Essential Nutrients-Cognition:  Research Article

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Nutrition and Cognitive Impairment in the Elderly

CITATION:  Gonzalez-Gross, M. Marcos, A., and Pietzik, K.  (2001) Nutrition and Cognitive Impairment in the Elderly.  British Journal of Nutrition, v. 86 (3), p. 313-21.

ABSTRACT:  As the number of older people is growing rapidly worldwide and the fact that elderly people are also apparently living longer, dementia, the most common cause of cognitive impairment is getting to be a greater public health problem. Nutrition plays a role in the ageing process, but there is still a lack of knowledge about nutrition-related risk factors in cognitive impairment. Research in this area has been intensive during the last decade, and results indicate that subclinical deficiency in essential nutrients (antioxidants such as vitamins C, E and beta-carotene, vitamin B[sub12], vitamin B[sub6], folate) and nutrition-related disorders, as hypercholesterolaemia, hypertriacylglycerolaemia, hypertension, and diabetes could be some of the nutrition-related risk factors, which can be present for a long time before cognitive impairment becomes evident. Large-scale clinical trials in high-risk populations are needed to determine whether lowering blood homocysteine levels reduces the risk of cognitive impairment and may delay the clinical onset of dementia and perhaps of Alzheimer's disease. A curative treatment of cognitive impairment, especially Alzheimer's disease, is currently impossible. Actual drug therapy, if started early enough, may slow down the progression of the disease. Longitudinal studies are required in order to establish the possible link of nutrient intake -- nutritional status with cognitive impairment, and if it is possible, in fact, to inhibit or delay the onset of dementia.


Agronin ME (1998) Personality and psychopathology in late life. Geriatrics 53, Suppl. 1, S35-S40.

American Dietetic Association (1996) Positioning of the ADA: nutrition, aging, and the continuum of care. Journal of the American Dietetic Association 96, 1048-1052.

Araki A, Sako Y, Ito H & Orimo H (1999) Plasma homocysteine, brain MR lesions, and cognitive functions in elderly diabetic patients. Amino Acids 17, 44, Abstr.

Basun H, Fratiglioni L & Winblad B (1994) Cobalamin levels are not reduced in Alzheimer's disease: results from a population based study. Journal of the American Geriatric Society 42, 132-136.

Behl C (1999) Vitamin E and other antioxidants in neuroprotection. International Journal of Vitamin and Nutrition Research 69, 213-219.

Behl C & Holsboer F (1998) Oxidative stress in the pathogenesis of Alzheimer's disease and antioxidant neuroprotection. Fortschrifte der Neurologie Psychiatrie 66, 113-121.

Bell IR, Edman JS, Selhub J, Morrow FD, Marby DW, Kayne HL & Cole JO (1992) Plasma homocysteine in vascular disease and in nonvascular dementia of depressed elderly people. Acta Psychiatrica Scandinavica 86, 386-390.

Brige SJ (1997) The role of estrogen in the treatment and prevention of dementia: introduction. American Journal of Medicine 22, 1S-2S.

Birge SJ (1998) Hormones and the aging brain. Geriatrics 53, S28-S30.

Birkhäuser MH, Strnad J, Kämpf C & Bahro M (2000) Oestrogens and Alzheimer's disease. International Journal of Geriatric Psychiatry 15, 600-609.

Bonarek M, Barberger-Gateau P, Letenneur L, Deschamps V, Iron A, Dubroca B & Dartigues JF (2000) Relationships between cholesterol, apolipoprotein E polymorphism and dementia: a cross-sectional analysis from the PAQUID study (2000). Neuroepidemiology 19, 141-148.

Botez MI, Fontaine F, Botez T & Bachevalier J (1977) Folate-responsive neurological and mental disorders: report of 16 cases. Neuropsychological correlates of computerized transaxial tomography and radionuclide cisternography in folic acid deficiencies. European Neurology 16, 230-246.

Bottiglieri T (1996) Folic acid, vitamin B[sub12], and neuropsychiatric disorders. Nutrition Reviews 54, 382-390.

Brönstrup A, Hages M & Pietrzik K (1999) Lowering of homocysteine concentrations in elderly men and women. International Journal of Vitamin and Nutrition Research 69, 187-193.

Callahan CM, Hendrie HC & Tierney WM (1995) Documentation and evaluation of cognitive impairment in elderly primary care patients. Annals of International Medicine 122, 422-429.

Carmel R, Gott PS, Waters CH, Cairo K, Green R, Bondareff W, De Giorgio CM, Cummings JL, Jacobsen DW & Buckwalter G (1995) The frequently low cobalamin levels in dementia usually signify treatable metabolic, neurologic and electrophysiologic abnormalities. European Journal of Haematology 54, 245-253.

Carr DB, Goate A, Phil D & Morris JC (1997) Current concepts in the pathogenesis of Alzheimer's disease. American Journal of Medicine 103, 3S-10S.

Cattin L, Bordin P, Fonda M, Adams C, Barbone I, Bovenzi M, Manto A, Pedone C & Pahor M (1997) Factors associated with cognitive impairment among older italian inpatients. Journal of American Geriatric Society 45, 1324-1330.

Chandra RK (1997) Graying of the immune system. Can nutrient supplements improve immunity in the elderly? Journal of the American Medical Association 277, 1398-1399.

Chandra RK, Imbach A, Moore C, Skelton D & Woolcott D (1991) Nutrition of the elderly. Canadian Medical Association Journal 145, 1475-1487.

Chapman J, Wang N, Treves TA, Korczyn AD & Bornstein NM (1998) ACE, MTHFR, factor V Leiden, and ApoE polymorphisms in patients with vascular and Alzheimer's dementia. Stroke 29, 1401-1404.

Chui HC, Victoroff JI, Jagust W, Saakle R & Katzman R (1992) Criteria for the clinical diagnosis of ischemic vascular dementia prepared by the State of California Alzheimer's Disease Diagnostic and Treatment Centers. Neurology 42, 473-480.

Clarke R, Smith AD, Jobst KA, Refsum H, Sutton L & Ueland PM (1998) Folic acid, vitamin B[sub12], and serum homocysteine levels in confirmed Alzheimer's disease. Archives of Neurology 55, 1449-1455.

Desmond DW, Tatemichi TK, Paik M & Stern Y (1993) Risk factors for cerebrovascular disease as correlates of cognitive function in a stroke-free cohort. Archives of Neurology 50, 162-166.

Diaz Brinton R & Yamazaki RS (1998) Advances and challenges in the prevention and treatment of Alzheimer's disease. Pharmaceutical Research 15, 386-398.

Doraiswamy PM & Steffens DC (1998) Combination therapy for early Alzheimer's disease: what are we waiting for? Journal of the American Geriatric Society 46, 1322-1324.

Doty RL (1991) Olfactory capacities in aging and Alzheimer's disease: psychophysical and anatomic considerations. Annals of the New York Academy of Science 640, 20-27.

Durnbaugh T, Haley B & Roberts S (1996) Assessing problem feeding behaviors in mid-stage Alzheimer's disease. Geriatric Nursing 17, 63-67.

Elias MF (1998) Effects of chronic hypertension on cognitive functioning. Geriatrics 53, S49-S52.

Elsborg L, Hansen T & Rafaelsen OJ (1979) Vitamin B[sub12] concentrations in psychiatric patients. Acta Psychiatrica Scandinavica 59, 145-152.

Fassbender K, Mielke O, Bertsch T, Nafe B, Fröschen S & Hennerici M (1999) Homocysteine in cerebal macroangiography and microangiopathy. Lancet 353, 1586-1587.

Fekkes D, van der Cammen TJM, van Loon CPM, Verschoor C, van Harskamp F, de Koning I, Schudel WJ & Pepplinkhuizen L (1998) Abnormal amino acid metabolism in patients with early stage Alzheimer dementia. Journal of Neural Transmission 105, 287-294.

Fernström JD & Wurtman RJ (1972) Brain serotonin content: physiological regulation by plasma neutral amino acids. Science 178, 414-416.

Folstein MF, Folstein SE & McHugh PR (1975) Mini Mental State. A practical method for grading the cognitive state of patients for the clinician. Journal of Psychiatric Reasearch 12, 189-198.

Foy CJ, Passmore AP, Vahidassr MD, Young IS & Lawson JT (1999) Plasma chain-breaking antioxidants in Alzheimer's disease, vascular dementia and Parkinson's disease. Quarterly Journal of Medicine 92, 39-45.

Fraser GE, Singh PN & Bennett H (1996) Variables associated with cognitive function in elderly California Seventh-day adventist. American Journal of Epidemiology 143, 1181-1190.

Frey WH 2nd, Najarian MM, Kumar KS, Emory CR, Menning PM, Frank JC, Johnson MN & Ala TA (1996) Endogenous Alzheimer's brain factor and oxidized glutathione inhibit antagonist binding to the muscarinic receptor. Brain Research 714, 87-94.

Galan P, Preziosi P, Monget AL, Richard MJ, Arnaud J & Lesourd B, Girodon F, Alfarez MJ, Bourgeois C, Keller H, Iavier A & Hercberg S (1997) Effects of trace element and/or vitamin supplementation on vitamin and mineral status, free radical metabolism and immunological markers in elderly long term-hospitalized subjects. International Journal of Vitamin and Nutrition Research 67, 450-460.

Gale CR, Martyn CN & Cooper C (1996) Cognitive impairment and mortality in a cohort of elderly people. British Medical Journal 312, 608-611.

Gomes-Trolin C, Regland B & Oreland L (1995) Decreased methionine adenosyltransferase activity in erythrocytes of patients with dementia disorders.
European Neuropsychopharmacology 5, 107-114.

Gomez de Caso JA, Rodriguez-Artalejo F, Claveria LE & Coria F (1994) Value of Hodkinson's test for detecting dementia and mild cognitive impairment in epidemiological surveys. Neuroepidemiology 13, 64-68.

Goodwin J, Goodwin J & Garry P (1983) Association between nutritional status and cognitive functioning in a healthy elderly population. Journal of the American Medical Association 249, 2917-2921.

Gottfries CG, Lehmann W & Regland B (1998) Early diagnosis of cognitive impairment in the elderly with the focus on Alzheimer's disease. Journal of Neural Transmission 105, 773-786.

Gray GE (1989) Nutrition and dementia. Journal of the American Dietetic Association 89, 1795-1802.

Haller J, Weggemans RM, Ferry M & Guigoz Y (1996) Mental health: minimental state examination and geriatric depression score of elderly europeans in the SENECA study of 1993. European Journal of Clinical Nutrition 50, S112-S116.

Huijbregts PPCW, Feskens EJM, Räsänen L, Fidanza F, Alberti-Fidanza A, Nissinen A, Giampaoli S & Kromhout D (1998) Dietary patterns and cognitive function in elderly men in Finland, Italy and the Netherlands. European Journal of Clinical Nutrition 52, 826-831.

Ihl R, Brinkmeyer J, Janner M & Kerdar MS (2000) A comparison of ADAS and EEG in the discrimination of patients with dementia of the Alzheimer type from healthy controls. Neuropsychobiology 41, 102-107.

Jama I, Launer LJ, Witterman JCM, den Breeijen JH, Breteler MMB & Grobbee DE (1996) Dietary antioxidants and cognitive function in a population-based sample of elder people. American Journal of Epidemiology 144, 275-280.

Joosten E, Lesaffre E, Riezler R, Ghekiere V, Dereymaeker L, Pelemans W & Dejaeger E (1997) Is metabolic evidence for vitamin B-12 and folic acid deficiency more frequent in elderly patients with Alzheimer's disease? Journal of Gerontology
A Biological Science and Medical Science 52, M76-M79.

Kalmijn S, Fesikens EJ, Launer LJ & Kromhout D (1997) Polyunsaturated fatty acids, antioxidants, and cognitive functions in very old men. American Journal of Epidemiology 145, 33-41.

Kelly GS (1998) Folic acids: supplemental forms and therapeutic applications. Alternative Medicine Review 3, 208-220.

Knopman DS (1998) Current pharmacotherapies for Alzheimer's disease. Geriatrics 53, S31-S34.

Koehler KM, Pareo-Tubbeh SL, Romero LJ, Baumgartner RN & Garry PJ (1997) Folic acid nutrition and older adults: challenges and opportunities. Journal of American Dietetic Association 97, 167-173.

Lappalainen R, Koikkalainen M, Julkunen J, Saarinen T & Mykkänen H (1998) Association of sociodemographic factors with barriers reported by patients receiving nutrition counselling as part of cardiac rehabilitation. Journal of American Dietetic Association 98, 1026-1029.

Launer LJ (1992) Overview of incidence studies of dementia conducted in Europe. Neuroepidemiology 11, 2-13.

Lethem R & Orrell M (1997) Antioxidants and dementia. Lancet 349, 1189-1190.

Lewis CJ, Crane NT, Wilson DB & Yetley EA (1999) Estimated folic acid intakes: data updated to reflect food fortification, increased bicavailability, and dietary supplement use. American Journal of Clinical Nutrition 70, 198-207.

Lopez GH, Ilincheta de Boschero MG, Castagnet PI & Giusto NM (1995) Age-associated changes in the content and fatty acids composition of brain glycerophospholipids. Comparative Biochemistry and Physiology Part B Biochemistry and Molecular Biology 112, 331-343.

Lutjohann D, Papassotiropoulos A, Bjorkhem K, Locotelli S, Bagli M, Oehring RD, Schlegel U, Jessen I, Rao ML, von Bergmann K & Heur R (2000) Plasma 24S-hydroxycholesterol (cerebrosterol) is increased in Alzheimer and vascular demented patients. Journal of Lipid Research 41, 195-198.

McCaddon A, Davies G, Hudson P, Tandy S & Cattell H (1998) Total serum homocysteine in senile dementia of Alzheimer type. International Journal of Geriatric Psychiatry 13, 235-239.

Marcus EL & Berry EM (1998) Refusal to eat in the elderly. Nutrition Reviews 56, 163-171.

Markesbery WR & Carney JM (1999) Oxidative alterations in Alzheimer's disease. Brain Pathology 9, 133-146.

Mattis S (1976) Mental status examination for organic mental syndrome in the elderly patient. In Geriatric Psychiatry, pp. 77-121 [L Bellak and TE Karasu, editors]. New York, NY: Grune & Stratton.

Maurer K, Ihl R, Dierks T & Frolich L (1997) Clinical efficacy of Ginkgo biloba special extract EGb761 in dementia of the Alzheimer type. Journal of Psychiatric Research 31, 645-655.

Medline: National Library of Medicine (1999)
Miller JW (1999) Homocysteine and Alzheimer's disease. Nutrition Reviews 57, 126-129.

Moroney JT, Tang MX, Berglund L, Small S, Merchant C, Bell K, Stern Y & Mageux R (1999) Low-density lipoprotein cholesterol and the risk of dementia with stroke. Journal of the American Medical Association 21, 254-260.

Morris MC, Beckett LA, Scherr PA, Hebert LE, Bennett DA, Field TS & Evans DA (1998) Vitamin E and vitamin C supplement use and risk of incident Alzheimer disease. Alzheimer Disease and Associated Disorders 12, 121-126.

National Center for Health Statistics (NCHS) (1999)
Nilsson K, Gustafson L, Faldt R, Andersson A, Brattstrom L, Lindgren A, Israelsson
B & Hultberg B (1996) Hyperhomocysteinaemia - a common finding in a psychogeriatric population. European Journal of Clinical Investigation 26, 853-859.

Norberg A & Athlin E (1989) Eating problems in severely demented patients: issues and ethical dilemmas. Nursing Clinics of North America 24, 781-789.

Paleologos M, Cumming RG & Lazarus R (1998) Cohort study of vitamin C intake and cognitive impairment. American Journal of Epidemiology 148, 45-50.

Parnetti L, Bottiglieri T & Lowenthal D (1997) Role of homocysteine in age-related vascular and non-vascular diseases. Aging (Milano) 9, 241-257.

Pietrzik K & Brönstrup A (1997) Folic acid in preventive medicine: a new role in cardiovascular disease, neural tube defects and cancer. Annals of Nutrition and Metabolism 41, 331-343.

Pitchumoni SS & Doraiswamy PM (1998) Current status of antioxidant therapy for Alzheimer's disease. Journal of the American Geriatric Society 46, 1566-1572.

Prince M, Lovestone S, Cervilla J, Joels S, Powell J, Russ C & Mann A (2000) The association between apoE and dementia does not seem to be mediated by vascular factors. Neurology 25, 397-402.

Ramirez-Lassepas M (1998) Stroke and the aging of the brain and the arteries. Geriatrics 53, S44-S48.

Regland B, Blennow K, Germgard T, Koch-Schmidt AC & Gottfries CG (1999) The role of the polymorphic genes apolipoprotein E and methylene-tetrahydrofolic acid reductase in the development of dementia of the Alzheimer type. Dementia and Geriatric Cognitive Disorders 10, 245-251.

Riggs KM, Spiro A, Tucker K & Rush D (1996) Relations of vitamin B12, vitamin B6, and homocysteine to cognitive performance in the Normative Aging Study. American Journal of Clinical Nutrition 63, 306-314.

Riviere S, Birlouey-Aragon I, Nourhashemi F & Vellas B (1998) Low plasma vitamin C in Alzheimer patients despite an adequate diet. International Journal of Geriatric Psychiatry 13, 749-754.

Rosenberg IH & Miller JW (1992) Nutritional factors in physical and cognitive functions of elderly people. American Journal of Clinical Nutrition 55, 1237S-1243S.

Rosler M, Retz W, Thome J & Riederer P (1998) Free radicals in Alzheimer's dementia: currently available therapeutic strategies. Journal of Neural Transmission 54, Suppl., 211-219.

Roth M, Tym E, Mountjoy CQ, Huppert FA, Hendrie H, Verma S & Goddard R (1986) CAMEX: A standardised instrument for the diagnosis of medical disorder in the elderly with special reference to the early detection of dementia. British Journal of Psychiatry 149, 698-709.

Sano M, Ernesto C, Thomas RG, Klauber MR, Schafer K, Grundmann M, Woodbury P, Growdon J, Cotman CW, Pfeiffer E, Schneider LS & Thal LJ (1997) A controlled trial of selegiline, alpha-tocopherol, or both as treatment for Alzheimer's disease. New England Journal of Medicine 336, 1216-1222.

Schmidt R, Haydn M, Reinhard B, Roob G, Schmidt H, Schumacher M, Watzinger N & Launer LJ (1998) Plasma antioxidants and cognitive performance in middle-aged and older adults: results of the Austrian Stroke Prevention Study. Journal of American Geriatric Society 46, 1407-1410.

Schneider LS (1998) New therapeutic approaches to cognitive impairment. Journal of Clinical Psychiatry 59, 8-13.

Selkoe DJ (1997) Alzheimer's disease: genotypes, phenotype, and treatments. Science 275, 630-631.

Simonson W (1998) Promising agents for treating Alzheimer's disease. American Journal of Health Systems Pharmacy 55, S11-S16.

Sinclair AJ, Bayer AJ, Johnston J, Warner C & Maxwell SR (1998) Altered plasma antioxidant status in subjects with Alzheimer's disease and vascular dementia. International Journal of Geriatric Psychiatry 13, 840-845.

Skoog I, Lernfelt B, Landahl S, Palmertz B, Andreasson LA, Nilsson L, Persson G, Oden A & Svanborg A (1996) Fifteen-year longitudinal study of blood pressure and dementia. Lancet 347, 1141-1145.

Small GW & Leiter F (1998) Neuroimaging for diagnosis of dementia. Journal of Clinical Psychiatry 59, 4-7.

Snowdon DA, Tully CL, Smith CD, Perez Riley K & Markesberry WR (2000) Serum folate and the severity of atrophy of the neocortex in Alzheimer disease: findings from the Nun Study. American Journal of Clinical Nutrition 71, 993-998.

Solfrizzi V, Panza F, Torres F, Mastroianni F, Del Parigi A, Venezia A & Capurso A (1999) High monounsaturated fatty acids intake protects against age-related cognitive decline. Neurology 52, 1563-1569.

Swain R (1995) An update of vitamin B12 metabolism and deficiency states. Journal of Family Practice 41, 595-600.

Tang JL, Armitage JM, Lancaster T, Silagy CH, Fowler GH & Neil HA (1998) Systematic review of dietary intervention trials to lower blood total cholesterol in free-living subjects. British Medical Journal 18, 1213-1220.

Tysoe C, Galinsky D, Robinson D, Brayne CE, Easton DF, Huppert FA, Dening T, Paybel ES & Rubinstein DC (1997) Analysis of alpha-1 antichymotrypsin, persenilin-1, angiotensin-converting enzyme, and methylenetetrahydrofolic acid reductase loci as candidates for dementia. American Journal of Medical Genetics 74, 207-212.

Varela G (1992) La Dieta Mediterránea (The Mediterranean diet). In Aciete de Oliva de la Comunidad Europea (Olive Oil from the European Community), Madrid: Vegeland-Farma.

Venters HD Jr, Bonilla LE, Jensen T, Garner HP, Bordayo EZ, Najarian MM, Ala TA, Mason RP & Frey WH 2nd (1997) Heme from Alzheimer's brain inhibits muscarinic receptor binding via thiyl radical generation. Brain Research 764, 93-100.

Wehr H, Parnowski T, Puzynski S, Bednarska-Makanick M, Bisko M, Kotapka-Minc S, Rodo M, Wolkowska M (2000) Apolipoprotein E genotype and lipid and lipoprotein levels in dementia. Dementia and Geriatric Cognitive Disorders 11, 70-73.

Wolfram G (1995) Diet therapy in gout. Therapeutische Umshau 52, 524-527.

World Health Organization (1999) World Health Day will focus on ageing. Bulletin of the World Health Organization 77, 293-294.

World Health Organization (2000). The World Health Report 2000.