Efficacy of probiotics on cognition, and biomarkers of inflammation and oxidative stress in adults with Alzheimer’s disease or mild cognitive impairment — a meta-analysis of randomized controlled trials

Probiotics are live microbes that confer health benefits to the host. Preliminary animal evidence supports the potential role of probiotics in ameliorating cognitive health, however, findings from clinical trials in Alzheimer's disease (AD) or mild cognitive impairment (MCI) subjects are controversial. Thus, a meta-analysis is needed to clarify the efficacy of probiotics on cognition in AD or MCI patients. EMBASE, PubMed, Web of Science and Cochrane library were systematically searched and manually screened for relevant published randomized controlled trials (RCTs). Among the 890 citations identified, 5 studies involving 297 subjects met eligibility. There was a significant improvement in cognition (SMD = 0.37; 95% CI, 0.14, 0.61; P = 0.002; I 2 = 24%), while a significant reduction in malondialdehyde (SMD = -0.60; 95% CI, -0.91, -0.28; P = 0.000; I 2 = 0.0%) and high-sensitivity C-reactive protein (SMD = -0.57; 95% CI, -0.95, -0.20; P = 0.003; I 2 = 0.0%) post-intervention levels between the probiotics and control group. This meta-analysis indicated that probiotics improved cognitive performance in AD or MCI patients, possibly through decreasing levels of inflammatory and oxidative biomarkers. However, current evidence is insufficient, and more reliable evidence from large-scale, long-period, RCT is needed.