Hanyang Med Rev.  2014 May;34(2):53-59. 10.7599/hmr.2014.34.2.53.

Mild Cognitive Impairment and Nutrition in Old Adults

• Yang YJ

• KMID: 2284405
• DOI: http://doi.org/10.7599/hmr.2014.34.2.53

Abstract

As the number of elderly in Korea is growing, the prevalence of cognitive impairment and dementia are increasing. Mild cognitive impairment (MCI) is a transitional state between the cognitive changes of normal aging and dementia. As for the prevention of MCI and dementia, vascular risk factor control, physical activity, social engagement, recognition of depression and high quality diet are suggested. Many epidemiologic studies have reported that inadequate levels of folate, vitamin B12, and vitamin B6 increase the risk of MCI. Elevated plasma homocysteine, which is biochemically associated with low status of B vitamins, similarly increased the risk of MCI. However, B vitamin supplementation studies have not demonstrated a protective or therapeutic cognitive benefit. Oxidative stress seems to play a key role in the development of cognitive impairment, thus, dietary and plasma antioxidants have been studied to investigate the effects on MCI, but the results are inconclusive. Diet quality has been reported to be associated with MCI. In particular, Mediterranean diet has been proposed to provide benefits on cognitive decline, but results are inconsistent. Further studies are warranted to determine the association between nutritional status or diet quality and MCI.

Keyword

Mild Cognitive Impairment; Vitamin B Complex; Antioxidants; Diet Therapy

MeSH Terms

Adult*
Aged
Aging
Antioxidants
Dementia
Dementia, Vascular
Depression
Diet
Diet Therapy
Diet, Mediterranean
Folic Acid
Homocysteine
Humans
Korea
Mild Cognitive Impairment*
Motor Activity
Nutritional Status
Oxidative Stress
Plasma
Prevalence
Risk Factors
Vitamin B 12
Vitamin B 6
Vitamin B Complex
Vitamins
Antioxidants
Folic Acid
Homocysteine
Vitamin B 12
Vitamin B 6
Vitamin B Complex
Vitamins

Figure

• 

  Fig. 1 Homocysteine metabolism in man and animals. Enzyme reactions that are regulated by S-adenosylmethionine (SAM) are indicated by large arrows: closed arrow indicates inhibition, open arrow indicates activation. Enzymes: 1, N-5-methyltetrahydrofolate: homocysteine methyltransferase; 2, methylenetetrahydrofolate reductase; 3, betaine: homocysteine methyltransferase; 4, choline dehydrogenase; 5, cystathionine/3-synthase; 6, -y-cystathionase. THF, tetrahydrofolate; PLP, pyridoxal-5'-phosphate. Ref 5 with permission from American Society for Nutrition.

Reference

1. Statistics Korea. Korean Statistical Information Service: Population [Internet]. Daejeon (KR): Statistics Korea;c2013. cited 2014 Feb 2. Available from: http://kosis.kr/statisticsList/statisticsList_01List.jsp?vwcd=MT_ZTITLE&parentId=A.

2. Ministry of Health and Welfare. Report No.: 11-1351000-000227-01. A Nationwide Survey on the Prevalence of Dementia in Korean Elders. Sejong (KR): Ministry of Health and Welfare;2008. 12. p. 227.

3. Yanhong O, Chandra M, Venkatesh D. Mild cognitive impairment in adult: a neuropsychological review. Ann Indian Acad Neurol. 2013; 16:310–318.

4. Middleton LE, Yaffe K. Promising strategies for the prevention of dementia. Arch Neurol. 2009; 66:1210–1215.

5. Selhub J, Miller JW. The pathogenesis of homocysteinemia: interruption of the coordinate regulation by S-adenosylmethionine of the remethylation and transsulfuration of homocysteine. Am J Clin Nutr. 1992; 55:131–138.

6. Boadle-Biber MC. Regulation of serotonin synthesis. Prog Biophys Mol Biol. 1993; 60:1–15.

7. Seshadri S, Beiser A, Selhub J, Jacques PF, Rosenberg IH, D'Agostino RB, et al. Plasma homocysteine as a risk factor for dementia and Alzheimer's disease. N Engl J Med. 2002; 346:476–483.

8. Nilsson K, Gustafson L, Hultberg B. Elevated plasma homocysteine level in vascular dementia reflects the vascular disease process. Dement Geriatr Cogn Dis Extra. 2013; 3:16–24.

9. Whalley LJ, Duthie SJ, Collins AR, Starr JM, Deary IJ, Lemmon H, et al. Homocysteine, antioxidant micronutrients and late onset dementia. Eur J Nutr. 2014; 53:277–285.

10. Hooshmand B, Solomon A, Kareholt I, Rusanen M, Hanninen T, Leiviska J, et al. Associations between serum homocysteine, holotranscobalamin, folate and cognition in the elderly: a longitudinal study. J Intern Med. 2012; 271:204–212.

11. Blasko I, Hinterberger M, Kemmler G, Jungwirth S, Krampla W, Leitha T, et al. Conversion from mild cognitive impairment to dementia: influence of folic acid and vitamin B12 use in the VITA cohort. J Nutr Health Aging. 2012; 16:687–694.

12. Wald DS, Kasturiratne A, Simmonds M. Serum homocysteine and dementia: meta-analysis of eight cohort studies including 8,669 participants. Alzheimers Dement. 2011; 7:412–417.

13. Harris E, Macpherson H, Vitetta L, Kirk J, Sali A, Pipingas A. Effects of a multivitamin, mineral and herbal supplement on cognition and blood biomarkers in older men: a randomised, placebo-controlled trial. Hum Psychopharmacol. 2012; 27:370–377.

14. Lehmann M, Regland B, Blennow K, Gottfries CG. Vitamin B12-B6-folate treatment improves blood-brain barrier function in patients with hyperhomocysteinaemia and mild cognitive impairment. Dement Geriatr Cogn Disord. 2003; 16:145–150.

15. de Jager CA, Oulhaj A, Jacoby R, Refsum H, Smith AD. Cognitive and clinical outcomes of homocysteine-lowering B-vitamin treatment in mild cognitive impairment: a randomized controlled trial. Int J Geriatr Psychiatry. 2012; 27:592–600.

16. Aisen PS, Schneider LS, Sano M, Diaz-Arrastia R, van Dyck CH, Weiner MF, et al. High-dose B vitamin supplementation and cognitive decline in Alzheimer disease: a randomized controlled trial. JAMA. 2008; 300:1774–1783.

17. Olson CR, Mello CV. Significance of vitamin A to brain function, behavior and learning. Mol Nutr Food Res. 2010; 54:489–495.

18. Mey J, McCaffery P. Retinoic acid signaling in the nervous system of adult vertebrates. Neuroscientist. 2004; 10:409–421.

19. Lane MA, Bailey SJ. Role of retinoid signalling in the adult brain. Prog Neurobiol. 2005; 75:275–293.

20. Valdenaire O, Maus-Moatti M, Vincent JD, Mallet J, Vernier P. Retinoic acid regulates the developmental expression of dopamine D2 receptor in rat striatal primary cultures. J Neurochem. 1998; 71:929–936.

21. Valdenaire O, Vernier P, Maus M, Dumas Milne, Mallet J. Transcription of the rat dopamine-D2-receptor gene from two promoters. Eur J Biochem. 1994; 220:577–584.

22. Padayatty SJ, Katz A, Wang Y, Eck P, Kwon O, Lee JH, et al. Vitamin C as an antioxidant: evaluation of its role in disease prevention. J Am Coll Nutr. 2003; 22:18–35.

23. Harrison FE, May JM. Vitamin C function in the brain: vital role of the ascorbate transporter SVCT2. Free Radic Biol Med. 2009; 46:719–730.

24. Brigelius-Flohe R. Vitamin E: the shrew waiting to be tamed. Free Radic Biol Med. 2009; 46:543–554.

25. Morris MC, Evans DA, Bienias JL, Tangney CC, Bennett DA, Aggarwal N, et al. Dietary intake of antioxidant nutrients and the risk of incident Alzheimer disease in a biracial community study. JAMA. 2002; 287:3230–3237.

26. Rinaldi P, Polidori MC, Metastasio A, Mariani E, Mattioli P, Cherubini A, et al. Plasma antioxidants are similarly depleted in mild cognitive impairment and in Alzheimer's disease. Neurobiol Aging. 2003; 24:915–919.

27. Bowman GL, Dodge H, Frei B, Calabrese C, Oken BS, Kaye JA, et al. Ascorbic acid and rates of cognitive decline in Alzheimer's disease. J Alzheimers Dis. 2009; 16:93–98.

28. Mangialasche F, Solomon A, Kareholt I, Hooshmand B, Cecchetti R, Fratiglioni L, et al. Serum levels of vitamin E forms and risk of cognitive impairment in a Finnish cohort of older adults. Exp Gerontol. 2013; 48:1428–1435.

29. Crichton GE, Bryan J, Murphy KJ. Dietary antioxidants, cognitive function and dementia--a systematic review. Plant Foods Hum Nutr. 2013; 68:279–292.

30. Alavi Naeini AM, Elmadfa I, Djazayery A, Barekatain M, Aghaye Ghazvini MR, Djalali M, et al. The effect of antioxidant vitamins E and C on cognitive performance of the elderly with mild cognitive impairment in Isfahan, Iran: a double-blind, randomized, placebo-controlled trial. Eur J Nutr. 2013; Forthcoming.

31. Kang JH, Cook N, Manson J, Buring JE, Grodstein F. A randomized trial of vitamin E supplementation and cognitive function in women. Arch Intern Med. 2006; 166:2462–2468.

32. Petersen RC, Thomas RG, Grundman M, Bennett D, Doody R, Ferris S, et al. Vitamin E and donepezil for the treatment of mild cognitive impairment. N Engl J Med. 2005; 352:2379–2388.

33. McCullough ML, Feskanich D, Stampfer MJ, Rosner BA, Hu FB, Hunter DJ, et al. Adherence to the Dietary Guidelines for Americans and risk of major chronic disease in women. Am J Clin Nutr. 2000; 72:1214–1222.

34. Haines PS, Siega-Riz AM, Popkin BM. The Diet Quality Index revised: a measurement instrument for populations. J Am Diet Assoc. 1999; 99:697–704.

35. Kim S, Haines PS, Siega-Riz AM, Popkin BM. The Diet Quality Index-International (DQI-I) provides an effective tool for cross-national comparison of diet quality as illustrated by China and the United States. J Nutr. 2003; 133:3476–3484.

36. Kant AK, Schatzkin A, Graubard BI, Schairer C. A prospective study of diet quality and mortality in women. JAMA. 2000; 283:2109–2115.

37. Kim JY, Yang YJ, Yang YK, Oh SY, Hong YC, Lee EK, et al. Diet quality scores and oxidative stress in Korean adults. Eur J Clin Nutr. 2011; 65:1271–1278.

38. Trichopoulou A, Costacou T, Bamia C, Trichopoulos D. Adherence to a Mediterranean diet and survival in a Greek population. N Engl J Med. 2003; 348:2599–2608.

39. Trichopoulou A, Kouris-Blazos A, Wahlqvist ML, Gnardellis C, Lagiou P, Polychronopoulos E, et al. Diet and overall survival in elderly people. BMJ. 1995; 311:1457–1460.

40. Wengreen HJ, Neilson C, Munger R, Corcoran C. Diet quality is associated with better cognitive test performance among aging men and women. J Nutr. 2009; 139:1944–1949.

41. Tangney CC, Kwasny MJ, Li H, Wilson RS, Evans DA, Morris MC. Adherence to a Mediterranean-type dietary pattern and cognitive decline in a community population. Am J Clin Nutr. 2011; 93:601–607.

42. Scarmeas N, Stern Y, Mayeux R, Manly JJ, Schupf N, Luchsinger JA. Mediterranean diet and mild cognitive impairment. Arch Neurol. 2009; 66:216–225.

43. Scarmeas N, Stern Y, Tang MX, Mayeux R, Luchsinger JA. Mediterranean diet and risk for Alzheimer's disease. Ann Neurol. 2006; 59:912–921.

44. Feart C, Samieri C, Barberger-Gateau P. Mediterranean diet and cognitive function in older adults. Curr Opin Clin Nutr Metab Care. 2010; 13:14–18.

45. Psaltopoulou T, Kyrozis A, Stathopoulos P, Trichopoulos D, Vassilopoulos D, Trichopoulou A. Diet, physical activity and cognitive impairment among elders: the EPIC-Greece cohort (European Prospective Investigation into Cancer and Nutrition). Public Health Nutr. 2008; 11:1054–1062.