Abstract

Background

Annonaceae fruits including soursop (Annona muricata) and sugar apple (Annona squamosa) are widely consumed across tropical regions and contain acetogenins, mitochondrial complex I inhibitors causing neuronal energy failure and tau-related neurodegeneration in animal models. The potential impact of long-term dietary Annonaceae exposure on human neurocognition remains largely unknown.

Methods

We retrospectively analyzed medical records from 96 adults of tropical origin presenting with cognitive complaints at a French tertiary memory clinic (2015–2023). Dietary exposure was assessed using a semiquantitative Annonaceae Consumption Score (ACS). Cognitive performance was evaluated using the Mini-Mental State Examination (MMSE) and a comprehensive neuropsychological battery. Neurocognitive disorders were diagnosed according to DSM-5 criteria. A subsample of 50 participants underwent 3D T1-weighted MRI allowing voxel-based morphometry (VBM). Multivariate models were adjusted for confounding factors.

Results

Participants were aged 65.7 ± 10.5 years (54% female) and originated from the Americas (58.3%), Africa (26.0%), and Asia (15.6%). Regular Annonaceae consumption was highly prevalent (83%). Higher lifetime ACS was independently associated with lower MMSE scores (β = −0.42, P < 0.001) and increased odds of dementia (OR 1.22 [95% CI 1.10–1.39], P < 0.001). Greater exposure was associated with reduced grey matter volume bilaterally in temporal, occipitotemporal, and frontal regions (P_{FDR-corrected} < 0.05).

Conclusions

Chronic Annonaceae consumption was associated with worse cognitive performance and region-specific brain atrophy in this exploratory study. These findings identify chronic Annonaceae fruit consumption as a candidate environmental risk factor for dementia in tropical and diaspora populations, warranting prospective epidemiological investigation with quantitative exposure assessment.