence of fat slows down glucose absorption. The findings suggest that only foods with a relatively fast glucose absorption rate are able to significantly enhance the encoding and long-term retention of novel memory materials in healthy young adults.

Response variability to glucose facilitation of cognitive enhancement

Glucose facilitation of cognitive function has been widely reported in previous studies (including our own). However, several studies have also failed to detect glucose facilitation. There is sparsity of research examining the factors that modify the effect of glucose on cognition. The aims of the present study were to (1) demonstrate the previously observed enhancement of cognition through glucose administration and (2) investigate some of the factors that may exert moderating roles on the behavioural response to glucose, including glucose regulation, body composition (BC) and hypothalamic–pituitary–adrenal axis response. A total of twenty-four participants took part in a double-blind, placebo-controlled, randomised, repeated-measures study, which examined the effect of 25 and 60 g glucose compared with placebo on cognitive function. At 1 week before the study commencement, all participants underwent an oral glucose tolerance test. Glucose facilitated performance on tasks of numeric and spatial working memory, verbal declarative memory and speed of recognition. Moderating variables were examined using several indices of glucoregulation and BC. Poorer glucoregulation predicted improved immediate word recall accuracy following the administration of 25 g glucose compared with placebo. Those with better glucoregulation showed performance decrements on word recall accuracy following the administration of 25 g glucose compared with placebo. These findings are in line with accumulating evidence that glucose load may preferentially enhance cognition in those with poorer glucoregulation. Furthermore, the finding that individuals with better glucoregulation may suffer impaired performance following a glucose load is novel and requires further substantiation.

Memory enhancement produced by post-training exposure to sucrose-conditioned cues

A number of aversive and appetitive unconditioned stimuli (such as shock and food) are known to produce memory enhancement when they occur during the post-training period. Post-training exposure to conditioned aversive stimuli has also been shown to enhance memory consolidation processes. The present study shows for the first time that post-training exposure to conditioned stimuli previously paired with consumption of a sucrose solution also enhances memory consolidation. Male Long Evans rats were trained on a one-session conditioned cue preference (CCP) task on a radial arm maze. Immediately or 2 hours after training, rats consumed a sucrose solution or were exposed to cues previously paired with consumption of sucrose or cues previously paired with water. Twenty-four hours later, the rats were tested for a CCP. Immediate, but not delayed, post-training consumption of sucrose enhanced memory for the CCP. Immediate, but not delayed, post-training exposure to cues previously paired with sucrose, but not with water, also enhanced CCP memory. The possibility that rewarding and aversive conditioned stimuli affect memory by a common physiological process is discussed.

Insulin in the brain: sources, localization and functions

Historically, insulin is best known for its role in peripheral glucose homeostasis, and insulin signaling in the brain has received less attention. Insulin-independent brain glucose uptake has been the main reason for considering the brain as an insulin-insensitive organ. However, recent findings showing a high concentration of insulin in brain extracts, and expression of insulin receptors (IRs) in central nervous system tissues have gathered considerable attention over the sources, localization, and functions of insulin in the brain. This review summarizes the current status of knowledge of the peripheral and central sources of insulin in the brain, site-specific expression of IRs, and also neurophysiological functions of insulin including the regulation of food intake, weight control, reproduction, and cognition and memory formation. This review also considers the neuromodulatory and neurotrophic effects of insulin, resulting in proliferation, differentiation, and neurite outgrowth, introducing insulin as an attractive tool for neuroprotection against apoptosis, oxidative stress, beta amyloid toxicity, and brain ischemia.

Local amplification of glucocorticoids in the aging brain and impaired spatial memory

The hippocampus is a prime target for glucocorticoids (GCs) and a brain structure particularly vulnerable to aging. Prolonged exposure to excess GCs compromises hippocampal electrophysiology, structure, and function. Blood GC levels tend to increase with aging and correlate with impaired spatial memory in aging rodents and humans. The magnitude of GC action within tissues depends not only on levels of steroid hormone that enter the cells from the periphery and the density of intracellular receptors but also on the local metabolism of GCs by 11β-hydroxysteroid dehydrogenases (11β-HSD). The predominant isozyme in the adult brain, 11β-HSD1, locally regenerates active GCs from inert 11-keto forms thus amplifying GC levels within specific target cells including in the hippocampus and cortex. Aging associates with elevated hippocampal and neocortical 11β-HSD1 and impaired spatial learning while deficiency of 11β-HSD1 in knockout (KO) mice prevents the emergence of cognitive decline with age. Furthermore, short-term pharmacological inhibition of 11β-HSD1 in already aged mice reverses spatial memory impairments. Here, we review research findings that support a key role for GCs with special emphasis on their intracellular regulation by 11β-HSD1 in the emergence of spatial memory deficits with aging, and discuss the use of 11β-HSD1 inhibitors as a promising novel treatment in ameliorating/improving age-related memory impairments.

Thyroid hormone's role in regulating brain glucose metabolism and potentially modulating hippocampal cognitive processes

Cognitive performance is dependent on adequate glucose supply to the brain. Insulin, which regulates systemic glucose metabolism, has been recently shown both to regulate hippocampal metabolism and to be a mandatory component of hippocampally-mediated cognitive performance. Thyroid hormones (TH) regulate systemic glucose metabolism and may also be involved in regulation of brain glucose metabolism. Here we review potential mechanisms for such regulation. Importantly, TH imbalance is often encountered in combination with metabolic disorders such as diabetes, and may cause additional metabolic dysregulation and hence worsening of disease states. TH's potential as a regulator of brain glucose metabolism is heightened by interactions with insulin signaling, but there have been relatively few studies on this topic or on the actions of TH in a mature brain. This review discusses evidence for mechanistic links between TH, insulin, cognitive function, and brain glucose metabolism, and reaches the conclusion that TH may modulate memory processes, likely at least in part by modulation of central insulin signaling and glucose metabolism.

[Changes in cognitive function in patients with diabetes mellitus]

Patients with diabetes are approximately 1.5 times more likely to experience cognitive decline than individuals without diabetes mellitus. Most of the data suggest that patients with diabetes have reduced performance in numerous domains of cognitive function. In patients with type 1 diabetes, specific and global deficits involving speed of psychomotor efficiency, information processing, mental flexibility, attention, and visual perception seem to be present, while in patients with type 2 diabetes an increase in memory deficits, a reduction in psychomotor speed, and reduced frontal lobe (executive) functions have been found. The complex pathophysiology of changes in the central nervous system in diabetes has not yet been fully elucidated. It is important to consider the patient's age at the onset of diabetes, the glycemic control status, and the presence of diabetic complications. Neurological consequences of diabetes appear parallel to those observed in the aging brain. Neuroimaging studies highlight several structural cerebral changes, cortical and subcortical atrophy, beside increased leukoaraiosis that occurs in association with diabetes. There is supporting evidence from many hypotheses to explain the pathophysiology of cognitive decline associated with diabetes. The main hypotheses pointing to the potential, implied mechanisms involve hyperglycemia, hypoglycemia, microvascular disease, insulin resistance, hyperinsulinism, hyperphosphorylation of tau protein, and amyloid-β deposition.

The effect of glucose dose and fasting interval on cognitive function: a double-blind, placebo-controlled, six-way crossover study

RATIONALE

Previous research has identified a number of factors that appear to moderate the behavioural response to glucose administration. These include physiological state, dose, types of cognitive tasks used and level of cognitive demand. Another potential moderating factor is the length of the fasting interval prior to a glucose load.

OBJECTIVES

Therefore, we aimed to examine the effect of glucose dose and fasting interval on mood and cognitive function.

METHODS

The current study utilised a double-blind, placebo-controlled, balanced, six period crossover design to examine potential interactions between length of fasting interval (2 versus 12 hours) and optimal dose for cognition enhancement.

RESULTS

Results demonstrated that the higher dose (60 g) increased working memory performance following an overnight fast, whereas the lower dose (25 g) enhanced working memory performance following a 2-h fast.

CONCLUSIONS

The data suggest that optimal glucose dosage may differ under different conditions of depleted blood glucose resources. In addition, glucoregulation was observed to be a moderating factor. However, further research is needed to develop a model of the moderating and mediating factors under which glucose facilitation is best achieved.

The Impact of Age and Task Domain on Cognitive Performance: A Meta-Analytic Review of the Glucose Facilitation Effect

Considerable research has been devoted to the issue of whether the ingestion of glucose enhances cognitive performance in both younger and older adults. However, it has proven difficult to draw firm conclusions from this literature due to the diversity of methodologies that have been used, and it is therefore still unclear what factors might moderate the facilitative effect. The present study investigates methodological variations and their impact on the magnitude of the glucose enhancement effect. In particular, age group (young vs. old) and task domain (memory vs. nonmemory tasks) were considered as moderator variables. In addition, differences in experimental design, glucose dose and fasting regime were examined. The effect size d was extracted from studies comparing cognitive performance after the ingestion of either a glucose or control solution. Subsequent meta-analyses were conducted (using the procedures outlined by Hedges & Olkin, 1985) to examine potential moderators. A moderate overall effect size was found (d = 0.56), which clearly demonstrated the value of glucose ingestion as a cognitive enhancer. However, this effect size was not representative of the 104 individual effect sizes reported. Secondary analyses found larger effect sizes for memory compared to nonmemory tasks. Unexpectedly, no evidence was provided for greater beneficial effects of glucose on cognitive performance for older compared to younger adults. The impact of other methodological variables and the need for further exploration in an elderly population are discussed.

Metabolic agents that enhance ATP can improve cognitive functioning: a review of the evidence for glucose, oxygen, pyruvate, creatine, and L-carnitine

Over the past four or five decades, there has been increasing interest in the neurochemical regulation of cognition. This field received considerable attention in the 1980s, with the identification of possible cognition enhancing agents or "smart drugs". Even though many of the optimistic claims for some agents have proven premature, evidence suggests that several metabolic agents may prove to be effective in improving and preserving cognitive performance and may lead to better cognitive aging through the lifespan. Aging is characterized by a progressive deterioration in physiological functions and metabolic processes. There are a number of agents with the potential to improve metabolic activity. Research is now beginning to identify these various agents and delineate their potential usefulness for improving cognition in health and disease. This review provides a brief overview of the metabolic agents glucose, oxygen, pyruvate, creatine, and L-carnitine and their beneficial effects on cognitive function. These agents are directly responsible for generating ATP (adenosine triphosphate) the main cellular currency of energy. The brain is the most metabolically active organ in the body and as such is particularly vulnerable to disruption of energy resources. Therefore interventions that sustain adenosine triphosphate (ATP) levels may have importance for improving neuronal dysfunction and loss. Moreover, recently, it has been observed that environmental conditions and diet can affect transgenerational gene expression via epigenetic mechanisms. Metabolic agents might play a role in regulation of nutritional epigenetic effects. In summary, the reviewed metabolic agents represent a promising strategy for improving cognitive function and possibly slowing or preventing cognitive decline.

Dose-response investigation into glucose facilitation of memory performance and mood in healthy young adults

It has been suggested that the memory enhancing effect of glucose follows an inverted U-shaped curve, with 25 g resulting in optimal facilitation in healthy young adults. The aim of this study was to further investigate the dose dependency of the glucose facilitation effect in this population across different memory domains and to assess moderation by interindividual differences in glucose regulation and weight. Following a double-blind, repeated measures design, 30 participants were administered drinks containing five different doses of glucose (0 g, 15 g, 25 g, 50 g, and 60 g) and were tested across a range of memory tasks. Glycaemic response and changes in mood state were assessed following drink administration. Analysis of the data showed that glucose administration did not affect mood, but significant glucose facilitation of several memory tasks was observed. However, dose-response curves differed depending on the memory task with only performance on the long-term memory tasks adhering largely to the previously observed inverted U-shaped dose-response curve. Moderation of the response profiles by interindividual differences in glucose regulation and weight was observed. The current data suggest that dose-response function and optimal dose might depend on cognitive domain and are moderated by interindividual differences in glucose regulation and weight.

Carbohydrates for improving the cognitive performance of independent-living older adults with normal cognition or mild cognitive impairment

BACKGROUND

Mild cognitive impairment (MCI) is an intermediate state between normal cognition and dementia in which daily function is largely intact. This condition may present an opportunity for research into the prevention of dementia. Carbohydrate is an essential and easily accessible macronutrient which influences cognitive performance. A better understanding of carbohydrate-driven cognitive changes in normal cognition and mild cognitive impairment may suggest ways to prevent or reduce cognitive decline.

OBJECTIVES

To assess the effectiveness of carbohydrates in improving cognitive function in older adults.

SEARCH STRATEGY

We searched ALOIS, the Cochrane Dementia and Cognitive Improvement Group Specialized Register on 22 June 2010 using the terms: carbohydrates OR carbohydrate OR monosaccharides OR disaccharides OR oligosaccharides OR polysaccharides OR CARBS. ALOIS contains records from all major healthcare databases (The Cochrane Library, MEDLINE, EMBASE, PsycINFO, CINAHL, LILACS) as well as from many trial databases and grey literature sources.

SELECTION CRITERIA

All randomised controlled trials (RCT) that have examined the efficacy of any form of carbohydrates in normal cognition and MCI.

DATA COLLECTION AND ANALYSIS

One review author selected and retrieved relevant articles for further assessment. The remaining authors independently assessed whether any of the retrieved trials should be included. Disagreements were resolved by discussion. 

MAIN RESULTS

There is no suitable RCT of any form of carbohydrates involving independent-living older adults with normal cognition or mild cognitive impairment.

AUTHORS' CONCLUSIONS

There are no suitable RCTs on which to base any recommendations about the use of any form of carbohydrate for enhancing cognitive performance in older adults with normal cognition or mild cognitive impairment. More studies of many different carbohydrates are needed to tease out complex nutritional issues and further evaluate memory improvement.

Bidirectional metabolic regulation of neurocognitive function

The efficiency of somatic energy metabolism is correlated with cognitive change over the lifespan. This relationship is bidirectional, with improved overall fitness associated with enhanced synaptic function and neuroprotection, and synaptic endangerment occurring in the context of impaired energy metabolism. In this review, we discuss recent advancements in the fields of exercise, dietary energy intake and diabetes, as they relate to neuronal function in the hippocampus. Because hippocampal neurons have energy requirements that are relatively higher than those of other brain regions, they are uniquely poised to benefit from exercise, and to be harmed by diabetes. We view exercise and dietary energy restriction as being associated with enhanced hippocampal plasticity at one end of a continuum, with obesity and diabetes accompanied by cognitive impairment at the other end of the continuum. Understanding the mechanisms for this continuum may yield novel therapeutic targets for the prevention and treatment of cognitive decline following aging, disease, or injury.

Glucose enhancement of memory is modulated by trait anxiety in healthy adolescent males

Glucose administration is associated with memory enhancement in healthy young individuals under conditions of divided attention at encoding. While the specific neurocognitive mechanisms underlying this 'glucose memory facilitation effect' are currently uncertain, it is thought that individual differences in glucoregulatory efficiency may alter an individual's sensitivity to the glucose memory facilitation effect. In the present study, we sought to investigate whether basal hypothalamic-pituitary-adrenal axis function (itself a modulator of glucoregulatory efficiency), baseline self-reported stress and trait anxiety influence the glucose memory facilitation effect. Adolescent males (age range = 14-17 years) were administered glucose and placebo prior to completing a verbal episodic memory task on two separate testing days in a counter-balanced, within-subjects design. Glucose ingestion improved verbal episodic memory performance when memory recall was tested (i) within an hour of glucose ingestion and encoding, and (ii) one week subsequent to glucose ingestion and encoding. Basal hypothalamic-pituitary-adrenal axis function did not appear to influence the glucose memory facilitation effect; however, glucose ingestion only improved memory in participants reporting relatively higher trait anxiety. These findings suggest that the glucose memory facilitation effect may be mediated by biological mechanisms associated with trait anxiety.

Do specific dietary constituents and supplements affect mental energy? Review of the evidence

The numbers of marketing claims and food, beverage, and drug products claiming to increase mental energy have risen rapidly, thus increasing the need for scientific specificity in marketing and food label claims. Mental energy is a three-dimensional construct consisting of mood (transient feelings about the presence of fatigue or energy), motivation (determination and enthusiasm), and cognition (sustained attention and vigilance). The present review focuses on four dietary constituents/supplements (Ginkgo biloba, ginseng, glucose, and omega-3 polyunsaturated fatty acids) to illustrate the current state of the literature on dietary constituents and mental energy. The strongest evidence suggests effects of Ginkgo biloba on certain aspects of mood and on attention in healthy subjects, as well as associations between omega-3 polyunsaturated fatty acids and reduced risk of age-related cognitive decline. Limitations of the current data and challenges for future research are discussed.

Glucose enhancement of human memory: a comprehensive research review of the glucose memory facilitation effect

The brain relies upon glucose as its primary fuel. In recent years, a rich literature has developed from both human and animal studies indicating that increases in circulating blood glucose can facilitate cognitive functioning. This phenomenon has been termed the 'glucose memory facilitation effect'. The purpose of this review is to discuss a number of salient studies which have investigated the influence of glucose ingestion on neurocognitive performance in individuals with (a) compromised neurocognitive capacity, as well as (b) normally functioning individuals (with a focus on research conducted with human participants). The proposed neurocognitive mechanisms purported to underlie the modulatory effect of glucose on neurocognitive performance will also be considered. Many theories have focussed upon the hippocampus, given that this brain region is heavily implicated in learning and memory. Further, it will be suggested that glucose is a possible mechanism underlying the phenomenon that enhanced memory performance is typically observed for emotionally laden stimuli.

Ca2+/calmodulin-dependent protein kinase II and protein kinase C activities mediate extracellular glucose-regulated hippocampal synaptic efficacy

To define how extracellular glucose levels affect synaptic efficacy and long-term potentiation (LTP), we evaluated electrophysiological and neurochemical properties in hippocampal CA1 regions following alterations in glucose levels in the ACSF. In rat hippocampal slices prepared in ACSF with 3.5mM glucose, fEPSPs generated by Schaffer collateral/commissural stimulation markedly increased when ACSF glucose levels were increased from 3.5 to 7.0mM. The paired-pulse facilitation reflecting presynaptic transmitter release efficacy was significantly suppressed by elevation to 7.0mM glucose because of potentiation of the input-output relationship (I/O relationship) of fEPSPs by single pulse stimulation. Prolonged potentiation of fEPSPs by elevation to 7.0mM glucose coincided with increased autophosphorylation both of Ca(2+)/calmodulin-dependent protein kinase II (CaMKII) and protein kinase Cα (PKCα). The increased I/O relationship of fEPSPs was also associated with markedly increased synapsin I phosphorylation by CaMKII. Transmitter-evoked postsynaptic currents were also measured in CA1 neurons by electrophoretical application of NMDA and AMPA to the apical dendrites of pyramidal neurons. NMDA- and AMPA-evoked currents were significantly augmented by elevation to 7.0mM. Notably, high frequency stimulation of the Schaffer collateral/commissural pathway failed to induce LTP in the CA1 region at 3.5mM glucose but LTP was restored dose-dependently by increasing glucose levels to 7.0 and 10.0mM. LTP induction in the presence of 7.0mM glucose was closely associated with further increases in CaMKII autophosphorylation without changes in PKCα autophosphorylation. Taken together, CaMKII and PKC activation likely mediate potentiation of fEPSPs by elevated glucose levels, and CaMKII activity is also associated with LTP induction in the hippocampal CA1 region.

Saccharide effects on cognition and well-being in middle-aged adults: a randomized controlled trial

The current study used a randomized, double-blind, placebo-controlled design to investigate the effects of saccharide supplementation on cognition and well-being in middle-aged adults. Participants (N = 109; 45-60 years) took a teaspoon of a combination of saccharides or a placebo twice daily for 12 weeks (3.6 g per day). Before and after this supplementation period, participants completed alternate forms of standardized tests of cognition and self-report measures of well-being. Significant beneficial effects of saccharide supplementation were found for memory performance and indicators of well-being. The potential for these nutrients to optimize cognitive function and well-being in older adults warrants ongoing investigation.

Effect of age and glucoregulation on cognitive performance

Type 2 diabetes has been associated with a number of physiological consequences including neuropathy, retinopathy, and incidence of vascular disease. Less is known about the effect on cognition of prediabetes, a period when glucose regulation is abnormal. It is not clear which aspect of impaired glucoregulation is most predictive of cognitive deterioration. In the present experiment, we measured cognitive function in 93 healthy male and female nondiabetic older participants who ranged in age from 55 to 88 years. Various biological measures were obtained including a glucose tolerance test during which glucose and insulin were measured. Participants were evaluated twice, once after drinking a saccharin solution and on another occasion after drinking a glucose solution (50 g). The analysis of the correlations between the biological measures and the results of the cognitive tasks revealed that evoked glucose measures such as peak glucose and glucose at 1 hour were most often correlated with cognitive performance. We observed that progressively worse glucose regulation predicted poorer performance on measures of working memory and executive function-that is, on the Arithmetic, Digit Span Backward, Letter-Number Sequencing, Spatial Span Forward, Spatial Span Backward (trend), and Modified Brown-Peterson tasks. Although, there was no significant facilitative effect of glucose on cognitive performance, it reduced the association between glucose regulation and cognition, apparently by slightly improving performance. These results suggest that cognitive functions may be impaired before glucoregulatory impairment reaches levels consistent with a type 2 diabetes diagnosis.

Hippocampal memory processes are modulated by insulin and high-fat-induced insulin resistance

Insulin regulates glucose uptake and storage in peripheral tissues, and has been shown to act within the hypothalamus to acutely regulate food intake and metabolism. The machinery for transduction of insulin signaling is also present in other brain areas, particularly in the hippocampus, but a physiological role for brain insulin outside the hypothalamus has not been established. Recent studies suggest that insulin may be able to modulate cognitive functions including memory. Here we report that local delivery of insulin to the rat hippocampus enhances spatial memory, in a PI-3-kinase dependent manner, and that intrahippocampal insulin also increases local glycolytic metabolism. Selective blockade of endogenous intrahippocampal insulin signaling impairs memory performance. Further, a rodent model of type 2 diabetes mellitus produced by a high-fat diet impairs basal cognitive function and attenuates both cognitive and metabolic responses to hippocampal insulin administration. Our data demonstrate that insulin is required for optimal hippocampal memory processing. Insulin resistance within the telencephalon may underlie the cognitive deficits commonly reported to accompany type 2 diabetes.

Voluntary dehydration and cognitive performance in trained college athletes

Cognitive and mood decrements resulting from mild dehydration and glucose consumption were studied. Men and women (total N = 54; M age = 19.8 yr., SD = 1.2) were recruited from college athletic teams. Euhydration or dehydration was achieved by athletes completing team practices with or without water replacement. Dehydration was associated with higher thirst and negative mood ratings as well as better Digit Span performance. Participants showed better Vigilance Attention with euhydration. Hydration status and athlete's sex interacted with performance on Choice Reaction Time and Vigilance Attention. In a second study, half of the athletes received glucose prior to cognitive testing. Results for negative mood and thirst ratings were similar, but for cognitive performance the results were mixed. Effects of glucose on cognition were independent of dehydration.