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In data odierna mi scrive il Dottore Giuseppe Baldassarre, così “Caro Eustachio, ho il piacere di inviarTi copia di una lettera inviata da me ed altri ricercatori pugliesi alla prestigiosa rivista scientifica americana "Journal of American Geriatric Society", che l'ha gentilmente pubblicata. Il titolo in italiano è "Fattori correlati allo stile di vita, consumo di alcol e declino cognitivo moderato".
Il contenuto della lettera riguarda la possibilità di condurre studi più ampi per verificare se l'esercizio fisico moderato, l'attività fisica, una sana dieta mediterranea ed un consumo moderato di alcol (prevalentemente sotto forma di vino) sono in grado di agire in modo sinergico nel proteggere le persone anziane dal declino cognitivo o se sono efficaci nel ritardarne la progressione.Un cordiale saluto”.EUSTORISPOSTA – Grazie come sempre per il Tuo, e dei Tuoi colleghi, contributo alla Ricerca di questi tempi così difficili per chi opera in questo ambito. La lettera è pubblicata qui di seguito in maniera integrale, grazie. LIFESTYLE-RELATED FACTORS, ALCOHOLCONSUMPTION, AND MILD COGNITIVEIMPAIRMENTTo the Editor: Pharmacological treatments for mild cognitiveimpairment (MCI) would be considered successfulif they prevented progression of cognitive and functionaldeficits and the development of dementia, but there isno proven treatment, and randomized, clinical trials oncholinesterase inhibitors, nonsteroidal antiinflammatorydrugs, and vitamin E have failed to prevent progressionof MCI to dementia.1 Given the lack of effective pharmacologicaltherapies, lifestyle changes may be possibletreatment options for predementia syndromes (MCI orage-related cognitive decline (ARCD)). Evidence from population-based longitudinal epidemiological studies suggeststhat moderate exercise and physical activity are associatedwith a lower risk of dementia.1,2 Of the vascular-relatedfactors, the effect of diet, particularly the Mediterraneandiet, has been the subject of recent interest.3 Findingsfrom the Italian Longitudinal Study on Aging (ILSA)demonstrated that high monounsaturated fatty acids (MUFAs),polyunsaturated fatty acids (PUFAs), and totalenergy intake were significantly associated with better cognitiveperformance in subjects with ARCD in a 8.5-yearfollow-up.4 Furthermore, findings from the same population-based study demonstrated that, although dietary fattyacid intake was not associated with incidence of MCI, theyseemed to show a trend toward protection from the developmentof MCI with high PUFA intake.5 Finally, recentclinical trials have showed positive effects of n-3 PUFAsupplementation in mild AD, which usually representsMCI.6Recently, of lifestyle factors related to diet, the effect ofalcohol consumption on the incidence of MCI was evalu-JAGS OCTOBER 2007–VOL. 55, NO. 10 LETTERS TO THE EDITOR 1679ated in 1,445 non-cognitively impaired individuals and onits progression to dementia in 121 patients with MCI aged65 to 84 participating in the ILSA, with a 3.5-yearfollow-up. Patients with MCI who consumed up to 1 drinkper day had a lower rate of progression to dementia thanpatients with MCI who never consumed alcohol. Overall,patients with MCI who consumed 1.0 to 14.9 g of alcoholper day, derived mostly from wine, had a rate of progressionto dementia that was approximately 85% of that nondrinkers.Moderate intake of alcohol from wine was alsoassociated with a significantly lower rate of progressionto dementia than in nondrinkers. No significant associationswere found between any levels of drinking and theincidence of MCI in non-cognitively impaired individualsand abstainers.7Many studies have assessed the possible effect of alcoholconsumption on cognitive function in older adults butwith inconsistent results.8 To the best of our knowledge,only two other studies have examined the effect of alcoholconsumption on the risk for MCI.9,10 After an averagefollow-up of 23 years, nondrinkers and frequent drinkerswere more than twice as likely to have MCI in old age asoccasional drinkers,9 although the apolipoprotein E(APOE) genotype seemed to modify the relationship suchthat the risk of dementia was greater with greater midlifealcohol consumption only in carriers of the APOE e4 allele.9 In our report on the ILSA sample, we failed to confirmthese findings, but the alcohol consumption reported was amidlife determination.9 A follow-up period longer than 3.5years would likely have revealed that moderate alcoholconsumption might influence the incidence of MCI. Alternatively,our findings are consistent with those obtained inthe Women’s Health Initiative Memory Study with a 4.2year-follow-up, which found that moderate alcohol intakewas associated with an approximately 50% lower risk ofcombined probable dementia and MCI,10 although afteradjusting for demographic and socioeconomic factors andbaseline modified Mini-Mental State Examination, the significancedisappeared.10 Currently, ours is the first studyin which alcohol consumption was associated with the rateof progression of MCI to dementia; up to one drink per dayof alcohol or wine may decrease the rate of progression todementia in patients with MCI.8 It is also possible thatmoderate lifestyles in general, which vary according todifferent cultural environments, protect against cognitiveimpairment. Thus, it may not be the direct effect of alcoholor specific substances in alcoholic drinks that provide theprotection, but moderate alcohol drinking may be an indicatorof a complex set of favorable social and lifestyle factors.A protective effect of alcohol on cognitive function inmoderate drinkers may be due to poorer health status ofabstainers, or because cognitive status influences alcoholconsumption and overall health status. In conclusion, severalhallmarks of the Mediterranean diet (n-3 PUFA,MUFA, or moderate alcohol intake) and exercise and physicalactivity were linked to a protective effect against MCIand dementia.1–7 However, in most cases, these were onlyobservational studies, and results are awaited from largemulticenter randomized, clinical trials in older persons thatmay clarify the possible synergy between moderate exercise,physical activity, and a healthy Mediterranean diet oncognition in older people.Vincenzo Solfrizzi, MD, PhDAlessia D’Introno, PhDAnna M. Colacicco, PhDDepartment of GeriatricsCenter for Aging BrainMemory UnitUniversity of BariBari, ItalyCristiano Capurso, MD, PhDDepartment of GeriatricsUniversity of FoggiaFoggia, ItalyGaetano Gagliardi, MDDepartment of GeriatricsCenter for Aging BrainMemory UnitUniversity of BariBari, ItalyAndrea Santamato, MDDepartment of Physical Medicine and RehabilitationUniversity of FoggiaFoggia, ItalyGiuseppe Baldassarre, MDDepartment of Geriatrics, ‘‘Miulli’’ Regional HospitalAcquaviva delle FontiBari, ItalyAntonio Capurso, MDFrancesco Panza, MD, PhDDepartment of Geriatrics, Center for Aging BrainMemory Unit, University of BariBari, ItalyACKNOWLEDGMENTSFinancial Disclosure: This work was supported by the ILSA(Italian National Research CouncilFCNR-Targeted Projecton AgeingFGrants 9400419PF40 and 95973PF40)(Dr. Solfrizzi, Dr. D’Introno, Dr. Colacicco, Dr C. Capurso,Pr. A. Capurso, and Dr. Panza).The Editor in Chief has determined that the authors inthis paper have no financial or personal conflict of interestrelative to this study.Author Contributions: Dr. Solfrizzi and Dr. Panza contributedto concept, interpretation, and manuscript preparation.Dr. D’Introno, Dr. Colacicco, Dr. C. Capurso, Dr.Santamato, Dr. Gagliardi, Dr. Baldassarre, and Pr. A. Capurso,contributed to interpretation and manuscript preparation.Sponsor’s Role: The funding agencies had no role indesign or conduct of the study.REFERENCES1. Rosenberg PB, Johnston D, Lyketsos CG. A clinical approach to mild cognitiveimpairment. Am J Psychiatry 2006;163:1884–1890.2. Fratiglioni L, Paillard-Borg S,Winblad B. An active and socially integrated lifestylein late life might protect against dementia. Lancet Neurol 2004;3:343–353.1680 LETTERS TO THE EDITOR OCTOBER 2007–VOL. 55, NO. 10 JAGS3. Panza F, Capurso C, D’Introno A et al. Mediterranean diet, mild cognitiveimpairment, and Alzheimer’s disease. Exp Gerontol 2007;42:6–7.4. Solfrizzi V, Colacicco AM, D’Introno A et al. Dietary polyunsaturated fattyacids intakes and rate of mild cognitive impairment. The Italian LongitudinalStudy on Aging. Exp Gerontol 2006;41:619–627.5. Solfrizzi V, Colacicco AM, D’Introno A et al. Dietary intake of unsaturatedfatty acids and age-related cognitive decline: An 8.5-year follow-up of theItalian longitudinal study on aging. Neurobiol Aging 2006;27:1694–1704.6. Freund-Levi Y, Eriksdotter-JonhagenM, Cederholm Tet al. Omega-3 fatty acidtreatment in 174 patients with mild to moderate Alzheimer disease: OmegADStudy. A randomized double-blind trial. Arch Neurol 2006;63:1402–1408.7. Solfrizzi V, D’Introno A, ColaciccoAMet al. for the Italian Longitudinal Studyon Aging Working Group. Alcohol consumption, mild cognitive impairment,and progression to dementia. Neurology 2007;68:1790–1799.8. Solfrizzi V, Colacicco AM, D’Introno A et al. Macronutrients, aluminium fromdrinking water and foods, and other metals in cognitive decline and dementia.J Alzheimers Dis 2006;10:303–330.9. Anttila T, Helkala EL, Viitanen M et al. Alcohol drinking in middle age andsubsequent risk of mild cognitive impairment and dementia in old age: Aprospective population based study. BMJ 2004;329:539.10. Espeland MA, Gu L, Masaki KH et al. Association between reported alcoholintake and cognition: Results from the Women’s Health Initiative MemoryStudy. Am J Epidemiol 2005;161:228–238. |
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