NUTRITION GUIDELINES FOR DEMENTIA AND COGNITIVE IMPAIRMENT
-Smeetal Pereira, Dietitian (Clinical Nutritionist) (M.Sc. Foods, Nutrition and Dietetics)
Dementia is a syndrome affecting memory, thinking, behaviour and the ability to perform everyday activities, usually chronic or progressive by nature, which is caused by a variety of brain illnesses. Cognitive impairment, which includes the more operationalised category of ‘Mild Cognitive Impairment’ (MCI), describes measurable deficits in one or more cognitive abilities (e.g. memory, planning, language, attention or visuospatial skills) which may be noticeable to the older person or those around them, but do not yet interfere substantially with everyday living. When the impact on everyday abilities is significant, it suggests dementia.
Dementia is linked to several underlying brain pathologies, of which Alzheimer’s disease, vascular dementia, dementia with Lewy-Bodies, and frontotemporal dementia are the most common. The boundaries between the subtypes can be difficult to define, and mixed forms exist.
NUTRITION FOR BETTER BRAIN HEALTH:
- B Vitamins:
B vitamins, which play key roles in cell metabolism, cannot be synthesized in sufficient quantities and have to be acquired through healthy diet. Vitamins B6 (pyridoxine), B9 (folate) and B12 (cobalamin) have protective effects on cognitive ageing. When folate or vitamin B12 is deficient, homocysteine levels rise, which predisposes to cardiovascular disease, and may contribute to amyloid and tau protein accumulation and neuronal death. Deficiencies in B12 and in folate increase with age. High levels of homocysteine are associated with cognitive decline.
- Vitamin B6: Also known as pyridoxine, is involved in the synthesis of haemoglobin, neurotransmitters, and the production of Vitamin B3. Pyridoxine is also involved in the metabolism of lipids and amino acids.
Sources include multigrain bread, eggs, fish, milk, peanuts, potatoes, pork, poultry, soya beans, vegetables.
- Vitamin B9: Also known as folate, is involved in the production of red blood cells, in the metabolism of amino acids and nucleic acids and in aiding normal cell division during pregnancy.
Sources include asparagus, broccoli, brown rice, brussels sprouts, chickpeas, liver, peas, spinach.
- Vitamin B12: Also known as cobalamin, is essential in the production of red blood cells (together with folic acid) and nerve sheaths, and in the metabolism of carbohydrates, lipids and proteins.
Sources include cheese, cod, eggs, meat, milk, salmon
Neural inflammation and oxidative damage are thought to be key mechanisms in the development of dementia. Oxidative stress directly damages cell components, resulting in damage to synapses and nerve cell death. Antioxidants are thought to act against neurodegeneration by limiting the production of toxic substances and reducing damage by free radicals. Antioxidants include several different nutrients, such as vitamin C, vitamin E and flavonoids.
- Vitamin E: Belongs to a group of eight fat soluble complexes, which include tocopherols and tocotrienols. Vitamin E has important antioxidant functions, but it is also involved in gene expression and cell signalling, enzymatic activities and neurological functions. Sources include nuts and seeds, plant oils (corn, olive and soya oil), wheat germ
- Vitamin C: Also known as ascorbic acid or ascorbate, is a water-soluble vitamin, which cannot be stored in the body, and is a co-factor for several enzymatic reactions. Vitamin C is essential for connective tissue maintenance, helps protect cells and has important roles in wound healing. Vitamin C also has antioxidant properties.
Sources include blackcurrants, broccoli, brussel sprouts, oranges and orange juice, red and green peppers, potatoes, and strawberries.
- Flavonoids: A class of plant secondary metabolites, responsible for many plant colours. The term “flavonoids” include several different chemical structures, including flavanones, flavanonols, flavans, anthocyanidins and anthoxanthins. Flavonoids have antioxidant properties, but also support vitamin C, help with inflammation control, and in some cases have antibiotic properties.
Sources includes dark chocolate, dry beans, fruit (citrus, grapes, apples, berries), grains, herbs (thyme, parsley, celery, hot peppers), soy foods, tea, vegetables (broccoli, kale, onions, scallions [spring onions]) and wine.
- Omega-3 polyunsaturated fatty acids (PUFA):
Omega-3 PUFA (polyunsaturated fatty acids) cannot be synthesised in the human body but are an essential dietary constituent, particularly for the brain. Over 22% of both the cerebral cortex and the white matter are made of phospholipids, and the function of neuronal cell membranes is modulated by their fatty acid composition. Dietary omega-3 PUFA are also implicated in neuronal growth and influence synapse formations. Omega-3 PUFA may be implicated in the vascular, inflammatory and also the amyloid pathways of dementia, and are therefore potentially important in vascular dementia, Alzheimer’s disease and mixed forms. The main food sources of omega-3 PUFA are ‘oily fish’ such as salmon, mackerel, herring, sardines, fresh tuna, and swordfish.
- MEDITERRANEAN DIET
Mediterranean diet consists of high intake of cereals, fruits, fish, legumes, and vegetables. This diet is often rich in unsaturated fatty acids, its main source being olive oil, and low intake of meat, poultry and saturated fatty acids. Dairy products intake, especially yogurt and cheese, tend to be low to moderate and meals are often accompanied by a moderate amount of alcohol (particularly wine). It has been associated with reduced risk for cardiovascular disease, type 2 diabetes, some forms of cancer and overall mortality. Mediterranean diet could reduce the risk of dementia through its effects on the vascular system, reducing cardiovascular disease, by increasing the concentration of plasma neutrophins, which protect neurons against oxidative stress, or by limiting proinflammatory cascades.
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