Effect of a Modified Ketogenic-Mediterranean Diet on Alzheimer's Disease

Participants will be enrolled into 1 of 3 study groups. Group 1 will include healthy
volunteers with no apparent memory problems, memory complaints or family history of
Alzheimer's disease or dementia. This group will complete cognitive assessments, blood and
stool sample collection, neuroimaging, and lumbar puncture at week 0 only. Group 1 will NOT
take part in the diet study.

Group 2 will have pre-diabetes, but no apparent memory problems that can be observed during
cognitive testing. Group 2 will complete an 18-week diet study, with follow-up assessment 6
weeks after final diet completion. Throughout the study the following will also be completed;
cognitive assessments, blood and stool sample collection, neuroimaging, and lumbar puncture.

Group 3 will have mild memory problems that are observed during cognitive testing. Group 3
will complete an 18-week diet study, with follow-up assessment 6 weeks after diet final
completion. Throughout the study the following will also be completed; cognitive assessments,
blood and stool sample collection, neuroimaging, and lumbar puncture.

Inclusion Criteria:

1. Male or post-menopausal female;

2. Age 50 to 85 years inclusive;

3. Cognitive diagnosis ranged from cognitively normal for "'Healthy' and 'At-Risk'" to
mild/moderate cognitive impairment for "MCI/eAD;"

4. Stable medical condition (generally 3 months prior to screening visit) at the
discretion of study physician;

5. Stable on medications (generally 4 weeks prior to screening visit) at the discretion
of study physician;

6. Able to complete baseline assessments;

7. HbA1c and fasting glucose within the normal (Healthy or MCI/eAD) or pre-diabetic
(At-Risk or MCI/eAD) range depending on group.

Exclusion Criteria:

1. Diagnosis of neurodegenerative illness (except for MCI or early AD in the MCI/eAD
group);

2. History of a clinically significant stroke;

3. Current evidence or history in past year of focal brain lesion, head injury with loss
of consciousness or DSM-IV criteria for any major psychiatric disorder including
psychosis, major depression, bipolar disorder, alcohol or substance abuse;

4. Sensory impairment (i.e.: visual or auditory) that would preclude the participant from
participating in the protocol;

5. Diabetes that requires current use of diabetes medications;

6. Current use of cholesterol/lipid lowering medications;

7. Clinically significant elevations in liver function tests;

8. Active neoplastic disease (stable prostate cancer and non-melanoma skin cancer is
permissible);

9. History of epilepsy or seizure within past year;

10. Contraindications for MRI (claustrophobia, craniofacial metal implants, pacemakers);

11. Significant medical illness or organ failure, such as uncontrolled hypertension or
cardiovascular disease, chronic obstructive pulmonary disease, liver disease, or
kidney disease;

12. Use of the following medications: anticonvulsants, drugs with potential interfering
CNS effects (other than cholinesterase inhibitors or memantine), medications with
significant anticholinergic activity, anti-parkinsonian medications or regular use of
narcotic analgesics;

13. If female, menstruation in the past 12 months or hysterectomy and current hormone
replacement therapy medication;

14. Major digestive disorders, absorption issues, or surgeries that may be exacerbated by
diet changes;

15. Untreated hypothyroidism or B12 deficiency;

16. Participants currently using resveratrol, CoQ10 (coenzyme Q10), coconut oil/other
medium chain triglyceride-containing (ie: Axona) supplements, or curcumin will be
excluded unless they are willing to discontinue them 2 weeks prior to the start of
baseline visits and remain off for study duration.