Randomized crossover trial of a modified ketogenic diet in Alzheimer's disease

被引:140
作者
Phillips, Matthew C. L. [1 ]
Deprez, Laura M. [1 ,2 ]
Mortimer, Grace M. N. [3 ]
Murtagh, Deborah K. J. [3 ]
McCoy, Stacey [3 ]
Mylchreest, Ruth [4 ]
Gilbertson, Linda J. [1 ]
Clark, Karen M. [1 ]
Simpson, Patricia, V [1 ]
McManus, Eileen J. [1 ]
Oh, Jee-Eun [1 ]
Yadavaraj, Satish [1 ]
King, Vanessa M. [5 ]
Pillai, Avinesh [6 ]
Romero-Ferrando, Beatriz [1 ]
Brinkhuis, Martijn [7 ]
Copeland, Bronwyn M. [8 ]
Samad, Shah [9 ]
Liao, Shenyang [9 ]
Schepel, Jan A. C. [1 ]
机构
[1] Waikato Hosp, Dept Neurol, Hamilton, New Zealand
[2] Maastricht Univ, Fac Psychol & Neurosci, Maastricht, Netherlands
[3] Hlth Kitchen Christchurch Ltd, Hamilton, New Zealand
[4] Waikato Hosp, Dept Dietet Serv, Hamilton, New Zealand
[5] Tauranga Hosp, LINC Mental Hlth Serv, Tauranga, New Zealand
[6] Univ Auckland, Dept Stat, Auckland, New Zealand
[7] Waikato Hosp, Mental Hlth Serv Older People, Hamilton, New Zealand
[8] Tauranga Hosp, Mental Hlth Serv Older People, Tauranga, New Zealand
[9] Waikato Hosp, Older Persons & Rehabil Serv, Hamilton, New Zealand
关键词
Alzheimer’ s disease; Ketogenic diet; Randomized crossover trial; Cognition; Daily function; Quality of life;
D O I
10.1186/s13195-021-00783-x
中图分类号
R74 [神经病学与精神病学];
学科分类号
摘要
Background Brain energy metabolism is impaired in Alzheimer's disease (AD), which may be mitigated by a ketogenic diet. We conducted a randomized crossover trial to determine whether a 12-week modified ketogenic diet improved cognition, daily function, or quality of life in a hospital clinic of AD patients. Methods We randomly assigned patients with clinically confirmed diagnoses of AD to a modified ketogenic diet or usual diet supplemented with low-fat healthy-eating guidelines and enrolled them in a single-phase, assessor-blinded, two-period crossover trial (two 12-week treatment periods, separated by a 10-week washout period). Primary outcomes were mean within-individual changes in the Addenbrookes Cognitive Examination - III (ACE-III) scale, AD Cooperative Study - Activities of Daily Living (ADCS-ADL) inventory, and Quality of Life in AD (QOL-AD) questionnaire over 12 weeks. Secondary outcomes considered changes in cardiovascular risk factors and adverse effects. Results We randomized 26 patients, of whom 21 (81%) completed the ketogenic diet; only one withdrawal was attributed to the ketogenic diet. While on the ketogenic diet, patients achieved sustained physiological ketosis (12-week mean beta-hydroxybutyrate level: 0.95 +/- 0.34 mmol/L). Compared with usual diet, patients on the ketogenic diet increased their mean within-individual ADCS-ADL (+ 3.13 +/- 5.01 points, P = 0.0067) and QOL-AD (+ 3.37 +/- 6.86 points, P = 0.023) scores; the ACE-III also increased, but not significantly (+ 2.12 +/- 8.70 points, P = 0.24). Changes in cardiovascular risk factors were mostly favourable, and adverse effects were mild. Conclusions This is the first randomized trial to investigate the impact of a ketogenic diet in patients with uniform diagnoses of AD. High rates of retention, adherence, and safety appear to be achievable in applying a 12-week modified ketogenic diet to AD patients. Compared with a usual diet supplemented with low-fat healthy-eating guidelines, patients on the ketogenic diet improved in daily function and quality of life, two factors of great importance to people living with dementia.
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页数:12
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