Systematic Reviews
Copyright ©The Author(s) 2021. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Gastroenterol. Oct 21, 2021; 27(39): 6715-6732
Published online Oct 21, 2021. doi: 10.3748/wjg.v27.i39.6715
Microbiota shaping — the effects of probiotics, prebiotics, and fecal microbiota transplant on cognitive functions: A systematic review
Simone Baldi, Tiziana Mundula, Giulia Nannini, Amedeo Amedei
Simone Baldi, Tiziana Mundula, Giulia Nannini, Amedeo Amedei, Department of Experimental and Clinical Medicine, University of Florence, Florence 50134, Italy
Amedeo Amedei, SOD of Interdisciplinary Internal Medicine, Azienda Ospedaliera Universitaria Careggi, Florence 50134, Italy
Author contributions: Baldi S and Mundula T contributed equally to writing the manuscript; Baldi S, Mundula T, Nannini G, and Amedei A contributed to the conceptualization and design of the study; Baldi S, Mundula T, Nannini G, and Amedei A critically revised the paper; Amedei A contributed to the supervision of the study; Baldi S, Mundula T, Nannini G, and Amedei A approved the final version of the paper.
Supported by Università degli Studi di Firenze, No. EX60%2020.
Conflict-of-interest statement: The authors declare no competing interests.
PRISMA 2009 Checklist statement: The authors have read the PRISMA 2009 Checklist, and the manuscript was prepared and revised according to the PRISMA 2009 Checklist.
Open-Access: This article is an open-access article that was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution NonCommercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/Licenses/by-nc/4.0/
Corresponding author: Amedeo Amedei, BSc, Reader (Associate Professor), Department of Experimental and Clinical Medicine, University of Florence, Largo Brambilla 3, Florence 50134, Italy. aamedei@unifi.it
Received: February 25, 2021
Peer-review started: February 25, 2021
First decision: April 18, 2021
Revised: May 12, 2021
Accepted: September 2, 2021
Article in press: September 2, 2021
Published online: October 21, 2021
Processing time: 236 Days and 19.6 Hours
Abstract
BACKGROUND

Dementia is a chronic progressive neurological disease affecting millions of people worldwide, and represents a relevant economic burden for healthcare systems. Although its pathogenesis is still unknown, recent findings have reported that a dysregulated gut-brain axis communication, a fundamental relationship mediated by several host and microbial molecules, is associated with cognitive disorders. In addition, gut microbiota manipulation reduces neuroinflammation, improving cognitive function by restoring the functional gut-brain axis.

AIM

To better define the effects of probiotics, prebiotics, synbiotics, and fecal microbiota transplant (FMT) on cognitive function.

METHODS

We performed a literature search of human randomized clinical trials to examine the effects of the administration of probiotics, prebiotics, synbiotics, or FMT on cognition outcomes in healthy or sick people of every age, sex, and nationality. We systematically searched Embase, Medline/PubMed, Cochrane Library, central and clinicaltrials.gov databases with a combination of comprehensive terms related to cognition and gut microbiota manipulation. Then we carefully reviewed and synthesized the data by type of study design and setting, characteristics of the studied population, kind of intervention (strain type or mixture type, dosage, and frequency of administration), control treatment, inclusion and exclusion criteria, follow-up duration, and cognitive or memory outcomes.

RESULTS

After examining the titles and abstracts, the initial literature screening identified 995 articles, but we added 23 papers in our systematic review. The analyses of these selected studies highlighted that both probiotic supplementation and FMT improved cognitive function regardless of the type and posology of administration and the adopted cognitive tests and questionnaires. We found that most of the studies conducted in healthy people showed a significant positive effect of the intervention on at least one of the performed cognitive tests. Regarding unhealthy subjects, while FMT and especially probiotic administration had multiple beneficial effects on different cognitive functions, supplementation with prebiotics did not provide any cognitive improvement.

CONCLUSION

Probiotic supplementation and FMT may represent a promising strategy to restore gut eubiosis and enhance the cognitive functions of healthy people and patients with neurological disorders.

Keywords: Dementia; Cognitive disorders; Gut microbiota; Probiotics; Prebiotics; Fecal microbiota transplant

Core Tip: Dementia and cognitive impairment are age-related conditions that are on the rise worldwide. Recent studies have demonstrated the existence of a gut-brain axis and that the manipulation of gut microbiota composition can exert positive effects on cognition. The administration of probiotics, prebiotics, and fecal microbiota transplant may represent a good strategy to counteract gut dysbiosis and ameliorate cognitive dysfunction by reducing neuroinflammation and brain damage.