Samuel T. Henderson, Chapter 40 - Ketosis in Mild Cognitive Impairment and Alzheimer’s Disease, Editor(s): Colin R. Martin, Victor R. Preedy, Diet and Nutrition in Dementia and Cognitive Decline, Academic Press,  2015, Pages 447-456, ISBN 9780124078246,

[URL unfurl="true"]https://doi.org/10.1016/B978-0-12-407824-6.00040-9.[/URL]

Abstract

Aging is accompanied by decreased cerebral glucose metabolism (DCGM). Regional DCGM can be detected in patients with mild cognitive impairment and Alzheimer’s disease well before clinical signs of memory impairment are evident, and offers a possible target for intervention. One approach is to supplement the brain with ketone bodies. Ketone bodies include β-hydroxybutyrate, acetoacetate, and acetone. In adults, ketone bodies are normally produced during prolonged fasting or when a low-carbohydrate diet is consumed. Ketosis has demonstrated efficacy in human clinical trials of Alzheimer’s disease and mild cognitive impairment. Much of the benefit of ketosis can be attributed to increased mitochondrial efficiency and the ability to supplement the brain’s normal reliance on glucose. Research into the therapeutic potential of ketosis represents a promising, low-risk intervention that can be implemented early in the disease process and offers an exciting new area of study in age-associated cognitive decline.

Davis JJ, Fournakis N, Ellison J. Ketogenic Diet for the Treatment and Prevention of Dementia: A Review. J Geriatr Psychiatry Neurol. 2021 Jan;34(1):3-10. doi: 10.1177/0891988720901785. Epub 2020 Jan 30. PMID: 31996078.

Abstract

Dementia (major neurocognitive disorder) is an increasingly common syndrome with a significant burden on patients, caregivers, the health-care system, and the society. The prevalence of dementia will certainly continue to grow as the US population ages. Current treatments for dementia, though, are limited. One proposed nonpharmacologic approach for the delay or prevention of dementia is the use of a ketogenic diet. The ketogenic diet was originally employed to treat refractory epilepsy and has shown promise in many neurologic diseases. It has also gained recent popularity for its weight loss effects. Several preclinical studies have confirmed a benefit of ketosis on cognition and systemic inflammation. Given the renewed emphasis on neuroinflammation as a pathogenic contributor to cognitive decline, and the decreased systemic inflammation observed with the ketogenic diet, it is plausible that this diet may delay, ameliorate, or prevent progression of cognitive decline. Several small human studies have shown benefit on cognition in dementia with a ketogenic diet intervention. Future, large controlled studies are needed to confirm this benefit; however, the ketogenic diet has shown promise in regard to delay or mitigation of symptoms of cognitive decline.