Krolak-Salmon Pierre, Swerdlow Russell H, Mastain Thibault, Dive-Pouletty Catherine, Pooley Nick, Kisomi Masoumeh
Institut du Vieillissement - Hospices Civils de Lyon, Lyon, France.
Emeis, Group Medical Department, Puteaux Cedex, 92813, France.
Nutr Rev. 2025 Mar 1;83(3):e1034-e1048. doi: 10.1093/nutrit/nuae098.
Mild neurocognitive disorder (NCD), formally known as mild cognitive impairment, is usually the clinical stage preceding the development of Alzheimer's disease (AD), the most prevalent major NCD, and other causes of dementia. Glucose is a major source of energy for human brain metabolism and the uptake of glucose is reduced in patients with mild NCD, AD, and other NCDs. Unlike glucose, the uptake of ketones remains normal in people with mild NCD and AD, suggesting that the use of ketone bodies may compensate for glucose energy deficiency in patients with mild NCD and AD.
The aim of this systematic review was to summarize the efficacy and safety of exogenic ketones, including medium chain triglycerides (MCTs), on cognitive function in patients with mild NCD and AD.
The Embase, MEDLINE, MEDLINE In-Process, PubMed Ahead-of-Print, Cochrane Central Register of Controlled Trials, Europe PMC databases were searched from inception to April 2022. Studies reporting cognitive function efficacy and safety outcomes from randomized controlled trials of exogenic ketones in patients with mild NCD and AD were included.
Data were extracted by 1 reviewer and checked by a second reviewer. Risk of bias was assessed using the Cochrane risk of bias tool, version 2.
This review identified 13 individual trials investigating the efficacy and safety of MCT or coconut oil for patients with mild NCD or with AD. Because of the heterogeneity of the studies, a narrative synthesis was used.
Overall, improvements associated with exogenic ketones were observed in multiple aspects of cognitive abilities, although the large heterogeneity between the included studies makes it difficult to draw firm conclusions from the current literature. Although some studies investigated the impact of the apolipoprotein E ε4 allele status on treatment efficacy, the current data are insufficient to conclude whether such an effect is present.
PROSPERO registration No. CRD42022336664.
轻度神经认知障碍（NCD），以前正式称为轻度认知障碍，通常是阿尔茨海默病（AD）（最常见的主要神经认知障碍）及其他痴呆病因发展之前的临床阶段。葡萄糖是人类大脑代谢的主要能量来源，轻度神经认知障碍、阿尔茨海默病及其他神经认知障碍患者的葡萄糖摄取减少。与葡萄糖不同，轻度神经认知障碍和阿尔茨海默病患者的酮摄取保持正常，这表明使用酮体可能补偿轻度神经认知障碍和阿尔茨海默病患者的葡萄糖能量缺乏。
本系统评价的目的是总结外源性酮，包括中链甘油三酯（MCT），对轻度神经认知障碍和阿尔茨海默病患者认知功能的疗效和安全性。
检索了Embase、MEDLINE、MEDLINE在研数据库、PubMed预印本、Cochrane对照试验中央注册库、欧洲PMC数据库，检索时间从建库至2022年4月。纳入了报告外源性酮在轻度神经认知障碍和阿尔茨海默病患者中进行随机对照试验的认知功能疗效和安全性结果的研究。
由1名 reviewer提取数据，另一名reviewer进行核对。使用Cochrane偏倚风险工具第2版评估偏倚风险。
本评价纳入了13项分别研究MCT或椰子油对轻度神经认知障碍或阿尔茨海默病患者疗效和安全性的试验。由于研究的异质性，采用了叙述性综合分析。
总体而言，在外源性酮相关的多个认知能力方面观察到了改善，尽管纳入研究之间的巨大异质性使得难以从当前文献中得出确切结论。虽然一些研究调查了载脂蛋白E ε4等位基因状态对治疗疗效的影响，但目前的数据不足以得出是否存在这种效应的结论。
PROSPERO注册号CRD42022336664。
