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Antioxidant nutrients and age-related cognitive decline: a systematic review of population-based cohort studies

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Abstract

Purpose

To further inform the debate on the possible cognitive benefits of antioxidant nutrients in the elderly, we systematically reviewed available prospective studies while paying a special attention to their methodological quality.

Methods

This is a systematic review of studies involving major antioxidant nutrients and change in cognitive performance. Abstracts were independently reviewed; studies were selected based on prespecified criteria. Methodological quality of primary studies was assessed using a methodological checklist for cohort studies. Findings were presented using a narrative synthesis and tabulation of results.

Results

Eight-hundred and fifty potentially eligible studies were identified; 10 met the inclusion criteria and were retained for data extraction and appraisal. The main supportive evidence came from two studies, both judged to be of high quality: The first observed an accelerated decline in global cognition, attention, and psychomotor speed over 9 years, concomitant to a decrease in plasma selenium levels over the same period; the second study reported a slower rate of global cognitive decline over 3 years in persons in the highest quartile of intake of vitamins C, E, and carotenes. All associations persisted after adjustment for confounding factors. Evidence in favor of beneficial associations of higher dietary intake of vitamin E and flavonoids, as well as higher serum beta carotene levels, came from further studies of only adequate quality.

Conclusions

There is a possibility for protective effects of antioxidant nutrients against decline in cognition in older people although the supportive evidence is still limited in number. This association deserves further examination in additional quality investigations.

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References

  1. Fried LP (2000) Epidemiology of aging. Epidemiol Rev 22:95–106

    Article  CAS  Google Scholar 

  2. Waldstein SR, Elias MF (2003) Introduction to the special section on health and cognitive function. Health Psychol 22:555–558

    Article  Google Scholar 

  3. Melzer D, Ely M, Brayne C (1997) Cognitive impairment in elderly people: population based estimate of the future in England, Scotland, and Wales. Brit Med J 315:462

    Article  CAS  Google Scholar 

  4. Haan MN, Wallace R (2004) Can dementia be prevented? Brain aging in a population-based context. Annu Rev Public Health 25:1–24

    Article  Google Scholar 

  5. Ritchie K, Lovestone S (2002) The dementias. Lancet 360:1759–1766

    Article  Google Scholar 

  6. Seshadri S, Wolf PA (2007) Lifetime risk of stroke and dementia: current concepts, and estimates from the Framingham Study. Lancet Neurol 6:1106–1114

    Article  Google Scholar 

  7. van der Flier WM, Scheltens P (2005) Epidemiology and risk factors of dementia. J Neurol Neurosurg Psychiatry 76:v2–v7

    Article  Google Scholar 

  8. Alzheimer’s Disease International (2010) World Alzheimer report 2010. Alzheimer’s Disease International, London

    Google Scholar 

  9. Bruscoli M, Lovestone S (2004) Is MCI really just early dementia? A systematic review of conversion studies. Int Psychogeriatr 16:129–140

    Article  Google Scholar 

  10. Purandare N, Ballard C, Burns A (2005) Preventing dementia. Adv Psychiatr Treat 11:176–183

    Article  Google Scholar 

  11. Román GC (2003) Stroke, cognitive decline and vascular dementia: the silent epidemic of the 21st century. Neuroepidemiology 22:161–164

    Article  Google Scholar 

  12. Haan MN (2003) Can vitamin supplements prevent cognitive decline and dementia in old age? Am J Clin Nutr 77:762–763

    CAS  Google Scholar 

  13. Christen Y (2000) Oxidative stress and Alzheimer diseases. Am J Clin Nutr 71:621S–629S

    CAS  Google Scholar 

  14. Langseth L (1995) Oxidants, antioxidants, and disease prevention. International Life Sciences Institute (ILSI Europe), Brussels

    Google Scholar 

  15. Singh RP, Sharad S, Kapur S (2004) Free radicals and oxidative stress in neurodegenerative diseases: relevance of dietary antioxidants. J Ind Acad Clin Med 5:218–225

    Google Scholar 

  16. Willcox BJ, Curb JD, Rodriguez BL (2008) Antioxidants in cardiovascular health and disease: key lessons from epidemiologic studies. Am J Cardiol 101:75D–86D

    Article  CAS  Google Scholar 

  17. Morris MC, Christine TC (2011) A potential design flaw of randomized trials of vitamin supplements. J Am Med Assoc 305:1348–1349

    Article  CAS  Google Scholar 

  18. Isaac M, Gad El Kareem N, Quinn R, Tabet N (2008) Vitamin E for Alzheimer’s disease and mild cognitive impairment. Cochrane Database Syst Rev 3. doi:10.1002/14651858.CD002854.pub2

  19. Lee Y, Back JH, Kim J, Kim S-H, Na DL, Cheong H-K, Hong CH, Kim YG (2010) Systematic review of health behavioral risks and cognitive health in older adults. Int Psychogeriatr 22:174–187

    Article  Google Scholar 

  20. Serra-Majem L, Roman B, Estruch R (2006) Scientific evidence of interventions using the Mediterranean diet: a systematic review. Nutr Rev 2:S27–S47

    Article  Google Scholar 

  21. Stroup DF, Berlin JA, Morton SC, Olkin I, Williamson GD, Rennie D, Moher D, Becker BJ, Sipe TA, Thacker SB (2000) Meta-analysis of observational studies in epidemiology: a proposal for reporting. Meta-analysis of observational studies in epidemiology (MOOSE) group. J Am Med Assoc 283:2008–2012

    Article  CAS  Google Scholar 

  22. Mayne ST (2003) Antioxidant nutrients and chronic disease: use of biomarkers of exposure and of oxidative stress status in epidemiologic research. J Nutr 133:933S–940S

    CAS  Google Scholar 

  23. Mayne ST, Wright ME, Cartmel B (2004) Assessment of antioxidant nutrient intake and status for epidemiologic research. J Nutr 134:3199S–3200S

    CAS  Google Scholar 

  24. Sahu DR, Ramakantan RR, Bavdekar SB (2000) The art and science of web-based literature search: the MEDLINE. J Postgrad Med 46:123

    CAS  Google Scholar 

  25. Kundel HL, Polansky M (2003) Measurement of observer agreement. Radiology 228:303–308

    Article  Google Scholar 

  26. The Scottish Intercollegiate Guidelines Network (2001–2012) http://www.sign.ac.uk. Accessed 14 Dec 2011

  27. Centre for Reviews and Dissemination (CRD) (2009) Systematic reviews: CRD’s guidance for undertaking reviews in health care. http://www.york.ac.uk/inst/crd/pdf/Systematic_Reviews.pdf. Accessed 3 Apr 2012

  28. Morris MC, Evans DA, Tangney CC, Bienias JL, Wilson RS, Aggarwal NT, Scherr PA (2005) Relation of the tocopherol forms to incident Alzheimer disease and to cognitive change. Am J Clin Nutr 81:508–514

    CAS  Google Scholar 

  29. Hu P, Bretsky P, Crimmins EM, Guralnik JM, Reuben DB, Seeman TE (2006) Association between serum beta-carotene levels and decline of cognitive function in high-functioning older persons with and without apolipoprotein E 4 alleles: MacArthur studies of successful aging. J Gerontol (A Biol Sci Med Sci) 61A:616–620

    Article  CAS  Google Scholar 

  30. Wengreen HJ, Munger RG, Corcoran CD, Zandi P, Hayden KM, Fotuhi M, Skoog I, Norton MC, Tschanz J, Breitner JCS, Welsh-Bohmer KA (2007) Antioxidant intake and cognitive function of elderly men and women: the Cache County study. J Nutr Health Aging 11:230–237

    CAS  Google Scholar 

  31. Kang JH, Grodstein F (2008) Plasma carotenoids and tocopherols and cognitive function: a prospective study. Neurobiol Aging 29:1394–1403

    Article  CAS  Google Scholar 

  32. Kalmijn S, Feskens EJM, Launer LJ, Kromhout D (1997) Polyunsaturated fatty acids, antioxidants, and cognitive function in very old men. Am J Epidemiol 145:33–41

    Article  CAS  Google Scholar 

  33. Engelhart MJ, Ruitenberg M, Meijer J, Kiliaan A, van Swieten JC, Hofman A, Witteman JCM, Breteler MMB (2005) Plasma levels of antioxidants are not associated with Alzheimer’s disease or cognitive decline. A population-based study. Dement Geriatr Cogn 19:134–139

    Article  CAS  Google Scholar 

  34. Akbaraly NT, Hininger-Favier I, Carrière I, Arnaud J, Gourlet V, Roussel A-M, Berr C (2007) Plasma selenium over time and cognitive decline in the elderly. Epidemiology 18:52–58

    Article  Google Scholar 

  35. Letenneur L, Proust-Lima C, Le Gouge A, Dartigues JF, Barberger-Gateau P (2007) Flavonoid intake and cognitive decline over a 10-year period. Am J Epidemiol. doi:10.1093/aje/kwm036

    Google Scholar 

  36. Maxwell CJ, Hicks MS, Hogan DB, Basran J, Ebly EM (2005) Supplemental use of antioxidant vitamins and subsequent risk of cognitive decline and dementia. Dement Geriatr Cogn 20:45–51

    Article  CAS  Google Scholar 

  37. Velho S, Marques-Vidal P, Baptista F, Camilo ME (2008) Dietary intake adequacy and cognitive function in free-living elderly: a cross-sectional and short-term prospective study. Clin Nutr 27:77–86

    Article  Google Scholar 

  38. Castellani RJ, Lee H, Perry G, Smith MA (2006) Antioxidant protection and neurodegenerative disease: the role of amyloid-β and tau. Am J Alzheimers Dis Other Demen 21:126–130

    Article  Google Scholar 

  39. Anderson JK (2004) Oxidative stress in neurodegeneration: cause or consequence? Nat Rev Neurosci 5:S18–S25

    Article  Google Scholar 

  40. O’Brien JT, Erkinjuntti T, Reisberg B, Roman G, Sawada T, Pantoni L, Bowler JV, Ballard C, DeCarli C, Gorelick PB, Rockwood K, Burns A, Gauthier S, DeKosky ST (2003) Vascular cognitive impairment. Lancet 2:89–98

    Article  Google Scholar 

  41. Pashkow FJ (2011) Oxidative stress and inflammation in heart disease: do antioxidants have a role in treatment and/or prevention? Int J Inflamm. doi:10.4061/2011/514623

    Google Scholar 

  42. Morris MC, Evans DA, Hebert LE, Bienias JL (1999) Methodological issues in the study of cognitive decline. Am J Epidemiol 149:789–793

    Article  CAS  Google Scholar 

  43. Bischkopf J, Busse A, Angermeyer MC (2002) Mild cognitive impairment—a review of prevalence, incidence and outcome according to current approaches. Acta Psychiatr Scand 106:403–414

    Article  CAS  Google Scholar 

  44. Egger M, Schneider M, Smith GD (1998) Meta-analysis spurious precision? Meta-analysis of observational studies. Brit Med J 316:140–144

    Article  CAS  Google Scholar 

  45. Lezak M (1995) Neuropsychological assessment, 3rd edn. Oxford University Press, New York

    Google Scholar 

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Acknowledgments

This work was supported by the CHANCES (Consortium on Health and Ageing: Network of Cohorts in Europe and the United States) project (Grant Agreement number: 242244) funded by the European Commission under the FP7 framework programme. The authors would like to thank Professor Dimitrios Trichopoulos, Harvard School of Public Health, and Dr. Roger Humphry, Epidemiology Research Unit, Scottish Agricultural College, for providing valuable comments on earlier versions of this paper. Also, we thank the referees assigned to this paper for their constructive comments and suggestions which considerably helped improve the manuscript.

Conflict of interest

The authors declare that they have no conflict of interest.

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Authors and Affiliations

  1. Hellenic Health Foundation, Athens, Greece

    Snorri Bjorn Rafnsson, Vardis Dilis & Antonia Trichopoulou

  2. Centre for Population Health Sciences, University of Edinburgh, Teviot Place, Edinburgh, EH8 9AG, Scotland, UK

    Snorri Bjorn Rafnsson

  3. Department of Hygiene, Epidemiology and Medical Statistics, World Health Organization’s Collaborating Center for Food and Nutrition Policies, Athens, Greece

    Antonia Trichopoulou

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  1. Snorri Bjorn Rafnsson
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  2. Vardis Dilis
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  3. Antonia Trichopoulou
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Correspondence to Snorri Bjorn Rafnsson.

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Rafnsson, S.B., Dilis, V. & Trichopoulou, A. Antioxidant nutrients and age-related cognitive decline: a systematic review of population-based cohort studies. Eur J Nutr 52, 1553–1567 (2013). https://doi.org/10.1007/s00394-013-0541-7

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  • DOI: https://doi.org/10.1007/s00394-013-0541-7

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