Does Hydration Status Influence Executive Function? A Systematic Review

Background Cognitive function, including executive function (EF)-related capacities (eg, working memory, inhibitory and attentional control), has been linked to adherence to healthy lifestyle behaviors. Dehydration is associated with impaired cognitive function, whereas improvements in hydration status may improve inhibitory and attentional performance. No systematic reviews have examined the effects of both dehydration and euhydration on EF. Objective The objectives of this systematic review are to examine studies that have investigated the spectrum of hydration status and EF in adults, and to identify future research needs. Design The review was conducted according to the 2015 Preferred Reporting Items for Systematic Reviews and Meta-Analyses Protocols (PRISMA-P) guidelines. The database search was initially conducted on May 12, 2019 and then updated on April 26, 2020. Databases searched included PubMed, Medline, Psyc Info, SCOPUS, Proquest, and ISI Web of Science. Data extraction included the following: method used to assess de/hydration status, study design, participant characteristics, EF tasks and domain, and results. Article quality ratings were performed on included studies using the Academy of Nutrition and Dietetics Quality Rating Checklist. Participants/Setting Studies done with healthy or diseased adults, aged older than 18 years, in any setting, were included. Studies of individuals with disease states that impact fluid balance or require fluid restrictions as treatments were excluded. Main Outcome Measure All EF-related outcomes were included, such as working memory, inhibitory control, task switching, and attention. Results Four thousand eight hundred thirty-three articles were screened using title/ abstracts. Seventy-one full-text articles were assessed for eligibility; 33 were included (26 included investigations of dehydration; 27 included investigations of rehydration/ euhydration) with 3,636 participants across all studies. Little consistency was found across outcomes. Roughly half of the available studies suggested unclear or neutral EF effects, and half suggested effects on EF domains, particularly working memory, inhibitory control, and attention. Studies including a euhydration condition were slightly more likely to demonstrate improvements to EF capacities. Conclusions Overall, there is a strong need for consistent methodological approaches and a greater number of long-term (ie, >3 days) studies of dehydration and euhydration and EF. J Acad Nutr Diet. 2021;121(7):1284-1305.