Fish consumption and cognitive function in aging: a systematic review of observational studies

Epidemiological studies consistently link higher fish intake with slower rates of cognitive decline and lower dementia incidence. The aim of the present study was to systematically review existing observational studies investigating the association between fish consumption and cognitive function in older adults. A total of 25 studies (8 cross-sectional and 17 prospective including mainly healthy older adults, age range of participants ranging from 18 to 30 years at baseline in prospective studies to 65 to 91 years, representing the upper limit of the age spectrum) were reviewed. Cognitive functions currently investigated in most published studies included various domains, such as global cognition, memory (episodic, working), executive function (planning, inhibition, flexibility), attention and processing speed. Existing studies greatly vary in terms of design (cross-sectional and prospective), geographical area, number of participants involved, and tools used to assess the outcomes of interest. The main findings across studies are not univocal, with some studies reporting stronger evidence of association between fish consumption and various cognitive domains, while others addressed rather null findings. The most consistently responsive domains were processing speed, executive functioning, semantic memory, and global cognitive ability among individuals consuming fish at least weekly, which are highly relevant to both neurodegenerative and vascular forms of cognitive impairment. Positive associations were also observed for verbal memory and general memory, though these were less uniform and often attenuated after multivariable adjustment. In contrast, associations with reaction time, verbal-numerical reasoning, and broad composite scores were inconsistent, and several fully adjusted models showed null results. In conclusion, the evidence suggests that regular fish intake (typically ≥1-2 servings per week) is linked to preserved cognitive performance, although some inconsistent findings require further investigations.