Annonaceae Fruits Consumption and the Risk of Cognitive Impairment

New research by Laurent Cleret De Langavant, neurologist and Atlantic Fellow for Equity in Brain Health, suggests that even low consumption of Annonaceae fruits, juices, and herbal teas can increase risk for cognitive impairment and dementia in tropical areas.

The reduction of modifiable risk factors is a promising strategy for the prevention of dementia, which is projected to affect an increasing number of persons worldwide, especially in low- and middle-income countries. Common modifiable risk factors for dementia identified in high income countries include low education, midlife obesity, hypertension, hearing loss, diabetes, depression, social isolation, low physical activity, unhealthy diet, sleep disorders, tobacco and excessive alcohol use, and air pollution. Yet, many other risk factors are suspected to influence dementia risk in low- and middle-income countries. 

Cognitive and Neurological Effects of Annonaceae Consumption

In a recent study, published in Movement Disorders, we highlighted  the cognitive and neurological effects of consumption of Annonaceae fruits in tropical areas. Annonaceae is large family of trees bearing fruits among which the most popular are Annona muricata (soursop, corossol, graviola, guanabana), Annona squamosa (sweetsop, sugar apple, pomme-cannelle, saramuyo), Annona reticulata (custard apple, cachiman), Annona cherimola (anone, cherimoya), and Asimina triloba (pawpaw, asimine).

^{Above: Annonaceae fruits are available in tropical areas worldwide. In this article we studied the effect of the cumulative consumption of three of them: A. muricata, A. squamosa and A. reticulata.} 

Neurotoxicity

Fruits, juices, and herbal teas from Annonaceae have been consumed for their taste and traditional medicine applications for generations. Yet, recent experimental and epidemiological evidence indicate that acetogenins, natural components of Annonaceae fruits, may contribute to severe neurological disorders. Converging in vitro and in vivo studies suggest that acetogenins are neurotoxins through their capacity to induce mitochondrial dysfunction and tau-related abnormalities. Until now it was believed that only high consumption of Annonaceae fruits was associated with an increased risk of developing a severe atypical parkinsonism associated with profound cognitive impairment, a condition frequent in the Caribbean region. It was also believed that patients with Parkinson’s disease were not frequent users of these fruits. 

More Severe Disease and Higher Risk of Dementia

Our recent study tested whether low consumption levels of Annonaceae products could worsen the clinical symptoms of patients with any form of degenerative parkinsonism. We analyzed neurological data from 180 Caribbean patients with parkinsonism and specifically looked for dose effects of lifelong, cumulative Annonaceae consumption (A. muricata, A. squamosa, A. reticulata) on cognitive performance. Using unsupervised machine learning, we identified a group of patients with mild/moderate symptoms (N=102) and another with severe symptoms including cognitive impairment and dementia (N=78). We showed that low cumulative consumption of Annonaceae fruits/juices (> 0.2 fruit-years, i.e., one fruit every five days for one year) or any consumption of Annonaceae herbal tea increases the risk of having severe symptoms and dementia (Odds ratio fruits-juices: 3.76 (95% Confidence Interval: 1.13–15.18); Odds ratio herbal tea: 2.91 (95% Confidence Interval: 1.34–6.56)). The effect of Annonaceae consumption was similar in patients with Parkinson’s disease and in those with atypical parkinsonism. 

We hypothesize that even low consumption of Annonaceae fruits, juices and herbal teas is potentially a new risk factor for cognitive impairment and dementia in tropical areas. We suggest that more restrictive public health preventive recommendations should be made regarding the consumption of Annonaceae products.

Reference: 

Cleret de Langavant L, Roze E, Petit A, Tressières B, Gharbi-Meliani A, Chaumont H, Michel PP, Bachoud-Lévi AC, Remy P, Edragas R, Lannuzel A. Annonaceae Consumption Worsens Disease Severity and Cognitive Deficits in Degenerative Parkinsonism. Mov Disord. 2022 Oct 10. doi: 10.1002/mds.292