Global Journal of Medical Research, L: Nutrition & Food Science, Volume 22 Issue 2

IV. D iscussion The aim of the present study was to detect and quantify the benefits of EH Ε VOO in protecting the cognition and mental health of MS patients. The hypothesis was that, because of the protective effects already attributed to EH EVOO consumption, the patients from the intervention group would demonstrate improved scores in their neuropsychological assessment after six months of EH-EVOO treatment. In general, the results showed that in the intervention group there was statistically significant improvement in the FAB, the BVMT and the SDMT. These results show that EH EVOO has positive effects in executive functions, visual memory and processing speed. At the same time, there were no statistically significant results regarding the control group. Although there are no studies about the benefits of EH EVOO in MS, there are studies supporting that EVOO (and the Mediterranean diet) can prevent cognitive decline and Alzheimer’s disease in the elderly population [24, 25]. So, EVOO may have an important role in neuroprotection and staving off neurodegeneration, even if there is still a need for more studies regarding MS and other neurodegenerative diseases, such as Parkinson’s disease, ALS etc. With the use of FAB, functions related to the frontal lobes were evaluated. The fact that the patients had statistically significant improvement in FAB means that the EH EVOO may be helpful in order to improve goal directed behaviors, mental flexibility and adaptation to the environment. Moreover, the statistically significant scores in SDMT may be indicative of improvement in the brain processing speed. These findings confirm that some cognitive functions, which are impaired due to the neurodegeneration of MS, can be improved with consumption of EH EVOO. However, the benefits are not limited to MS patients. A three-city study has already claimed the beneficial effects of EVOO on cognition. This study was conducted in three French cities and used neuropsychological assessments repeated every two years to measure any cognitive decline and assess risk factors for dementia’s symptoms. The results indicated that participants who were less luckily of demonstrating cognitive deficit for verbal fluency and visual memory, whereas, during the 4-year follow-up there was significant association between intensive use of olive oil and prevention of visual memory’s decline [26]. In the present study, verbal fluency was evaluated with the second task of FAB and visual memory was evaluated by the BVMT. So, regarding cognitive decline, our extensive study expands the above findings, adding that EH EVOO is beneficial in these fields for MS patients too. EVOO offers protection to neuronal functions in neurodegenerative diseases as well. Olive oil’s phenolic compounds contain natural antioxidants, including vitamins E, which may reduce neuronal damage and death from oxidative reactions by inhibiting the generation of reactive oxygen species, apoptosis, protein oxidation, damages to cell membranes and β - amyloid toxicity. However, the mechanisms, which are used in order to achieve these benefits, are not clear yet and behest further study [11]. Another extensive study, the PREDIMED- NAVARRA randomized trial, which examined the benefits of Mediterranean diet, supplemented with EVOO, on people with high vascular risk, also advocate the present study’s results. In this study, the neuropsychological assessment included Mini Mental State Examination (MMSE) and Clock Drawing Test (CDT), which evaluate cognitive deficits and cover a wide range of cognitive functions. The results of these assessments indicated that after 6,5 years of follow-up the participants had better global cognitive performance and supported the protective effects of Mediterranean diet with EVOO on cognitive function [27]. As far as patients’ mental health, significant improvement was found in both BDI and MHI. Specifically, the majority of patients (16 out of 20) had lower scores in BDI, which means that the patients had fewer depressive symptoms after six months of using EH EVOO. In MHI, the majority of patients (17 out of 20) had higher scores after consumption of EVOO, which means that they had less mental health problems and this was confirmed by the findings of the BDI. Observational studies confirm these results because they have pointed to an inverse association between adherence to Mediterranean diet (MeDi) and risk for depression. Furthermore, two clinical trials have demonstrated significant improvement regarding depressive symptoms in patients who were following MeDi [17]. The PREDI-DEP trial was the first randomized clinical trial, designed to examine the role of the MeDi supplemented with EVOO in the prevention of recurrent depression. This study confirmed the positive effects of MeDi, in general, and EVOO in particular, in depression as it was found that they can reduce the recurrence of depression and increase the patients’ quality of life [28]. Moreover, other studies have pointed that a low-fat diet supplemented with EVOO can reduce the physical and emotional disease burden in MS patients [29, 30]. A possible mechanism behind the benefits of EVOO in mental health is that it can lower the markers of the above-mentioned oxidative stress, such as F2- isoprostane [11, 12,]. A limitation of this pilot study is that apart from the three subtests of the BICAMS, and the BDI, the neuropsychological tests, which have been used, are not validated for the Greek MS population. However, this 50 Year 2022 Global Journal of Medical Research Volume XXII Issue II Version I ( D ) L © 2022 Global Journals The Effects of Early-Harvest Extra Virgin Olive Oil on Cognition and Mental Health of Primary (PPMS) or Secondary (SPMS) Progressive Multiple Sclerosis Patients