Mediterranean diet and cognitive decline over time in an elderly Mediterranean population
Evidence suggests that dietary patterns compatible with the traditional Mediterranean diet (MD) may protect against cognitive decline. We prospectively assessed whether adherence to MD in the Mediterranean country of Greece is inversely associated with cognitive decline in the elderly and whether any particular MD component may play a key role.
Elderly men and women (N = 401) residing in the greater Athens area had dietary variables ascertained in 1994–1999. Adherence to MD was represented by the MD score [MDS, 0–3 (low), 4–5 (intermediate), 6–9 (high)]. The mini-mental state examination (MMSE) was administered by trained professionals to individuals aged 65 years or older in 2004–2006 (first assessment) and re-administered in 2011–2012 (second assessment). MMSE change (cMMSE) was categorized as: improved/unchanged (cMMSE ≥ 0), mildly lower (cMMSE −1 to −4) or substantially lower (cMMSE ≤ −5). Associations were evaluated through multinomial logistic regression.
Decline in MMSE performance was inversely associated with adherence to MD. For mild versus no decline, odds ratio (OR) comparing high to low MD adherence was 0.46 [95 % confidence interval (CI) 0.25–0.87, p = 0.012]. For substantial versus no decline, OR comparing high to low MD adherence was 0.34 (95 % CI 0.13–0.89, p = 0.025). Among the nine MDS components, only vegetable consumption exhibited a significant inverse association with cognitive decline.
Closer adherence to the traditional MD is highly likely to protect against cognitive decline in this elderly Mediterranean population. Higher vegetable consumption appears to play a key role, possibly in synergy with additional components of the diet.
KeywordsMediterranean diet Cognitive function Elderly Cognition Dementia
Mediterranean diet score
Mini-mental state examination
AT is the PI of EPIC-Greece and the initiator of the study. AK provided expertise in neurology and neuroepidemiology. MR and MK undertook the statistical analysis. DT, CL and PL were senior epidemiologists in the study. All authors contributed to the drafting and the revision of the manuscript and have all approved the submitted version. The study was supported by the Hellenic Health Foundation, the European Union CHANCES project and the Stavros Niarchos Foundation.
Conflict of interest
None of the authors has any conflict of interest.
- 7.Opie RS, Ralston RA, Walker KZ (2013) Adherence to a Mediterranean-style diet can slow the rate of cognitive decline and decrease the risk of dementia: a systematic review. Nutr Diet 70(3):206–217Google Scholar
- 11.Riboli E, Hunt KJ, Slimani N, Ferrari P, Norat T, Fahey M, Charrondiere UR, Hemon B, Casagrande C, Vignat J, Overvad K, Tjonneland A, Clavel-Chapelon F, Thiebaut A, Wahrendorf J, Boeing H, Trichopoulos D, Trichopoulou A, Vineis P, Palli D, Bueno-De-Mesquita HB, Peeters PH, Lund E, Engeset D, Gonzalez CA, Barricarte A, Berglund G, Hallmans G, Day NE, Key TJ, Kaaks R, Saracci R (2002) European Prospective investigation into cancer and nutrition (EPIC): study populations and data collection. Public Health Nutr 5(6B):1113–1124CrossRefGoogle Scholar
- 12.Katsouyanni K, Rimm EB, Gnardellis C, Trichopoulos D, Polychronopoulos E, Trichopoulou A (1997) Reproducibility and relative validity of an extensive semi-quantitative food frequency questionnaire using dietary records and biochemical markers among Greek schoolteachers. Int J Epidemiol 26(Suppl 1):S118–S127CrossRefGoogle Scholar
- 13.Trichopoulou A, Georga K (2004) Composition tables of simple and composite foods. Greece, AthensGoogle Scholar
- 18.Willett W (2013) Nutritional epidemiology. Oxford University Press, Oxford; New YorkGoogle Scholar
- 29.Gu Y, Luchsinger JA, Stern Y, Scarmeas N (2010) Mediterranean diet, inflammatory and metabolic biomarkers, and risk of Alzheimer’s disease. J Alzheimers Dis 22(2):483–492Google Scholar
- 30.Titova OE, Ax E, Brooks SJ, Sjogren P, Cederholm T, Kilander L, Kullberg J, Larsson EM, Johansson L, Ahlstrom H, Lind L, Schioth HB, Benedict C (2013) Mediterranean diet habits in older individuals: associations with cognitive functioning and brain volumes. Exp Gerontol 48(12):1443–1448CrossRefGoogle Scholar
- 33.Psaltopoulou T, Kyrozis A, Stathopoulos P, Trichopoulos D, Vassilopoulos D, Trichopoulou A (2008) Diet, physical activity and cognitive impairment among elders: the EPIC—Greece cohort (European prospective investigation into cancer and nutrition). Public Health Nutr 11(10):1054–1062CrossRefGoogle Scholar
- 37.Martinez-Lapiscina EH, Clavero P, Toledo E, Estruch R, Salas-Salvado J, San Julian B, Sanchez-Tainta A, Ros E, Valls-Pedret C, Martinez-Gonzalez MA (2013) Mediterranean diet improves cognition: the PREDIMED-NAVARRA randomised trial. J Neurol Neurosurg Psychiatry 84(12):1318–1325CrossRefGoogle Scholar
- 39.Solfrizzi V, Panza F (2014) Mediterranean diet and cognitive decline. A lesson from the whole-diet approach: what challenges lie ahead? J Alzheimers Dis 39(2):283–286Google Scholar
- 40.Singh B, Parsaik AK, Mielke MM, Erwin PJ, Knopman DS, Petersen RC, Roberts RO (2014) Association of mediterranean diet with mild cognitive impairment and Alzheimer’s disease: a systematic review and meta-analysis. J Alzheimers Dis 39(2):271–282Google Scholar
- 41.Dominguez LJ, Bes-Rastrollo M, de la Fuente-Arrillaga C, Toledo E, Beunza JJ, Barbagallo M, Martinez-Gonzalez MA (2013) Similar prediction of total mortality, diabetes incidence and cardiovascular events using relative-and absolute-component Mediterranean diet score: the SUN cohort. Nutr Metab Cardiovasc Dis 23(5):451–458CrossRefGoogle Scholar
- 47.Chui HC, Zheng L, Reed BR, Vinters HV, Mack WJ (2012) Vascular risk factors and Alzheimer’s disease: are these risk factors for plaques and tangles or for concomitant vascular pathology that increases the likelihood of dementia? An evidence-based review. Alzheimers Res Ther 4(1):1Google Scholar
- 52.Valls-Pedret C, Lamuela-Raventos RM, Medina-Remon A, Quintana M, Corella D, Pinto X, Martinez-Gonzalez MA, Estruch R, Ros E (2012) Polyphenol-rich foods in the mediterranean diet are associated with better cognitive function in elderly subjects at high cardiovascular risk. J Alzheimers Dis 29(4):773–782Google Scholar