Stephen Cunnane, PhD, Research Center on Aging, Universite de Sherbrooke, discussed the findings and implications of a recent study of the drink’s effects on patients with mild cognitive impairment.
A recent study found that a ketogenic medium chain triglyceride (kMCT) drink improved executive function, episodic memory, and language by increasing blood ketone levels and brain energy status in patients with evidence of mild cognitive impairment (MCI). These findings reinforce the potential of brain energy rescue as a strategy to reduce cognitive decline in MCI) and Alzheimer Disease (AD).1,2
The brain energy rescue process is achieved by offering the brain more ketones to metabolize when brain glucose metabolism decreases, which is a common effect of these disorders. Study author Stephen Cunnane, PhD, Research Center on Aging, Universite de Sherbrooke, and colleagues found that when compared to placebo, the kMCT group scored higher on free and cued recall (P = .047), verbal fluency (P = .024), Boston Naming Test (P = .033), and the Trail-Making Test (P = .017) after a 6-month randomized, controlled trial.
This study followed up the Brain Energy, Functional Imaging, and Cognition (BENEFIC [NCT02551419]) study that showed a kMCT drink improved brain energy status and aimed to assess the effect of kMCT on cognitive outcomes. To learn more about this new study and how its findings can help benefit those at risk for Alzheimer Disease, NeurologyLive spoke with Cunnane.
Stephen Cunnane, PhD: Yes and no. No because we're not the first to have tried ketogenic interventions in MCI or an Alzheimer's disease, I think the first reports date from 2004, so there was a bit of a trail that had been blazed by other pioneers in this area that encouraged us, but nothing was conclusive. So, we weren’t too surprised, but we were delighted to see an effect in MCI because it's an early stage of the disease. Logically, you would try to slow down the disease at the earliest stage possible. But it's a double-edged sword, because if the problem is quite minor, it's hard to show that you've actually corrected it. In some ways, it would be better to wait until the problem is more severe, and then you have a better chance of seeing an improvement, but that’s not a guarantee. This is the continued dilemma in this field as to when to start, how long to do it, what dose to give. In our case, because we didn't know what amount would be needed to achieve these results, we went with a dose that seemed to be near the upper widely tolerated limit. People do have gastrointestinal side effects, discomfort, stomach discomfort, sometimes diarrhea if they take too much in one shot. There's definitely an upper limit, but everything worked out in the end.
I think the most important thing is that it shows a proof of concept. That is, that you can improve cognitive outcomes in MCI. This is not a dead-end street—it looks like there's a way out, if you start early enough. And if you have something that can effectively help with brain energy status, there may be drugs that would be complimentary, that could help with the neurotransmitters in the brain or within your inflammation in the brain, or with some other aspect, and that would be synergistic. But it seems like dealing with the energy problem is part of the solution. So, it's a proof of concept for scientists and clinicians in this field, and hopefully encouragement for them to go on and do their own studies in their own way and confirm what we've seen. I think it also gives a ray of hope to people for a disease that will strike many of us. But if you take preventive approaches early enough, you can delay it. Well, we're looking to confirm that. This is the next step that we're going do, but we know that we can improve cognitive outcomes in a six-month period. Some people take ketogenic salts, perhaps for this reason or for other reasons. But exercise would also be complimentary. You still need to solve problems like depression, during aging, which contributes markedly to cognitive decline. You need to solve problems of inadequate sleep. social isolation—with COVID these days, that's an even bigger challenge than normally. But remember that there's no single solution. There'll be no miracles. And it's piecing together the parts that will this slow down this disease. That is, I think the only realistic strategy. Prevention strategies have been shown in other studies, as well involving dietary improvements over cardiovascular risk reduction, cognitive stimulation. And I think brain energy rescue is simply part of the package that will help them all become more effective.
Transcript edited for clarity.