Diet And Dementia Research Needs To Be Improved
If you look on the Internet for articles about foods that are good for your brain, you will find a lot of them. Some of these stories mention observational studies that have found a link between eating less or more of certain foods and the risk of dementia. But clinical studies that tried to find a link between certain nutrients or diets and how well the brain works have not found convincing evidence.
Hussein Yassine, MD, associate professor of medicine and neurology at the Keck School of Medicine of USC and the Kenneth and Bette Volk Chair of Neurology of USC, said that many trials have not found that making people eat healthy or exercise has the benefits that epidemiological research predicts. "That means either there isn't a cause-and-effect link or these studies aren't set up right."
To figure out why epidemiological research and clinical trials don't match up, Yassine led the Nutrition for Dementia Prevention Working Group, a group of scientists who spent two years reading all the research on nutrition and the risk of dementia. Their analysis, which was just published in The Lancet Healthy Longevity, points out major problems with existing trials that affect how nutrition affects the brain and gives a set of suggestions to guide and improve future research.
Nutritional research presents unique challenges
Yassine says that it's hard to do good research on nutrition in general. Epidemiological studies, for example, show that people who eat fatty seafood like salmon are less likely to get dementia. But it is hard to separate nutritional information from other things that might also play a role, like where a person lives, if they live a healthy lifestyle, or if they have access to good medical care.
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Most of the clinical research on food and brain health may not have been done for long enough for the results to be useful, because no one knows how long it takes for a healthy diet to affect cognition. Yassine said, "If it takes five to ten years, then studies that only lasted two years or less don't show the true effect of the diet on cognition."
Future research will also be better if more research is done to figure out how much of a certain nutrient a person needs to have a healthy brain. For example, there is an agreed-upon amount of vitamin D that keeps bones healthy, but this is not true for nutrients that are thought to affect brain health.
Using new technology and looking into new areas of study
The group says that using biomarkers instead of cognitive tests, which are the most common way to measure the success of an intervention, could lead to more useful results right away that can help guide longer interventions that focus on clinical outcomes. Brain imaging is a great example of a technology that can be used to see how the brain changes over time. Also, they say that testing blood or stool samples for certain biomarkers, such as not getting enough of a certain nutrient, can be used to find the best study participants and see if they are responding to the intervention being studied.
Yassine, who studies the gene APOE4, which is the strongest genetic risk factor for late-onset Alzheimer's disease, says that genetic testing can also be useful. He said that people with this genetic variation have a different response to diet than people who don't have it. In this case, genetic testing can improve the quality of research by making interventions more specific to each person.
New information about the microbiome can also help researchers do better work. Yassine said that different people get different benefits from food because their microbiomes are different. Yassine said, "You can't fully understand how the diet works without looking at the microbiome." There is also a need to learn more about how the gut microbiota and cognition are connected in large groups of people with different backgrounds.
A new way of thinking
The group finally came to the conclusion that researchers should think about using a wider range of study designs, not just randomised controlled trials, and that choosing trial participants should be done with more thought.
They say that one way to do this would be to make small, personalised trials that take into account the genetic risk of the participants, the quality of their diet, and an analysis of their microbiome while using biomarkers that show how the brain works. Another way is to use mobile phones or tablets to collect data from people with risk factors for dementia in large, practical electronic health trials.
So far, most of the research has been done on older people. However, several high-quality cohort studies suggest that middle age might be the best time to start this kind of research, before the changes that come with dementia, so that researchers can track changes over time. The group also says that studies need to take into account the food preferences of underrepresented groups, some of which are affected by dementia more than others.
Lon Schneider, MD, Professor of Psychiatry and the Behavioral Sciences at the Keck School of Medicine and Della Martin Chair in Psychiatry and Neuroscience, said, "This is an important document for anyone doing research on diet and how it affects dementia." Dr. Schneider is also a member of The Lancet Commission on preventing, treating, and caring for dementia. "It is important that future trials produce accurate results that can be used to give patients better care in the clinic."
Heather M. Snyder, Ph.D., vice president of medical and scientific relations for the Alzheimer's Association, said, "We are happy to be a part of this working group and to help make these suggestions a reality."
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