Cognitive function improvement after fecal microbiota transplantation in Alzheimer’s dementia patient: a case report

Figures & data

Table 1. Clinical characteristics of fecal microbiota transplantation.

	Administration of FMT
	1	2 (after 3 months of 1st FMT)
Presenting symptoms of CDI	Diarrhea (3 times/day), fever (37.8 °C), abdominal pain	Watery diarrhea (10 times/day), fever (38.0 °C), abdominal pain
Diagnosis	Positive Clostridioides difficile toxin/PCR (stool)	Positive Clostridioides difficile toxin/PCR (stool)
Antibiotics for CDI	Vancomycin (oral, 125 mg/qid), metronidazole (oral, 500 mg/tid)
FMT (number of trials, dose [g])	1, 60 g	1, 60 g
Complications after FMT	Nausea	None
Medication for dementia (dose, mg/ duration, years)	Donepezil (10/5)
Duration of dementia (years)	5

CDI: Clostridioides difficile infection; FMT: fecal microbiota transplantation.

Figure 1. Timeline of the fecal microbiota transplantation and cognitive function tests. The cognitive function test scores improved after fecal microbiota transplantation (Mini-Mental State Examination [MMSE], red line; Montreal Cognitive Assessment [MoCA], green line; Clinical Dementia Rating [CDR], blue line).

Table 2. Cognitive function test scores before and after fecal microbiota transplantation.

Cognitive functions	Test score
	1 (before 3 months 1st FMT)	1 (before 1 month 1st FMT)	2 (after 1 week 1st FMT)	3 (after 1 month 1st FMT)	4 (after 3 month 1st FMT)	5 (after 1 week 2nd FMT)
MMSE total (score)	15	15	18	18	20	20
Orientation to time (5)	3	3	3	3	3	3
Orientation to place (5)	2	2	2	2	3	3
Registration (3)	3	3	3	3	3	3
Attention and calculation (5)	2	2	4	4	4	4
Recall (3)	1	1	2	2	3	3
Language (8)	3	3	3	3	3	3
Visual Construction (pentagon) (1)	1	1	1	1	1	1
MoCA total (score)	–	11	11	12	16	17
Visuospatial and executive functioning (5)	–	0	0	1	1	1
Animal Naming (3)	–	3	3	3	3	3
Attention (6)	–	1	1	1	2	2
Language (3)	–	1	1	1	1	1
Abstraction (2)	–	1	1	1	2	2
Delayed recall (5)	–	2	2	2	3	3
Orientation (6)	–	3	3	3	4	4
CDR total (score)	1	1	1	1	0.5	0.5
Memory	1	1	1	1	0.5	0.5
Orientation	1	1	1	1	0.5	0.5
Judgment problem solving	1	1	0.5	0.5	1	1
Community affairs	1	1	1	1	1	1
Home and hobbies	0.5	0.5	0.5	0.5	0.5	0.5
Personal care	1	1	1	1	0.5	0.5

FMT: fecal microbiota transplantation; MMSE: mini-mental state examination; MoCA: Montreal Cognitive.

Table 3. Laboratory findings of fecal microbiota transplantation.

Value (before FMT/after FMT)	Test
	1 (before 3 months 1st FMT)	1 (before 3 months 1st FMT)	1 (before 3 months 1st FMT)	1 (before 3 months 1st FMT)	1 (before 3 months 1st FMT)	1 (before 3 months 1st FMT)
BUN, mg/dL (normal range: 6.0–20.0)	12.9	42.0	37.2	26.8	23.4	16.6
Creatinine, mg/dl (normal range: 0.5–1.20)	2.10	2.04	1.88	1.97	2.27	2.09
CRP, mg/dl (normal range: 0.0–0.5)	2.16	11.56	1.20	3.60	6.17	2.29
ESR, mm/h (normal range: 1–22)	49	60	12	68	67	NA
Procalcitonin, ng/ml (normal range: 0.0–0.50)	0.10	3.93	0.73	0.14	0.10	0.14
Ammonia, μg/dl (normal range: 12–66)	42	NA	NA	NA	NA	NA
Albumin, g/dL (normal range: 3.5–5.2)	3.6	2.9	2.7	2.7	2.7	3.4
Lactic acid, mmol/L (normal range: 0.5–2.20)	1.22	2.22	1.21	0.66	0.76	1.38

FMT: fecal microbiota transplantation; NA: not applicable.

Figure 2. Microbiome analysis of the pre- and post-fecal microbiota transplantation (FMT). (A) The α-diversity representing Shannon diversity index. (B) The β-diversity representing principal coordinates analysis. (C) Linear discriminant analysis (LDA) effect size analysis (LDA score > 2.0). *p-Value < .05, LDS: linear discriminant analysis.