European Journal of Nutrition

, Volume 54, Issue 8, pp 1311–1321 | Cite as

Mediterranean diet and cognitive decline over time in an elderly Mediterranean population

  • Antonia Trichopoulou
  • Andreas Kyrozis
  • Marta Rossi
  • Michalis Katsoulis
  • Dimitrios Trichopoulos
  • Carlo La Vecchia
  • Pagona Lagiou
Original Contribution



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.


Mediterranean 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.

Supplementary material

394_2014_811_MOESM1_ESM.docx (17 kb)
Supplementary material 1 (DOCX 16 kb)


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Copyright information

© Springer-Verlag Berlin Heidelberg 2014

Authors and Affiliations

  • Antonia Trichopoulou
    • 1
    • 2
  • Andreas Kyrozis
    • 1
    • 3
  • Marta Rossi
    • 4
  • Michalis Katsoulis
    • 1
  • Dimitrios Trichopoulos
    • 1
    • 2
    • 5
  • Carlo La Vecchia
    • 4
    • 6
  • Pagona Lagiou
    • 2
    • 5
    • 7
  1. 1.Hellenic Health FoundationAthensGreece
  2. 2.Bureau of Epidemiologic ResearchAcademy of AthensAthensGreece
  3. 3.1st Department of Neurology, Eginition HospitalUniversity of Athens Medical SchoolAthensGreece
  4. 4.Dipartimento di EpidemiologiaIRCCS - Istituto di Ricerche Farmacologiche Mario NegriMilanItaly
  5. 5.Department of EpidemiologyHarvard School of Public HealthBostonUSA
  6. 6.Department of Clinical Sciences and Community HealthUniversity of MilanMilanItaly
  7. 7.Department of Hygiene, Epidemiology and Medical StatisticsUniversity of Athens Medical SchoolAthensGreece

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