Mild cognitive impairment has similar alterations as Alzheimer's disease in gut microbiota

Alzheimers Dement. 2019 Oct;15(10):1357-1366. doi: 10.1016/j.jalz.2019.07.002. Epub 2019 Aug 18.


Objective: Gut microbiota changes before the onset of Alzheimer's disease (AD) and the alterations could be detected in the stage of mild cognitive impairment (MCI). The findings might offer diagnostic biomarkers before the onset of dementia.

Background: AD is the most common cause of dementia, and MCI is the predementia state. Recent studies suggest the alterations in the gut microbial communities associated with AD, whereas the microbiota in MCI before the onset of dementia has not been discovered and characterized in humans.

New/updated hypothesis: We hypothesize that the dysbiosis happens in the MCI stage. Patients with AD and MCI have decreased microbial diversity, and changes in gut microbiota could be detected for early detection of AD. In our preliminary study, we identified differences between AD and normal controls in 11 genera from the feces and 11 genera from the blood. No difference in genera between AD and MCI was detected. Using the diagnostic model from fecal samples with all different genera input, 93% (28 in 30) of patients with MCI could be identified correctly.

Major challenges for the hypothesis: The diagnosis of MCI and AD in the study was based on symptoms and neuroimaging, and AD biomarkers should be included for precise diagnosis in further validating studies. Besides, as the microbiota changes longitudinally, their relationship with the progress of dementia needs to be studied in the prospective studies.

Linkage to other major theories: Escherichia was observed increased at genus level in both fecal and blood samples from AD and MCI. For AD biomarker, postmortem brain tissue from patients with AD showed lipopolysaccharides and gram-negative Escherichia coli fragments colocalize with amyloid plaque. In this way, the amyloid pathogenesis for AD would be triggered during MCI by gut microbiota shifting. Besides, systemic inflammatory reactions caused by compounds secreted by bacteria may impair the blood-brain barrier and promote neuroinflammation and/or neurodegeneration. Furthermore, abnormal metabolites caused by microbial gene functions have an impact on neurodegeneration.

Keywords: 16S rRNA gene; Alzheimer's disease; Amyloid; Fecal microbiota; Mild cognitive impairment.

Publication types

  • Research Support, Non-U.S. Gov't

MeSH terms

  • Aged
  • Alzheimer Disease / diagnosis*
  • Biomarkers / metabolism*
  • Blood / microbiology
  • Cognitive Dysfunction / microbiology*
  • Early Diagnosis
  • Escherichia coli / isolation & purification
  • Feces / microbiology
  • Female
  • Gastrointestinal Microbiome*
  • Humans
  • Male
  • Middle Aged
  • Neuroimaging
  • Plaque, Amyloid / pathology
  • Prospective Studies


  • Biomarkers