Dietary patterns for healthier cognitive ageing
Berendsen, Agnes A.M. - \ 2017
Wageningen University. Promotor(en): C.P.G.M. de Groot; E.J.M. Feskens, co-promotor(en): O. van de Rest. - Wageningen : Wageningen University - ISBN 9789463436014 - 190
meal patterns - feeding habits - aging - cognition - health - food supplements - dementia - nutritional intervention - elderly - elderly nutrition - nutrition and health - maaltijdpatronen - voedingsgewoonten - verouderen - kenvermogen - gezondheid - voedselsupplementen - dementie - maatregel op voedingsgebied - ouderen - ouderenvoeding - voeding en gezondheid
With ageing of our population and the accompanying increase in the number of people living with dementia, it is important to find modifiable risk factors to postpone the onset of cognitive decline. Diet has been proposed such a modifiable risk factor. To date, numerous studies have been conducted demonstrating a possible role of specific nutrients and foods in cognitive functioning. However, as people do not consume single nutrients, the research field has shifted towards studying dietary patterns in which synergistic effects of single nutrients and/or foods can be studied. The main aim of this thesis was to study the association of healthful dietary patterns with cognitive functioning. In addition, nutrient intake inadequacies were assessed and the potential to change dietary intake in older adults aged 65 years and older was studied.
Chapter 2 describes nutrient intake of 245 Dutch adults aged 65-80 years. We identified the contribution of nutrient dense foods, fortified foods and dietary supplements to the total intake of micronutrients. Nutrient density of foods was evaluated using the Nutrient Rich Food score 9.3. Nutrient intake inadequacies were observed for vitamin D, vitamin B6 and selenium. Conventional foods were the main source of vitamin D, vitamin B6 and selenium intake. Foods with the highest nutrient density contributed most to total vitamin B6 intake. In order to optimize nutrient intakes of elderly, combinations of natural food sources, fortified foods and dietary supplements should be considered.
Chapter 3 provides a systematic review of the literature on human studies up to May 2014 that examined the role of dietary patterns in relation to cognitive decline or dementia. The results demonstrate that better adherence to a Mediterranean diet was associated with less cognitive decline, dementia or Alzheimer’s Disease (AD) in four out of six cross-sectional studies, six out of 12 longitudinal studies, one trial and three meta-analyses. Other healthy dietary patterns, among which the Healthy Diet Indicator, have shown to be associated with reduced cognitive decline and/or a reduced risk of dementia in all six cross-sectional studies and six out of eight longitudinal studies. The conclusion of this literature review was that more conclusive evidence is needed to come to more targeted and detailed dietary guidelines to prevent or postpone cognitive decline.
In chapter 4 the association between the Healthy Diet Indicator (HDI) and cognitive functioning in older adults from three different cohort studies was investigated. The cohorts included in total 21,837 subjects from Europe (SENECA and the Rotterdam Study [RS]) and the Unites States (Nurses’ Health Study [NHS]). Cognitive functioning was measured using the Mini-Mental State Examination (MMSE) in SENECA and RS, and the Telephone Interview for Cognitive Status (TICS) in NHS. In all three cohorts, the HDI was not significantly associated with cognitive decline, nor with cognitive function.
In chapter 5 the association of long-term adherence to the Dietary Approaches to Stop Hypertension (DASH) diet with cognitive function and decline in older American women was examined. A total of 16,144 women from the Nurses’ Health Study, aged ≥70 years, who underwent cognitive testing a total of 4 times by telephone from 1995-2001 (baseline), with multiple dietary assessments between 1984 and the first cognitive exam were studied. Greater adherence to long-term DASH score was significantly associated with better average global cognition, verbal memory and TICS score at older ages, but not with cognitive decline.
In chapter 6, the same cohort as in chapter 5 was studied to examine the association between long-term adherence to a recently developed Mediterranean-DASH Intervention for Neurodegenerative Delay (MIND) diet with cognitive function and decline. Higher MIND diet scores were associated with better verbal memory at older ages, but not with cognitive decline over 6 years in global cognition, verbal memory or TICS.
Chapter 7 provides an overview of the NU-AGE (NUtrients and AGEing) dietary intervention study. The NU-AGE study is a randomized one-year intervention in 1,250 apparently healthy, independently living European subjects aged 65 to 80 years. Subjects were randomised into either the intervention group or the control group. Participants in the intervention group received dietary advice aimed at meeting the dietary recommendations of the ageing population. At the start of this thesis, the NU-AGE study was the first dietary intervention investigating the effect of a whole diet and providing targeted dietary recommendations for optimal health and quality of life in apparently healthy European elderly.
In chapter 8, we evaluated if the NU-AGE intervention could be effective to shift the dietary intake of apparently healthy older adults aged 65-80 years living in Italy, the UK, the Netherlands, Poland, and France towards a more healthful diet. The NU-AGE index was created to assess adherence to the NU-AGE diet. At baseline and after one-year follow-up dietary intake was assessed by means of 7-day food records. In total, 1,296 participants were randomized and 1,145 participants completed the intervention (571 in intervention group, 570 in control group). After one-year follow-up, the intervention group improved mean intake of 13 out of 16 dietary recommendations of the NU-AGE diet (p<0.05) with a significant increase of the total NU-AGE index, compared to the control group (mean change in NU-AGE index 21.3±15.9, p<0.01). The NU-AGE dietary intervention, based on dietary recommendations for older adults, may be a feasible strategy to improve dietary intake in an ageing European population.
Chapter 9 shows the results of the NU-AGE parallel randomized dietary intervention study on cognitive functioning in the Dutch NU-AGE subpopulation, including 252 older adults aged 65-80 years (123 intervention, 129 control). The primary outcome was one-year change in global cognition and in four cognitive domains as measured through a comprehensive neuropsychological test battery. Comparing the intervention with the control group, there was no effect of the intervention on cognitive functioning.
In chapter 10 the main findings of this thesis were summarized and a reflection on methodological aspects was given. When grading the reported associations in previous studies and studies in this thesis, it was concluded that there is probable evidence for a role of the Mediterranean diet on cognitive functioning. For the DASH and MIND diet there is a possible link with cognitive functioning; for the HDI and the NU-AGE diet there is no sufficient evidence yet to conclude that there is a relation with cognitive functioning. Not only is there a need for well-designed intervention and prospective studies, we also call for communication strategies to the general public about the consumption of healthier diets to not only impact cardiovascular but also potentially impact brain health as many individuals will face progressive cognitive decline in the near future.
Nutrition and cognition in older adults : studies on the role of glucose, sucrose, protein, vitamin B12 and folic acid
Zwaluw, N.L. van der - \ 2014
Wageningen University. Promotor(en): Lisette de Groot, co-promotor(en): Ondine van de Rest; Rosalie Dhonukshe-Rutten. - Wageningen : Wageningen University - ISBN 9789462571075 - 184
ouderenvoeding - voeding - ouderen - kenvermogen - glucose - sucrose - eiwittoevoegingen - vitamine b12 - dementie - elderly nutrition - nutrition - elderly - cognition - glucose - sucrose - protein supplements - vitamin b12 - dementia
The age-related cognitive decline and the increase in dementia patients are large problems in societies with growing ageing populations. No cure is present for dementia, while the available medication only focuses on alleviating symptoms. It is therefore of major importance to find risk factors that can modify the development of cognitive decline and dementia. Pre-clinical and observational studies suggest a role for nutrients. Evidence derived from randomized controlled trials (RCTs) is, however, limited and equivocal with most studies showing no effect and only a few studies showing a beneficial effect of a nutritional intervention. In the current thesis, we investigated the acute and longer-term effects of different nutrients, i.e. glucose and sucrose, protein, resistance-type exercise training with or without protein, and vitamin B12 and folic acid in order to optimize and preserve cognitive functions in non-demented elderly people.
A comprehensive literature review was performed on the acute effects of glucose and sucrose on cognitive performance (Chapter 2). Glucose is the most important fuel for the brain, and as such, manipulation of the supply of glucose may affect cognitive functions. The main conclusion of our review was that a glucose load may have a short-term beneficial effect on episodic memory. Enhancing effects on other cognitive domains were less clear, partly due to the small number of studies examining these effects. Limited research was also done on the possible effects of sucrose on cognitive functions. Therefore, we investigated the acute effects of 50 g of glucose and 100 g of sucrose on a broad spectrum of cognitive functions reflecting performance on episodic memory, working memory, attention and information processing speed, and executive functions (Chapter 3). This was done by a cross-over study in 43 elderly participants who had self-reported memory complaints. In contrast to the conclusion of our review, we did not observe an effect of glucose or sucrose on episodic memory, though we showed a beneficial effect of sucrose on attention and information processing speed.
Protein supplementation was the next nutritional intervention that was investigated. Several amino acids are precursors for neurotransmitters, and their supply may affect the synthesis and release of these neurotransmitters, and may consequently affect cognitive performance. A 24-week randomized placebo-controlled trial was carried out in 65 frail and pre-frail elderly people (Chapter 4). The protein supplementation included twice a day 15 grams of protein in the form of a drink. Reaction time improved more in the protein group compared to the placebo group, but the scores on the cognitive domains, i.e. episodic memory, attention and working memory, information processing speed, and executive functions, or the other single test scores, did not differ between treatment groups. In addition, we investigated the effects of 24 weeks resistance-type exercise training with and without protein supplementation in pre-frail and frail elderly people (Chapter 5). Exercise training without extra protein (n=62) improved performance on the domain attention and working memory. Exercise training together with protein supplementation (n=65) improved performance on information processing speed.
Last, the role of vitamin B12 and folate on cognitive health was investigated. Low levels of these nutrients can increase homocysteine levels, which is a suggested risk factor for cognitive decline. The effect of daily supplementation with 500 µg vitamin B12 and 400 µg folic acid was investigated in 2,919 participants for two years (Chapter 6). Global cognitive function and episodic memory were assessed in the total study population, whereas extensive neuropsychological testing was done in a subpopulation (n=856). B-vitamin supplementation did not improve cognitive domain scores. Only a small, though significant, effect was observed on global cognitive performance, measured by the Mini-Mental State Examination, but this was suggested to be due to chance. Brain MRI scans were made in a subgroup (n=218) after two years of intervention to obtain volumetric measures of grey and white matter, and total brain volume (Chapter 7). We investigated the cross-sectional associations between follow-up levels of folate, homocysteine and three vitamin B12 status biomarkers, e.g. methylmalonic acid, holotranscobalamin and serum vitamin B12, and brain volumes. Fully adjusted regression models showed a borderline significant association between plasma homocysteine and total brain volume, with a stronger association in the group that received B-vitamin supplementation. Serum B12 and holotranscobalamin were not associated with brain volumes, whereas high methylmalonic acid levels were associated with lower brain volumes in the group that received B-vitamins. In contrast, higher folate levels were associated with lower total brain volumes. In addition, when comparing the group that received two years of B-vitamin supplementation and those who did not, we observed lower brain volumes in the B-vitamin group, which might be a result of a difference in age between the two groups.
To conclude, the nutritional intervention studies showed little evidence for a beneficial effect on cognitive performance in relatively healthy older adults. Given the large problem of dementia, research on modifiable risk factors, including nutrition, should continue, with well thought out research methods, including large and long-term observational and intervention studies with high-sensitive study populations and early biomarkers (e.g. imaging techniques) for cognitive decline in combination with neuropsychological tests. In this way, nutrition can be added to the list of lifestyle factors that can fight dementia.
Voeding en beweging ter preventie van cognitieve achteruitgang
Severs, A. ; Rest, O. van de; Groot, C.P.G.M. de; Loon, L.J.C. van - \ 2014
VoedingsMagazine 27 (2014)1. - ISSN 0922-8012 - p. 18 - 20.
ouderen - ouderenvoeding - eiwittoevoegingen - dementie - kenvermogen - lichaamsbeweging - voeding en gezondheid - voedingsstoffen - elderly - elderly nutrition - protein supplements - dementia - cognition - exercise - nutrition and health - nutrients
Dementie wordt een steeds groter en kostbaarder probleem door de vergrijzing. Wetenschappers zijn naarstig op zoek naar mogelijkheden om het tij te keren. Zo ook dr.ir. Ondine van de Rest, onderzoeker aan Wageningen University. Haar onderzoek is gericht op de rol van voeding bij leeftijdsgerelateerde cognitieve achteruitgang. Samen met prof. dr.Lisette de Groot, hoogleraar voeding voor de oudere mens aan Wageningen Universiteit, en Prof. Dr. Luc van Loon, hoogleraar fysiologie van inspanning aan Maastricht Universiteit, voerde ze binnen het Top Instituut Food and Nutrition (TIFN) een interventiestudie uit bij ouderen naar het effect van eiwitsuppletie en beweging op de cognitie.
Gemeenten en zorgboerderijen : een kansrijke combinatie binnen de Wmo voor mensen met dementie, mits...
Bruin, S. ; Hop, P. ; Molema, C. ; Nowak, S. ; Baan, C. ; Oosting, S.J. - \ 2013
Bilthoven : Rijksinstituut voor Volksgezondheid en Milieu
zorgboerderijen - sociale zorg - langdurige zorg - sociale voorzieningen - dementie - ouderen - social care farms - social care - long term care - social services - dementia - elderly
Boerderijen en mensen met dementie: het lijkt geen voor de hand liggende combinatie. Toch is er een aanzienlijk aantal zorgboerderijen waar mensen met dementie terecht kunnen voor dagopvang. Zorgboerderijen bieden mensen met dementie een zinvolle en prettige dagbesteding in een landelijke omgeving. Hun mantelzorgers worden daarmee tijdelijk ontlast van de zorg. Hiermee kunnen zorgboerderijen mogelijk bijdragen aan het langer thuis wonen van mensen met dementie; één van de doelstellingen van het beleid van de rijksoverheid op het gebied van de langdurige zorg.
Eten en drinken bij dementie
Wapenaar, J. ; Groot, C.P.G.M. de - \ 2013
Amsterdam : Reed Business Education - ISBN 9789035235397 - 88
dementie - humane voeding - voeding - voeding en gezondheid - gezondheidszorg - ouderen - dementia - human feeding - nutrition - nutrition and health - health care - elderly
Voor veel mensen met dementie is eten en drinken moeilijk. Goede zorg bij eten en drinken is essentieel om mensen met dementie zo gezond mogelijk te houden en hun kwaliteit van leven hoog te houden. Verzorgenden, verpleegkundigen en voedingsassistenten krijgen met dit boek praktische handvatten om hun cliënten te kunnen ondersteunen. Ze leren met dit boek hoe ze kunnen helpen bij het eten en drinken en hoe ze het thema eten en drinken kunnen gebruiken om de kwaliteit van leven van mensen met dementie te verbeteren.
Thuis op de zorgboerderij : handreiking kleinschalig wonen voor ouderen met dementie
Roest, A.E. ; Oltmer, K. ; Driest, P. ; Jans, A. - \ 2010
[S.l.] : Taskforce Multifunctionele Landbouw
welzijnsvoorzieningen - gezondheidszorg - ouderen - dementie - zorgboerderijen - multifunctionele landbouw - welfare services - health care - elderly - dementia - social care farms - multifunctional agriculture
Nederland telt momenteel rond de 1.000 zorgboerderijen. Zorgboerderijen verlenen zorg aan mensen met een verstandelijke of lichamelijke beperking, jongeren met ontwikkelingsproblemen, mensen met verslavings- of GGZ-achtergrond en/of mensen met burn-out. Rond de 150 zorgboerderijen richten zich op ouderen met dementie. Deze doelgroep zal in de komende decennia het sterkst in omvang toenemen en daarmee ook de kansen voor de zorgboerderijen op een zorgvraag met een redelijk zekere financiering. De zorgboerderijen gericht op ouderen met dementie bieden vooral dagbesteding. Slechts een handjevol zorgboerderijen biedt intensievere vormen van zorg en ondersteuning, waaronder woonvoorzieningen, aan ouderen die een grote zorgbehoefte hebben en niet meer zelfstandig kunnen wonen. De meeste van deze ouderen hebben een vorm van dementie
Sowing in the autumn season : exploring benefits of green care farms for dementia patients
Bruin, S.R. de - \ 2009
Wageningen University. Promotor(en): Akke van der Zijpp, co-promotor(en): J.M.G.A. Schols; Simon Oosting; M.J. Enders-Slegers. - [S.l. : S.n. - ISBN 9789085855095 - 196
dementie - oudere patiënten - patiëntenzorg - dagopvang - gezondheid - menselijke activiteit - voedselopname - zorgboerderijen - multifunctionele landbouw - welzijn - dementia - elderly patients - patient care - day care - health - human activity - food intake - social care farms - multifunctional agriculture - well-being
In the Netherlands an increasing number of farms combine agricultural production with care services for people with care needs. It is generally believed that these green care farms (GCFs) have beneficial effects on the health status of a diversity of target groups. At present, empirical studies testing this hypothesis are scarce. The main objective of the studies described in this thesis was to gain insight into the potential benefits of day care at GCFs for community‐dwelling older dementia patients. Day care at GCFs was therefore compared with day care at regular day care facilities (RDCFs). In view of the differences between both day care types regarding the day care setting and day care program it was hypothesized that they would differ in their effects on the health status of dementia patients. In two cross‐sectional studies it was tested to what extent the day program of dementia patients at GCFs differed from those at RDCFs. It appeared that at GCFs, dementia patients were (physically) more active, participated in more diverse activities, were more outdoors, and had more opportunities to perform activities in smaller groups than those at RDCFs. It was tested whether these differences resulted into different effects for five domains of health: dietary intake, cognition, emotional well‐being, behaviour, and functional performance. In a comparative cross‐sectional study dietary intake of dementia patients attending day care at GCFs or RDCFs was recorded both at home and during their time at the day care facility. The study showed that dementia patients attending day care at GCFs had significantly higher intakes of energy, carbohydrate, and fluid than their counterparts attending day care at RDCFs. In a cohort study, rates of change during 1 year in cognitive functioning, emotional well‐being, behavioural symptoms, and functional performance were compared between dementia patients attending day care at GCFs and RDCFs. Functioning in these domains remained rather stable and no differences were observed between subjects from GCFs and RDCFs. In the cohort study, also caregiver burden of family caregivers of these dementia patients was assessed. Caregivers’ quality of life, emotional distress, and feelings of competence remained rather stable in family caregivers of dementia patients from both day care settings. In conclusion, the present work has shown that GCFs exceeded RDCFs in offering older dementia patients a diverse day program and in stimulating their dietary intake. The latter may result into a better preserved nutritional status in dementia patients attending day care at GCFs than in those attending day care at RDCFs. GCFs and RDCFs were equally effective in preventing significant decrease of cognitive functioning, emotional well‐being, and functional performance and in preventing significant increase of the number of behavioural symptoms. Both day care types further prevented significant increase of caregiver burden. Day care at GCFs is a new and valuable addition to the present care modalities for community‐dwelling older dementia patients and their caregivers