Nutrition Programs for Cognitive Impairment

Overseen By Julia L Sheffler, PhD

Age: 18+

Sex: Any

Travel: May Be Covered

Time Reimbursement: Varies

Trial Phase: Academic

Waitlist Available

Sponsor: Florida State University

Must not be taking: Anticonvulsants, Anticholinergics, Immunosuppressants, others

Disqualifiers: Neurodegenerative illness, Major psychiatric disorder, Type 1 diabetes, others

No Placebo Group

Trial Summary

What is the purpose of this trial?

This trial tests two diets on older adults in rural Black and African-American communities in North Florida. One diet is rich in natural foods, while the other also helps the body burn fat for energy. Researchers want to see if these diets can improve health and brain function.

Will I have to stop taking my current medications?

The trial requires that participants be stable on their medications for at least 4 weeks before the screening visit, but it does not specify if you need to stop taking them. However, certain medications like Warfarin, insulin, and some others are not allowed.

What data supports the effectiveness of the treatment Mediterranean Nutrition Adherence Program and similar diets for cognitive impairment?

Research suggests that adherence to a Mediterranean diet, which is part of the Mediterranean Nutrition Adherence Program, may be associated with better cognitive performance in older adults. Studies have shown that this diet can improve cognitive function over time, particularly in those with high cardiovascular disease risk. ^{1 2 3 4 5}

Is the Mediterranean or Mediterranean-Ketogenic diet safe for humans?

The Mediterranean and Mediterranean-Ketogenic diets have been studied in various contexts, including cognitive function and dementia risk, and are generally considered safe for humans. Participants in studies often report high satisfaction with these diets, and they are associated with positive health outcomes without significant safety concerns. ^{1 3 6 7 8}

How does the Mediterranean-Ketogenic Nutrition treatment differ from other treatments for cognitive impairment?

The Mediterranean-Ketogenic Nutrition treatment is unique because it combines the benefits of the Mediterranean diet with a ketogenic approach, potentially targeting multiple brain-related mechanisms linked to dementia risk. This treatment also incorporates motivational interviewing and behavior change techniques to improve adherence, which may enhance its effectiveness compared to standard nutrition education programs. ^{1 2 4 7 9}

Eligibility Criteria

This trial is for adults aged 55-85 with mild cognitive impairment or early Alzheimer's, who are interested in a nutrition program. They should have stable health and medication use for some time before the study starts. The trial focuses on Black and African-American communities in rural North Florida.

Inclusion Criteria

If you scored between 17 and 26 on the MoCA test, you may not be able to participate. If you scored 27 or higher, you may be eligible.

I am between 55 and 85 years old.

My medications have been stable for at least 4 weeks.

Treatment Details

Interventions

• Mediterranean Nutrition Adherence Program (Behavioral Intervention)
• Modified Mediterranean Ketogenic Nutrition Adherence Program (Behavioral Intervention)

Trial Overview The study tests two diets: a Mediterranean diet and a modified ketogenic version of it, to see which one better adheres to participants' lifestyles. It also looks at how these diets affect gut-brain markers related to Alzheimer's disease over a 10-week period.

Participant Groups

Group I: MKN Adherence Program + Maintenance Opt 2 Experimental Treatment 1 Intervention

The M-KN adherence program will consist of 10, 1-hour weekly group meetings, which will take place via HIPAA-compliant Zoom. Sessions will be devoted to providing nutrition information, building group support, identifying participant goals, and working as a group to overcome barriers. Participants will be provided with access to an online forum after the program.

Group II: MKN Adherence Program + Maintenance Opt 1 Experimental Treatment 1 Intervention

The M-KN adherence program will consist of 10, 1-hour weekly group meetings, which will take place via HIPAA-compliant Zoom. Sessions will be devoted to providing nutrition information, building group support, identifying participant goals, and working as a group to overcome barriers. Participants will be provided with access to ongoing monthly support groups after the 10-week program ends and/or continued use of an online forum after the program.

Group III: Mediterranean Adherence Program + Maintenance Opt 1 Active Control 1 Intervention

The Mediterranean adherence program will consist of 10, 1-hour weekly group meetings, which will take place via HIPAA-compliant Zoom. Sessions will be devoted to providing nutrition information, building group support, identifying participant goals, and working as a group to overcome barriers. Participants will be provided with access to ongoing monthly support groups after the 10-week program ends and/or continued use of an online forum after the program.

Group IV: Mediterranean Adherence Program + Maintenance Opt 2 Active Control 1 Intervention

The Mediterranean adherence program will consist of 10, 1-hour weekly group meetings, which will take place via HIPAA-compliant Zoom. Sessions will be devoted to providing nutrition information, building group support, identifying participant goals, and working as a group to overcome barriers. Participants will be provided with access to an online forum after the program.

Who Is Running the Clinical Trial?

Florida State University

Lead Sponsor

Trials

234

Recruited

41,100+

Findings from Research

The Mediterranean ketogenic nutrition (MKN) program that included motivational interviewing and behavior change techniques led to higher participant retention (82%) and attendance (91%) compared to a standard education program, indicating it may be more effective in engaging older adults with memory concerns.

Participants in the MKN Adherence program showed better adherence to the diet and some clinical benefits, although these benefits were less pronounced at the 3-month follow-up, suggesting that ongoing support may be necessary for sustained effects.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

Improving Adherence to a Mediterranean Ketogenic Nutrition Program for High-Risk Older Adults: A Pilot Randomized Trial. Sheffler, JL., Kiosses, DN., He, Z., et al.[2023]

A 6-week ketogenic nutrition adherence program was successfully completed by all 9 older adults (ages 64-75) with mild cognitive impairment, showing high adherence and measurable ketone levels in 8 participants.

Significant improvements in cognitive performance were observed, with a median score increase from 88 to 96, indicating potential benefits of the ketogenic diet for cognitive function in this population.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

Feasibility of an MI-CBT ketogenic adherence program for older adults with mild cognitive impairment. Sheffler, JL., Arjmandi, B., Quinn, J., et al.[2022]

Adherence to the Mediterranean Diet (aMED) was linked to a significantly lower risk of cognitive impairment in a study of 7,756 participants, with odds ratios indicating a strong protective effect against cognitive decline.

Higher fish intake was associated with better cognitive function and a slower rate of cognitive decline over 5 to 10 years, suggesting that specific dietary components may enhance cognitive health.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

Adherence to a Mediterranean diet and cognitive function in the Age-Related Eye Disease Studies 1 & 2. Keenan, TD., Agrón, E., Mares, JA., et al.[2022]

In a study of 6,647 older adults with overweight or obesity, higher adherence to the Mediterranean diet was linked to improved cognitive performance over 2 years, particularly in general cognitive screening and executive function tests.

Adherence to the MIND diet also showed positive effects on working memory, while the DASH diet did not demonstrate any significant association with cognitive function changes during the same period.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

Mediterranean, DASH, and MIND Dietary Patterns and Cognitive Function: The 2-Year Longitudinal Changes in an Older Spanish Cohort. Nishi, SK., Babio, N., Gómez-Martínez, C., et al.[2023]

In a study of 2830 older adults, an optimal Mediterranean diet adherence score of 4 was identified, indicating that those who adhered to this diet had better cognitive performance and lower inflammatory markers.

Higher levels of white blood cells and neutrophils were linked to poorer cognitive performance in those with low adherence to the Mediterranean diet, while a higher platelet-to-lymphocyte ratio was associated with better cognitive outcomes in those with high adherence.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

MedDiet adherence score for the association between inflammatory markers and cognitive performance in the elderly: a study of the NHANES 2011-2014. Liu, S., Chen, X.[2022]

In a 3-year study involving 70 cognitively normal participants aged 30 to 60, those with higher adherence to a Mediterranean-style diet (MeDi+) showed significantly better brain health, with lower levels of β-amyloid deposition and better glucose metabolism compared to those with lower adherence (MeDi-).

The findings suggest that higher adherence to the Mediterranean diet may provide 1.5 to 3.5 years of protection against Alzheimer's disease (AD) biomarkers, indicating the potential of dietary interventions in promoting brain health and preventing AD.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

Mediterranean diet and 3-year Alzheimer brain biomarker changes in middle-aged adults. Berti, V., Walters, M., Sterling, J., et al.[2022]

A review of recent randomized controlled trials (RCTs) found that chronic intake of whole foods from Mediterranean, DASH, MIND, and ketogenic diets generally supports improvements in cognitive function, with 26 out of 29 studies showing positive results.

Despite variations in study design and small sample sizes, the evidence suggests that these dietary patterns can be an effective nonpharmacological approach to enhance cognitive health in middle-aged and older adults.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

Effect of Dietary Intake Through Whole Foods on Cognitive Function: Review of Randomized Controlled Trials. Jiwani, R., Robbins, R., Neri, A., et al.[2022]

In a study of 140 frail elderly individuals in Northern Italy, a strong adherence to the Mediterranean diet was linked to better cognitive performance, particularly in attention and executive function.

The research suggests that good nutritional status, characterized by a high adherence to the Mediterranean diet, may play a protective role against cognitive decline in older adults.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

The Impact of Nutrition on Cognitive Performance in a Frail Elderly Population Living in Northern Italy. Fostinelli, S., Ferrari, C., De Amicis, R., et al.[2023]

References

1. Switzerland pubmed.ncbi.nlm.nih.gov

Improving Adherence to a Mediterranean Ketogenic Nutrition Program for High-Risk Older Adults: A Pilot Randomized Trial. [2023]

2. England pubmed.ncbi.nlm.nih.gov

Feasibility of an MI-CBT ketogenic adherence program for older adults with mild cognitive impairment. [2022]

3. United States pubmed.ncbi.nlm.nih.gov

Adherence to a Mediterranean diet and cognitive function in the Age-Related Eye Disease Studies 1 & 2. [2022]

4. Switzerland pubmed.ncbi.nlm.nih.gov

Mediterranean, DASH, and MIND Dietary Patterns and Cognitive Function: The 2-Year Longitudinal Changes in an Older Spanish Cohort. [2023]

5. England pubmed.ncbi.nlm.nih.gov

MedDiet adherence score for the association between inflammatory markers and cognitive performance in the elderly: a study of the NHANES 2011-2014. [2022]

6. United States pubmed.ncbi.nlm.nih.gov

Mediterranean diet and 3-year Alzheimer brain biomarker changes in middle-aged adults. [2022]

7. United States pubmed.ncbi.nlm.nih.gov

Long-term adherence to the Mediterranean diet is associated with overall cognitive status, but not cognitive decline, in women. [2023]

8. United States pubmed.ncbi.nlm.nih.gov

Effect of Dietary Intake Through Whole Foods on Cognitive Function: Review of Randomized Controlled Trials. [2022]

9. United States pubmed.ncbi.nlm.nih.gov

The Impact of Nutrition on Cognitive Performance in a Frail Elderly Population Living in Northern Italy. [2023]