IMPORTANCE Developing interventions against age-related memory decline and for older adultsexperiencing neurodegenerative disease is one of the greatest challenges of our generation.Spermidine supplementation has shown beneficial effects on brain and cognitive health in animal models, and there has been preliminary evidence of memory improvement in individuals with subjective cognitive decline.
OBJECTIVETo determine the effect of longer-term spermidine supplementation on memory performance and biomarkers in this at-risk group.
DESIGN, SETTING, AND PARTICIPANTSThis 12-month randomized, double-masked, placebocontrolled phase 2b trial (the SmartAge trial) was conducted between January 2017 and May 2020.The study was a monocenter trial carried out at an academic clinical research center in Germany.Eligible individuals were aged 60 to 90 years with subjective cognitive decline who were recruited from health care facilities as well as through advertisements in the general population. Data analysis was conducted between January and March 2021.INTERVENTIONS One hundred participants were randomly assigned (1:1 ratio) to 12 months of dietary supplementation with either a spermidine-rich dietary supplement extracted from wheat germ (0.9 mg spermidine/d) or placebo (microcrystalline cellulose). Eighty-nine participants (89%) successfully completed the trial intervention.
MAIN OUTCOMES AND MEASURESPrimary outcome was change in memory performance from baseline to 12-month postintervention assessment (intention-to-treat analysis), operationalized by mnemonic discrimination performance assessed by the Mnemonic Similarity Task. Secondary outcomes included additional neuropsychological, behavioral, and physiological parameters. Safety was assessed in all participants and exploratory per-protocol, as well as subgroup, analyses were performed. RESULTS A total of 100 participants (51 in the spermidine group and 49 in the placebo group) were included in the analysis (mean [SD] age, 69 [5] years; 49 female participants [49%]). Over 12 months, no significant changes were observed in mnemonic discrimination performance (between-group difference, −0.03; 95% CI, −0.11 to 0.05; P = .47) and secondary outcomes. Exploratory analyses indicated possible beneficial effects of the intervention on inflammation and verbal memory. Adverse events were balanced between groups. (continued) Key Points Question Does 12-month spermidine supplementation have a beneficial impact on memory performance, as well as on other neuropsychological, behavioral, and physiological parameters, in older individuals with subjective cognitive decline when compared with placebo? Findings In this randomized clinical trial that included 100 older adults, spermidine supplementation over 12 months did not result in a significant beneficial effect on mnemonic discrimination performance as compared with placebo. Meaning Longer-term spermidine supplementation with an increased daily supply of spermidine by about 10% did not modify memory and other biomarkers in a group of older a...