Despite data showing that nutritional interventions high in antioxidant/anti-inflammatory properties (anthocyanin-rich foods, such as blueberries/elderberries) may decrease risk of memory loss and cognitive decline, evidence for such effects in mild cognitive impairment (MCI) is limited. This study examined preliminary effects of American elderberry (Sambucus nigra subsp. canadensis) juice on cognition and inflammatory markers in patients with MCI. In a randomized, double-blind, placebo–controlled trial, patients with MCI (n = 24, M_age = 76.33 ± 6.95) received American elderberry (n = 11) or placebo (n = 13) juice (5 mL orally 3 times a day) for 6 months. At baseline, 3 months, and 6 months, patients completed tasks measuring global cognition, verbal memory, language, visuospatial cognitive flexibility/problem solving, and memory. A subsample (n = 12, 7 elderberry/5 placebo) provided blood samples to measure serum inflammatory markers. Multilevel models examined effects of the condition (elderberry/placebo), time (baseline/3 months/6 months), and condition by time interactions on cognition/inflammation outcomes. Attrition rates for elderberry (18%) and placebo (15%) conditions were fairly low. The dosage compliance (elderberry—97%; placebo—97%) and completion of cognitive (elderberry—88%; placebo—87%) and blood-based (elderberry—100%; placebo—100%) assessments was high. Elderberry (not placebo) trended (p = 0.09) towards faster visuospatial problem solving performance from baseline to 6 months. For the elderberry condition, there were significant or significantly trending decreases over time across several markers of low-grade peripheral inflammation, including vasorin, prenylcysteine oxidase 1, and complement Factor D. Only one inflammatory marker showed an increase over time (alpha-2-macroglobin). In contrast, for the placebo, several inflammatory marker levels increased across time (L-lactate dehydrogenase B chain, complement Factor D), with one showing deceased levels over time (L-lactate dehydrogenase A chain). Daily elderberry juice consumption in patients with MCI is feasible and well tolerated and may provide some benefit to visuospatial cognitive flexibility. Preliminary findings suggest elderberry juice may reduce low-grade inflammation compared to a placebo–control. These promising findings support the need for larger, more definitive prospective studies with longer follow-ups to better understand mechanisms of action and the clinical utility of elderberries for potentially mitigating cognitive decline.

Background: A large number of individual potentially modifiable factors are associated with risk for Alzheimer’s disease (AD). However, less is known about the interactions between the individual factors. Methods: In order to begin to examine the relationship between a pair of factors, we performed a pilot study, surveying patients with AD and controls for stress exposure and dietary omega-3 fatty acid intake to explore their relationship for risk of AD. Results: For individuals with the greatest stress exposure, omega-3 fatty acid intake was significantly greater in healthy controls than in AD patients. There was no difference among those with low stress exposure. Conclusions: These initial results begin to suggest that omega-3 fatty acids may mitigate AD risk in the setting of greater stress exposure. This will need to be examined with larger populations and other pairs of risk factors to better understand these important relationships. Examining how individual risk factors interact will ultimately be important for learning how to optimally decrease the risk of AD.

Previous work examining dietary interventions high in polyphenols (i.e., antioxidant/anti-inflammatory properties) has shown cognitive benefits. In a prior investigation examining American elderberry juice consumption with inflammation and cognition in mild cognitive impairment (MCI), we found a trend toward better visuospatial construct flexibility in MCI patients who consumed elderberry relative to the placebo control. This study aims to further examine the preliminary effects of American elderberry juice on the cognitive domains in MCI using cognitive composite scores. MCI patients (N = 24; M_age = 76.33 ± 6.95) received elderberry (n = 11) or placebo (n = 13) juice for 6 months and completed cognitive tasks targeting memory, visuospatial ability, and cognitive flexibility at the baseline, 3 months, and 6 months. For the composite z-scores calculated for global cognition and each domain, multilevel models and Kenward–Roger post hoc tests examined the interaction between condition (elderberry/placebo) and time (baseline/3 months/6 months). The findings showed a significant interaction between global cognitive flexibility (p = 0.049) and elderberry juice (not the placebo) trending toward a significant decrease (better) in composite cognitive flexibility latency scores from the baseline (M = 29.89, SE = 18.12) to 6 months (M = 18.57, SE = 9.68). Preliminary findings suggest elderberry juice may provide overall cognitive flexibility benefits in MCI. These promising results provide support for prospective investigations examining the potential underlying mechanisms of elderberries that may provide cognitive benefits in MCI, possibly due to anti-inflammatory effects.

We investigated the nature of covertly processed visual elements in a patient with simultanagnosia, a disorder characterized by the inability to perceive multiple aspects of a visual scene all at once. Using the first letter of the color words red, green, or blue, we created a novel testing paradigm that combined Navon global–local stimuli with a single-letter Stroop task. The letters R, G, or B were arranged in the overall configuration of a large R, G, or B. The patient never could report seeing the larger letter, and always could name the smaller letters. But, when asked to name ink color only, and ignore letter identity, the large letter covertly affected responding. That is, when the large letter was the same as the first letter of the ink color, the patient named ink color more quickly and accurately than when the large letter was incongruent with the correct response. Moreover, when the covert global and overt local visual processing conflicted, the global letter always dominated over the local letters, despite the patient’s inability to perceive it consciously. These data show that the covert processing of global visual information in simultanagnosia can dominate overt local information, even across different streams of information processing.

As age progresses and the population increases, the prevalence of dementia also increases. Pharmacological interventions are used to treat cognitive decline. Alternative approaches to traditional pharmacology, such as dietary interventions, may help combat cognitive decline in aging populations. This review summarizes existing investigations using complementary and alternative approaches as mitigating interventions. We also briefly note other important modifiable factors to decrease the risk of cognitive decline, and Alzheimer’s disease and related dementias. Such approaches include nutrition and dietary interventions that show promising results for mitigating cognitive decline, as well as additional lifestyle modifying factors that are important to note (e.g., sleep, cardiovascular diseases, environmental factors, physical, social and leisure activities, cognitive stimulation, psychosocial factors, and sensory functioning) for their impact on cognition in aging. Despite the limited findings and support for complementary and alternative approaches in combating existing cognitive decline, findings suggest that such approaches may be most beneficial prior to the onset of cognitive impairment. Specific nutrition components, including flavonoids and omega fatty acids, may mitigate cognitive decline, and emerging evidence suggests that these nutrients may promote a healthy gut microbiota. Of the complementary and alternative approaches, adhering to specific diets, generally, has the most consistent support to combat cognitive decline. It is important to note that other non-nutritional or non-dietary modifiable lifestyle factors also show promising benefits in mitigating further cognitive decline. Future investigations and clinical trials with replication studies are needed to elucidate these complementary and alternative approaches as effective treatment options for clinicians.