Patent Description:
Neuropathies or neurological problems may find their cause in aging, in prevalent pathologies in the brain, like those associated with the formation of plaques or neurofibrillary tangles in the brain. In many occasions neuropathies or neurological problems lead to a loss of independency and a need to provide extra care or a need to move the person to a nursing home or the like, in order to ensure a sustainable life of these persons.

<CIT> describes the neuroprotective effect of a lipoic acid derivative of uridine. <CIT> relates to methods of improving cognitive and neurological functions and increasing synthesis and release of neurotransmitters and membrane synthesis by neural cells and brain cells, comprising administering a composition comprising a uridine. <CIT> describes a composition containing DHA and arachidonic acid that has an activity of ameliorating reduced higher brain functions resulting from organic brain lesions. <CIT> discloses a composition having an activity of ameliorating the reduced amount of diurnal activity and/or depressive symptoms, comprising arachidonic acid and/or a compound having arachidonic acid as a constituent fatty acid. <CIT> describes methods of improving memory, learning, cognition, synaptic transmission and synthesis and release of neurotransmitters and increasing brain phospholipid levels in a subject. <CIT> discloses a composition comprising DHA and UMP for the treatment of a subject with a memory disorder, learning problems, or a neurological disorder, such as an Alzheimer patient.

<NPL> disclose a combination of choline, UMP and DHA as being able to enhance the quantity of synaptic proteins and phospholipids in gerbil brains and being potentially useful in treating Alzheimer's disease. <CIT> discloses a composition for feeding infants of a mother who suffered from metabolic disorders during pregnancy, comprising inter alia DHA, EPA, uridine and choline. <CIT> discloses a composition for treating a number of diseases such as AIDS, diarrhoea, etc. wherein said composition comprises inter alia a) DHA and EPA, b) uridine and c) choline. <CIT> discloses a combination of DHA and uridine for the treatment of Alzheimer, depression and/or diabetes. <CIT> discloses a nutritional composition for favourable growth and maintenance of healthy conditions comprising DHA and UMP. <CIT> discloses a composition comprising DHA, EPA, choline, methionine, vitamin B6, folic acid, zinc, magnesium and UMP as alternative for nucleobases for the treatment of Parkinson's disease, epilepsy, schizophrenia, paranoia, depression, sleep disorders, psychoses, dementia, ADHA, impaired memory function, chronic fatigue syndrome and motor disorders.

None of the above documents discloses the improvement of activities of daily living, as defined in this invention. Moreover, it is imperative to understand that the invention is not concerned with the treatment of Alzheimer's disease or dementia itself. Described is the treatment of persons suffering from Alzheimer's disease, dementia and/or elderly.

The present inventors found that the administration of the present composition improves activities wherein the (i) operational activities and the executive brain functions play an important role (i.e. the instrumental and/or basic activities of daily living). Such activities include many activities that take place throughout the day, particularly housekeeping, personal hygiene practices and meal preparation. This finding particularly enables persons that are suffering from difficulty in performing such activities (e.g. humans suffering from Alzheimer's disease, dementia and/or non-dementing or dementing elderly) to prolong an independent way of living. The improvement in ability to perform the instrumental and/or basic activities of daily living is often considered more important than improving memory and/or cognitive function.

This finding is particularly unexpected as the coordination of these complex activities of daily living is coordinated by different parts of the brain, i.e. the operational parts of the activities are (mainly) coordinated by the motor cortex, the executive (e.g. planning) parts of the activities of daily living are (mainly) coordinated by the prefrontal cortex, while memory functions are (mainly) coordinated by the hippocampus and temporal cortex. Experimental results showed that administration of the present composition to subjects suffering from impaired brain functions (particularly Alzheimer's disease) restored the activities, to near normal levels. Hence, the present inventors found that the present composition has an important stimulatory effect on the instrumental and/or basic activities of daily living, particularly in humans suffering from Alzheimer's disease. The present composition supports and enables those complex activities where initiation, planning and effective operation performances play a role.

In a further aspect, the present inventors found, in addition to the above, that the present composition for supporting the activities of daily living advantageously comprises folic acid, vitamin B12 and B6, preferably in relatively high dosages. The administration of the B vitamins was found to decrease locomotor activity during the resting period, hence ensuring a good rest during the night. Hence, the present composition, B-vitamins advantageously support the present activities of daily living, while providing a good resting period.

The present finding enables a solution for an important problem for humans suffering from Alzheimer's, dementia and/or aging (i.e. the elderly). Many subjects fear the time that they become dependent on the help and support from others when desiring to perform activities of daily living. Hence, for these subjects it is particularly desirable to extend the period of independence. The present inventors solved this problem by providing a (nutritional) composition that is easy to ingest, and enables a prolonged capacity to perform the relatively complex activities of daily living.

In particular, the present disclosure relates to improvements in independent performance of activities wherein the operational aspect has a dominant role. The present disclosure particularly relates to improvements in independent performance of the following activities: coordination of movements, particularly when eating or drinking; grasping goods; putting objects on a desired location/position; making rapid movements; walking; maintaining balance in body position; doing the laundry; doing the dishes.

In a further aspect the present disclosure relates to improvements in independent performance of activities wherein the operational aspect has a main role, in addition to other higher brain functions. The present disclosure particularly relates to improvements in independent performance of the following activities: using communication equipment, especially telephone; using household appliances, especially television; personal hygiene practices, particularly cutting nails, doing hair properly or apply shaving practices; dressing, preparing a meal, shopping, travelling.

It was found that particularly the administration of a preparation that comprises DHA and uridine results in the desired improvements. It is considered particularly advantageous to co-administer with the DHA and uridine at least one of vitamin B6, vitamin B12 and folic acid. Inclusion of these vitamins improves the effects of the administration of DHA and nucleotide. Further improvements can be achieved by co-administration of phospholipids. Without wishing to be bound by theory, the present inventors believe that the phospholipids enable effective membrane function, further improving effectiveness of the present composition in its support for daily living activities.

At the same time, the present product preferably is formulated so that it has a relatively low impact on appetite and consumption patterns of other food, and is easy to consume. It preferably does not comprise herb extracts, which may be varying in quality, and under normal circumstances are difficult to include in stable sterilized liquid products and may comprise components which have a badly defined biological action.

Disclosed is the use of a composition comprising (a) DHA and/or EPA, and (b) uridine or its equivalent, in the manufacture of a composition for supporting activities in daily living. Also disclosed is a method for supporting activities in daily living, said method comprising administering to a patient (particularly a patient suffering from Alzheimer's disease) a composition comprising (a) DHA and/or EPA, and (b) uridine or its equivalent.

The present invention provides a liquid composition according to claim <NUM>.

The present invention comprises the use of long chain polyunsaturated fatty acids (LCP), preferably at least one LCP selected from docosahexaenoic acid (<NUM>:<NUM>ω-<NUM>; DHA), docosapentaenoic acid (<NUM>:<NUM>ω-<NUM>; DPA) and eicosapentaenoic acid (<NUM>:<NUM>ω-<NUM>; EPA). The present composition contains at least DHA, preferably DHA and EPA. More preferably the composition contains DHA and at least one precursor of DHA selected from EPA and DPA, more preferably the present composition comprises DHA, DPA and EPA. The inventors recognized that only part of the DHA incorporated in the brain is from orally ingested DHA. An important part of the DHA incorporated in the brain is derived from conversion of DPA to DHA in the brain. In a further aspect the present composition preferably contains a significant amount of EPA. EPA is converted to DPA (ω-<NUM>), increasing subsequent conversion of DPA (ω-<NUM>) to DHA in the brain. Hence, the present composition preferably also contains a significant amount of EPA, so to further stimulate in-vivo DHA formation.

The LCP is preferably provided as triglycerides, diglycerides, monoglycerides, free fatty acids or their salts or esters, phospholipids, lysophospholipids, glycerol ethers, lipoproteins, ceramides, glycolipids or combinations thereof. Preferably, the present composition comprises at least DHA in triglyceride form.

The described method preferably comprises the administration of <NUM>-<NUM> (DHA+EPA) per day, more preferably <NUM>-<NUM> per day. The proportion of (DHA+EPA) of the total fatty acids is preferably <NUM>-<NUM> wt. %, more preferably <NUM>-<NUM> wt. %, most preferably <NUM>-<NUM> wt. The described method preferably comprises the administration of DHA, preferably in an amount of <NUM>-<NUM> per day, more preferably <NUM>-<NUM> per day. The method preferably comprises the administration of DHA, preferably a composition comprising <NUM>-<NUM> DHA per <NUM> day, more preferably <NUM>-<NUM> DHA per <NUM>. The described composition preferably comprises <NUM>-<NUM> wt. % DHA based on total fatty acids, preferably <NUM>-<NUM> wt. % DHA based on total fatty acids, more preferably <NUM>-<NUM> wt. % DHA based on total fatty acids. The described composition preferably comprises <NUM>-<NUM> wt. % EPA based on total fatty acids, preferably <NUM>-<NUM> wt. % EPA based on total fatty acids, more preferably <NUM>-<NUM> wt. % EPA based on total fatty acids. The ratio of the weights of DHA to the sum of EPA and DPA (ω-<NUM>) is preferably larger than <NUM>, more preferably <NUM>-<NUM>, most preferably <NUM>-<NUM>. The above-mentioned ratios and amounts take into account and optimise several aspects, including taste (too high LCP levels reduce taste, resulting in a reduced compliance), balance between DHA and precursors thereof to ensure optimal effectiveness in relation to maximum dosage and possibility of product formulations such as liquid form, bar or capsule.

The described composition preferably contains a very low amount of arachidonic acid (AA; <NUM>:<NUM>ω-<NUM>). Arachidonic acid is believed to counteract the effects of the present composition. The subjects of the present method normally ingest sufficient (precursors of) AA, and an excess daily dosage may stimulate inflammatory responses, inhibiting activities of daily living. Preferably the weight ratio DHA/AA in the present composition is at least <NUM>, preferably at least <NUM>, more preferably at least <NUM>, up to e.g. <NUM> or up to <NUM>. The described method preferably comprises the administration of a composition comprising less than <NUM> wt. % arachidonic acid based on total fatty acids, more preferably below <NUM> wt. %, e.g. down to <NUM> wt. The ratio ω-<NUM>/ω-<NUM> fatty acids (C <NUM> and higher) in the product is preferably below <NUM>, more preferably below <NUM>, e.g. down to <NUM> or to <NUM>. The ratio ω-<NUM>/ω-<NUM> fatty acids (C <NUM> and higher) in the present product is preferably below <NUM>, more preferably below <NUM>, e.g. down to <NUM> or to <NUM>.

The composition preferably contains at least one oil selected from fish oil, algal oil and eggs lipids. Preferably the present composition contains fish oil comprising DHA, EPA and preferably DPA.

The composition preferably comprises saturated and/or mono-unsaturated fatty acids. The amount of saturated fatty acids is preferably <NUM>-<NUM> wt. % based on total fatty acids, preferably <NUM>-<NUM> wt. %, more preferably <NUM>-<NUM> wt. % based on total fatty acids. In particular the amount of C14:<NUM> (myristic acid) + C16:<NUM> (palmitic acid) is preferably <NUM>-<NUM> wt. %, preferably <NUM>-<NUM>, more preferably <NUM>-<NUM> wt. % based on total fatty acids. The total amount of monounsaturated fatty acids, such as oleic acid and palmitoleic acid, is preferably between <NUM> and <NUM> wt. %, more preferably between <NUM> and <NUM> wt. Including of the saturated and/or monounsaturated fatty acids provides an energy source, improving the activities of daily living.

Preferably, the composition comprises phospholipids, preferably <NUM>-<NUM> wt. % phospholipids based on total weight of lipids, more preferably <NUM>-<NUM> wt. %, more preferably between <NUM> and <NUM> wt. % based on total weight of lipids. The total amount of lipids is preferably between <NUM> and <NUM> wt. % on dry matter, and/or between <NUM> and <NUM> lipid per <NUM> for a liquid composition. Inclusion of phospholipids beneficially improves membrane function, thereby enabling an improved functioning of the different parts of the brain that play a (main) role in activities of daily living. Furthermore, the phospholipids improve stability of the present product.

The present composition contains folic acid, vitamin B12 and vitamin B6, particularly in (relatively) high dosages. Inclusion of these vitamins advantageously provides the combination of support and enablement of activities of daily living, while providing a reduced locomotor activity during the resting period. Further advantage of co-administration of folic acid, vitamin B12 and vitamin B6 is that is relief's patients of deficiencies in these vitamins. The present composition comprises folic acid, vitamin B12 and vitamin B6.

The present composition comprises <NUM>-<NUM> microgram folic acid per <NUM> liquid product, more preferably <NUM>-<NUM> microgram folic acid per <NUM> liquid product, more preferably <NUM> - <NUM> microgram folic acid per <NUM> liquid product. The described method preferably comprises the administration <NUM>-<NUM> microgram folic acid per day, more preferably <NUM>-<NUM> microgram folic acid per day, more preferably <NUM> - <NUM> microgram folic acid per day. The present composition comprises <NUM>-<NUM> microgram vitamin B12 per <NUM> liquid product, more preferably <NUM>-<NUM> microgram vitamin B12 per <NUM> liquid product, more preferably <NUM> - <NUM> microgram vitamin B12 per <NUM> liquid product. The described method preferably comprises the administration <NUM>-<NUM> microgram vitamin B12 per day, more preferably <NUM>-<NUM> microgram vitamin B12 per day, more preferably <NUM>-<NUM> microgram vitamin B12 per day. The present composition comprises <NUM> - <NUM> vitamin B6 per <NUM> liquid product, more preferably <NUM>-<NUM> vitamin B6 per <NUM> liquid product, more preferably <NUM> - <NUM> vitamin B6 per <NUM> liquid product. The method preferably comprises the administration <NUM>-<NUM> microgram vitamin B6 per day, more preferably <NUM>-<NUM> vitamin B6 per day, more preferably <NUM> - <NUM> vitamin B6 per day.

The present composition comprises uridine and/or an equivalent thereof, preferably at least one uridine or an equivalent thereof selected from the group consisting of uridine (i.e. ribosyl uracil), deoxyuridine (deoxyribosyl uracil), uridine phosphates (UMP, dUMP, UDP, UTP), nucleobase uracil and acylated uridine derivatives. Preferably the present composition comprises one or more uridine phosphate selected from the group consisting of uridine monophosphate (UMP), uridine diphosphate (UDP and uridine triphosphate (UTP). Most preferably the present composition comprises UMP, as UMP is most efficiently being taken up by the body. Preferably at least <NUM> wt. % of the uridine in the present composition is provided by UMP, more preferably at least <NUM> wt. %, most preferably at least <NUM> wt. The method preferably comprises the administration of uridine (the cumulative amount of uridine, deoxyuridine, uridine phosphates, nucleobase uracil and acylated uridine derivatives) in an amount of <NUM>-<NUM> per day, preferably <NUM>-<NUM> per day, more preferably <NUM>-<NUM> per day.

Preferably the present composition comprises uridine phosphate, preferably uridine monophosphate (UMP). The UMP is very efficiently taken up by the body. Hence, inclusion of UMP in the present product enables a high effectively at the lowest dosage and/or the administration of a low volume to the subject. Preferably the weight ratio of uridine to cytidine is larger that <NUM>, more preferably <NUM>, most preferably more than <NUM>. The term uridine as used herein relates to uridine and/or equivalents thereof. The term cytidine as used herein relates to cytidine and/or equivalent thereof. Although cytidine is a precursor of uridine, which passes the blood brain barrier, it is more efficient and effective to include uridine in the present composition.

The described method preferably comprises the administration of uridine monophosphate (UMP) in an amount of <NUM>-<NUM> per day, preferably <NUM>-<NUM> per day, more preferably <NUM>-<NUM> per day. The method preferably comprises the administration of a composition comprising uridine in an amount of <NUM>-<NUM> UMP per <NUM> liquid product, preferably <NUM>-<NUM> UMP per <NUM> liquid product, more preferably <NUM>-<NUM> per <NUM> liquid product. Preferably <NUM>-<NUM> UMP per kilogram body weight is administered per day. The required dosages of the equivalents on a weight base can be calculated from the dose for UMP by taking equimolar amounts using the molecular weight of the equivalent and of UMP, the latter being <NUM> Dalton. The amount of nucleotides or nucleosides and derivatives is preferably <NUM>-<NUM>µmol, preferably <NUM>-<NUM>µmol per kg body weight per day, or <NUM> to <NUM> mmol, preferably <NUM>-<NUM>, most preferably <NUM>-<NUM> mmol per day.

Uridine derivatives like UDP, which is readily formed from dietetic UMP, appear to be important for transport of glycoproteins and glycolipids within the cell and availability thereof in the cytosol and plasma membrane.

In a further preferred embodiment the present composition preferably does not contain high amounts of other nucleotides. Hence, preferably the weight ratio adenosine/uridine in the present composition is below <NUM>, more preferably below <NUM>, most preferably <NUM>. Preferably the weight ratio guanosine/uridine in the present composition is below <NUM>, more preferably below <NUM>, most preferably <NUM>. Preferably the weight ratio inosine/ uridine in the present composition is below <NUM>, more preferably below <NUM>, most preferably <NUM>.

It was found by the inventors that the nucleotide equivalents as defined, and in particular the uridine sources as defined are important to support and/or enhance the effect of the lipid fractions as defined above on activities of daily living. The present combination, particularly of (i) uridine and (ii) DHA and preferably EPA is surprisingly effective. On a biochemical level this may be observed by an improvement of ceramide metabolism in membranes and in particular an increase in glycolipids at the expense of the presence of simple ceramides.

The present composition contains methyl donors. Methyl donors are those food grade compounds which are capable of providing a methyl, methylene or formyl group when administered to a human individual in vivo. The methyl donor included in the present composition is preferably selected from the group consisting of serine, methionine, choline, betaine, dimethylglycine and sarcosine and derivatives thereof.

The present composition contains choline and/or phosphatidylcholine. The described method preferably comprises the administration of more than <NUM> choline per day, preferably <NUM>-<NUM> choline per day, more preferably <NUM>-<NUM> choline per day, most preferably <NUM>-<NUM> choline per day. The present composition comprises <NUM> to <NUM> gram choline per <NUM> of the present liquid formula, preferably <NUM> - <NUM> choline/<NUM>. The methyl donor (choline) is an important precursor of the brain membrane and thereby enables a improved functioning of the brain area involved in supporting activities of daily living. In a particularly preferred embodiment the present composition comprises phospholipids and choline. It was found that the administration of phospholipids with choline results in maintenance of high choline level. As choline is an important precursor of muscle neurotransmitters, high choline levels (as a result of administration of phospholipids) support of daily living activities.

The present composition can be further improved by including one or more minerals. Preferably the present composition comprises at least one mineral selected from zinc, magnesium, copper, manganese and molybdenum. Preferably the present composition comprises manganese and molybdenum.

Inclusion of manganese in a diet is important for improving membrane function of cells, in particular the membrane function of nerve cells. Especially those persons that are malnourished or have an inherited or metabolic disorder involving imparted metabolic capacity for producing sphingomyelin and/or related compounds like sulfatides and glycosylated ceramides, benefit from inclusion of the mineral fraction. The amount of manganese administered per day is preferably more than <NUM>, more preferably <NUM>-<NUM>. Preferably the method comprises the administration of a (liquid) composition comprising <NUM> to <NUM> manganese per <NUM>, preferably <NUM>-<NUM> manganese per <NUM>.

Additional molybdenum is strongly preferred to allow proper functioning of the cofactors, which appears important for creating a proper composition of the membranes, e.g. their sulfatide content, and in particular ensures a proper functioning of nerve cells. Further, inclusion of a proper amount of molybdenum delays brain shrinkage in part of the elderly during aging. The method preferably comprises the administration of a composition comprising <NUM> - <NUM> microgram molybdenum per <NUM>, preferably <NUM>-<NUM>µg molybdenum per <NUM>.

It is also preferred to include additional zinc into the product which comprises the lipids or nucleotide fraction as described above, in order to stabilize proteins in the brain and prevent agglomeration thereof, which could impart daily life activities. The described method preferably comprises the administration of a composition comprising <NUM> - <NUM> zinc per <NUM>, preferably <NUM>-<NUM> zinc per <NUM>.

The present composition preferably contain selenium. The antioxidant activity of selenium advantageously prevents and/or inhibits damaged to the brain areas which enable activities of daily living. A low selenium levels increases the risk for hospitalisation, particularly in elderly and patients suffering from Alzheimer's disease. Preferably the described method provides the administration of a composition comprising <NUM> and <NUM> selenium per <NUM> liquid product, preferably <NUM> and <NUM> selenium per <NUM> liquid product. The amount of selenium administered per day is preferably more than <NUM>, more preferably <NUM>-<NUM>.

The present composition is a liquid product. It can also be in a concentrated form suitable for dissolving or dilution or suitable for the purpose of fortifying a second product. The preparation can be a drink, an emulsion, a dispersion, a soup or other liquid form known in the art. The present composition is preferably enterally administered, more preferably orally. Most preferably the present composition is administered through a straw.

The subjects that can benefit from the composition of the invention (particularly patients suffering from Alzheimer's, dementia and/or elderly) often experience problems with eating. Their sensory capabilities and/or control of muscles have become imparted, as well as in some instances their ambition to apply proper eating habits. Swallowing and/or mastication are often problematic. The present invention therefore preferably has a low viscosity between <NUM> and <NUM> mPa. s measured at a shear rate of <NUM> sec-<NUM> at <NUM>. More preferably, the present composition is preferably provided in the form of a drink capable of being ingested through a straw which makes the product even easier to ingest and improves compliance. To be optimally accepted by the patient, the present composition preferably has an osmolality of <NUM> to <NUM> mOsm/kg.

Additionally many of the subjects (e.g. suffering from Alzheimer's, dementia and/or elderly) experience a general loss in appetite and/or become malnourished. Hence it is advantageous to include within the present composition other nutrients. However, the energy density of the product is preferably not so high that it interferes with normal eating habits. When in liquid form, the present product contains between <NUM> and <NUM> kcal/ml, more preferably between <NUM> and <NUM>, between <NUM> and <NUM> kcal/ml.

The present composition contains digestible carbohydrates. The digestible carbohydrates positively influence the operational skills of the subject, and have an advantageous effect over and above the effects for the present composition containing LCP and/or uridine. The present composition contains between <NUM>-<NUM> gram carbohydrates per <NUM> of a liquid product.

The total amount of digestible carbohydrates is preferably between <NUM> and <NUM> wt. % on dry matter, preferably <NUM> - <NUM> wt. % based on dry matter.

The product is mainly administered to frail elderly, wherein muscle strength is preferably improved. The present composition preferably contains protein to improve muscle strength. The improved muscle strength provides an important stimulus for support of activities of daily living, and advantageously contributes to the present method. The present composition preferably contains <NUM> - <NUM> gram protein per <NUM> of the liquid product, preferably <NUM>-<NUM> grams per <NUM> of the liquid product, more preferably <NUM>-<NUM> grams per <NUM> of the liquid product. Preferably the present composition contains at least <NUM> wt. % milk derived protein (e.g. whey and/or casein) based on total protein.

The described method preferably comprises the administration of a composition of <NUM> to <NUM>, preferably <NUM> to <NUM>.

The present composition is preferably administered to a human, more preferably to (i) an elderly human (dementing or non-dementing) and/or a human suffering from Alzheimer's disease, (senile) dementia, Parkinson's Disease, Multiple Sclerosis, aphasia, apraxia, ataxia, dystonia or dyskinesia. In this respect, it is submitted that in the context of this application, an elderly person is a person of the age of <NUM> or more, in particular of the age of <NUM> or more, more in particular of the age of <NUM> or more, more in particular of the age of <NUM> or more. This rather broad definition takes into account the fact that the average age varies between different populations, on different continents, etc. Most developed world countries have accepted the chronological age of <NUM> years as a definition of 'elderly' or older person (associated with the age at which one may begin to receive pension benefits), but like many westernized concepts, this does not adapt well to e.g. the situation in Africa. At the moment, there is no United Nations (UN) standard numerical criterion, but the UN agreed cut-off is <NUM>+ years to refer to the older population in Western world. The more traditional African definitions of an elder or 'elderly' person correlate with the chronological ages of <NUM> to <NUM> years, depending on the setting, the region and the country.

The described method is particularly suitable for patients suffering from Alzheimer's disease and/or MCI. Preferably, the present composition is administered to a subject suffering from Alzheimer's, more preferably a subject suffering from early or mild Alzheimer's, preferably to a subject suffering from Alzheimer's disease, wherein said subject with a mini mental state examination (MMSE) score of <NUM> to <NUM>, preferably <NUM> to <NUM>. It was found that in this subgroup of Alzheimer patients the present composition was particularly effective. This patient group is often on the edge of loosing independence on the activities of daily living. Hence, restoring and improving the present skills of this group of patients have a particularly high benefit. The described method is also suitable for dementing and non-dementing elderly, in particular non-dementing elderly, for the same reasons as given above.

The described method particularly aims to (i) support and/or enhance the activities of daily living and/or prolonged independent living.

The term "activities of daily living" as used in the present disclosure relates to instrumental and/or basic activities of daily living. In particular the present disclosure provides a method for supporting and/or enhancing the instrumental and/or basic activities of daily living. Preferably at least one of the following instrumental activities of daily living is supported and/or enhanced: performing light and/or heavy housework, preparing meals and/or drinks, shopping for groceries, using household appliances (particularly the telephone) and taking medication. Preferably at least one of the following basic activities of daily living is supported or enhanced: personal hygiene activities (particularly washing and/or bathing), dressing, walking and/or using the toilet.

"Prolonging independent living" as used in the present disclosure can be easily determined by tests which determine the effect of a therapy on the time before the patient is moving to an institution. The present disclosure also relates to a method for increasing the time to nursing home admission, comprising administering the present composition. A further benefit of the present disclosure is a reduced caregiver burden.

In one aspect the present disclosure provides for a method (or use) of the present composition for improving the ability to/for: (i) eating, walking, toileting, bathing, grooming and/or dressing; and/or (ii) use of communication equipment (particularly telephone), making conversations, keeping appointments, use of household appliances (particularly television), cleaning dishes, preparation of meal or drink, writing, reading, independent housekeeping, transportation and/or shopping. Typically, the disclosed method aims at supporting or improving the capability of performing practical operations which more rely on motor capacities than on cognitive capacities. The disclosed method thus serves at improving quality of life.

The activities of daily living also include the power or capability to make rapid or secure movements, or to walk safely or without feelings of fear of falling on the ground or to maintain equilibrium of the body under those conditions that for young healthy persons give no problem. The support of these activities in persons in need of such support result in a maintenance, a restoration or a decrease in the decline of the capabilities to go out walking safely, to go shopping, walk timely to the bathroom or climb the stairs.

Other activities of daily living include sensory-motor skills, whose adequate presence becomes evident in the capability to coordinate movements of muscles or limbs, in particular during eating or drinking, while wanting to grasp goods, or while aiming to put things on an exact location or in a particular position. Support of these activities in persons in need of such support, is meant to be the maintenance, restoration or a decrease in the rate of decline of the capabilities to prepare or consume a meal, a drink.

The activities of daily life also include the capability to feel, notify, touch or clean all areas of the body. Support of these activities in persons in need of such support is meant to be a restoration, maintenance or decrease of the decline of feeling or full sensation of all parts of the body, of cleaning practices and of the application of hygienic practices of the person's own body and the person's environment.

Such support of the activities as occur in normal daily life, to a level which keeps the persons in a state of independency and/or self maintenance in the society, can be achieved by administration of an effective amount of the present composition.

The improvement of the activities of daily living can be measured. Activities of daily living can be measured using a number of tests, among which the Alzheimer's Disease Cooperative Study Activities of Daily Living Inventory (ADCS-ADL). This is a caregiver rated questionnaire of <NUM> items, with possible scores over a range of <NUM>-<NUM>, where <NUM> implies full functioning with no impairment (see: <NPL>). The questions relative in particular to eating (<NUM>); walking (<NUM>); toileting (<NUM>); bathing (<NUM>); grooming (<NUM>); selecting clothes and dressing (<NUM>); making telephone calls (<NUM>); watching television (<NUM>); making conversation (<NUM>); clearing dishes from a table (<NUM>); finding personal belongings (<NUM>); getting or preparing a beverage (<NUM>); preparing a meal or snack (<NUM>); disposing of garbage or litter (<NUM>); travelling (<NUM>); shopping (<NUM>); keeping appointments or meetings (<NUM>); being alone (<NUM>); talking about current events (<NUM>); reading (<NUM>); writing (<NUM>); pastime, hobby or game (<NUM>), and using household appliances (<NUM>). This test was used in the clinical test of Example <NUM>.

In one embodiment the present disclosure provides the present composition together with instructions for (preferably oral) administration of the composition and indication that said product can be used for one or more of (i) supporting the activities of daily living and/or prolong independent living; or (ii) stimulating eating, walking, toileting, bathing, grooming and/or dressing; or (iii) stimulating use of communication equipment (particularly telephone), making conversations, keeping appointments, use of household appliances (particularly television), cleaning dishes, preparation of meal or drink, writing, reading, independent housekeeping, transportation and/or shopping.

In a further embodiment present disclosure provides the present composition together with instructions for (preferably oral) administration of the composition and indication that administration of the present composition provides the health benefit as described in a published scientific paper, said scientific paper describing a positive outcome for one or more of (i) supporting the activities of daily living and/or prolong independent living; or (ii) stimulating eating, walking, toileting, bathing, grooming and/or dressing ; or (iii) stimulating use of communication equipment (particularly telephone), making conversations, keeping appointments, use of household appliances (particularly television), cleaning dishes, preparation of meal or drink, writing, reading, independent housekeeping, transportation and/or shopping.

Rats can be modelled for the capacity to deal with difficulties in instrumental and/or basic activities of daily living by infusing the rats with beta-amyloid, a protein causing toxicity in the brain leading to neuropathies, into the lateral ventricle of the brain. Rats infused this way show impairment in spontaneous activity in a new environment, which is an important part of activities of daily living, and indicative for the instrumental and/or basic activities of daily living in humans, particularly humans suffering from Alzheimer's disease. The infused rats do not explore the new environment as extensively as control rats do, which is reflected in reduced exploration time and a decrease in walking distance. This study uses a dietary composition (diet B) to overcome the difficulties in daily life activities.

Four groups of rats received either an infusion into the lateral ventricle with beta-amyloid (Abeta) or a saline solution (Sham). Five weeks prior to the infusions the rats were fed one of two diets, A or B. The four groups are summarized in table <NUM>. Table <NUM> lists the dietary composition of the two diets. Diet A serves as a control diet. Diet B is enriched in e.g. DHA, uridine and choline. The rats are placed in a new environment (circular arena, <NUM> in diameter) for <NUM> minutes and their walking pattern is analysed.

On the control diet (A) rats infused with abeta show decreased walking distance in the new environment. When fed the experimental diet (B) to abeta infused rats restored exploration of the new environment to levels of control rats (Sham operated rats, no abeta infusion). <FIG> shows that Abeta infused rats displayed ~<NUM>% reduced locomotor activity in the Open Field on diet A diet, but not in animals on diet B.

Lateral ventricle infusions of abeta induce a reduction in activity. These effects were completely diminished by feeding the present treatment diet. The beneficial effects are indicative for the advantageous used of the present composition in the present method, particularly for improving instrumental and/or basic activities of daily living.

Packaged composition comprising per <NUM>:.

Minerals and trace elements: Sodium <NUM>; Potassium <NUM>; Chloride <NUM>; Calcium <NUM>; Phosphorus <NUM>; Magnesium <NUM>; Iron <NUM>; Zinc <NUM>; Copper <NUM>µg; Manganese <NUM>; Molybdenum <NUM>µg; Chromium <NUM>µg; Iodine <NUM>µg. Vitamins: Vit. A <NUM>µg-RE; vit. D3 <NUM>µg; vit. K <NUM>µg; Thiamin (B1) <NUM>; Riboflavin (B2) <NUM>; Niacin (B3) <NUM>-NE; Pantothenic acid (B5) <NUM>; Biotin <NUM>µg.

The package indicates that the composition improves the activities of daily living, particularly stimulating independent walking, bathing, grooming, dressing, use of communication equipment (particularly telephone), use of household appliances (particularly television), cleaning dishes, preparation of meal or drink and/or writing. The composition is suitable for administration to patients suffering from dementia or Alzheimer's disease.

Rats were fed diets specific in B-vitamins (vitamin B<NUM>, vitamin B<NUM>, and folic acid) content during four weeks. One group was fed a diet deficient of B vitamins and the other group was fed a B-vitamin enriched diet. The rats were housed in groups of four and locomotor activity was assessed in the home cages. The average percentage of the change in activity between the four week intervention period and a control period was calculated.

During the sleep (inactive) period, the average change in activity was decreased in rats fed the B-vitamin enriched diet as compared to the B-vitamin deficient diet (p=<NUM>). In fact, the locomotor activity increased in the rats fed the B-vitamin deficient diet, while it decreased in the rats fed the B-vitamin enriched diet as compared to the control period. Locomotor activity was increased during the sleep period of the rat by feeding a B-vitamin deficient diet. In contrast, activity during the sleep period was decreased by feeding B-vitamin enriched diet. This indicates that rats show a disturbed sleeping pattern when a B-vitamin deficiency is induced. Hence, wellbeing is affected by the B-vitamin deficient diet, as a disturbed sleeping pattern most likely decreases wellbeing. In contrast, wellbeing was improved in rats fed the B-vitamin enriched diet: locomotor activity was decreased and therefore time spent at rest increased.

The present study was performed to assess the effect of an intervention with a medical food on activities of daily living in Alzheimer's Disease (AD) subjects. <NUM> subjects were randomly allocated in a double-blind <NUM> weeks study to receive a <NUM> (<NUM> kcal) once-a-day milk-based drink with: (a) the formula according to Example <NUM> (active product) or (b) an iso-caloric control drink (control product) according to Example <NUM>, but without EPA, DHA, phospholipids, choline, UMP, vitamin E, vitamin C, selenium, vitamin B12, vitamin B6 and folic acid. Outcome measure was an ADCS - ADL Inventory (Alzheimer's Disease Cooperative Study - Activities of Daily Living).

Activities of daily living were measured using the Alzheimer's Disease Cooperative Study Activities of Daily Living Inventory (ADCS-ADL). This is a caregiver rated questionnaire of <NUM> items, with possible scores over a range of <NUM>-<NUM>, where <NUM> implies full functioning with no impairment. The ADCS-ADL assesses functional capacity across a wide spectrum of severity and was the primary tool for collecting ADL data for this study population.

At baseline, there was no significant difference between the group treated with the active product and the group treated with the control product. However, there was a significant difference between the two groups in the increase in ADCS-ADL score over the <NUM> weeks intervention period (p = <NUM>). The control group (n=<NUM>) had an average improvement of + <NUM> points, whereas the active group (n=<NUM>) had an average improvement of +<NUM> points on the ADCS-ADL scale (<FIG>).

The improved ADCS-ADL score over <NUM> weeks was mainly the result of an improvement in instrumental activities.

Claim 1:
A liquid composition comprising per <NUM>, <NUM>-<NUM> gram uridine or an uridine equivalent selected from the group consisting of uridine, deoxyuridine, uridine phosphates, nucleobase uracil and acylated uridine derivatives; <NUM>-<NUM> DHA; <NUM> - <NUM> choline; <NUM> - <NUM> protein; <NUM>- <NUM> carbohydrates; <NUM>-<NUM> microgram vitamin B12; <NUM>-<NUM> microgram folic acid and <NUM> - <NUM> vitamin B6, wherein the composition has a viscosity of <NUM> - <NUM> mPas measured at a shear rate of <NUM> per sec at <NUM>; an osmolality of <NUM> to <NUM> mOsm/kg and a caloric density between <NUM> and <NUM> kcal/ml.