This study sought to determine if the MIND diet (a hybrid of the Mediterranean and Dash diets, with modifications based on the science of nutrition and the brain), is effective in preventing cognitive decline after stroke.
We analyzed 106 participants of a community cohort study who had completed a diet assessment and two or more annual cognitive assessments and who also had a clinical history of stroke. Cognition in five cognitive domains was assessed using structured clinical evaluations that included a battery of 19 cognitive tests. MIND diet scores were computed using a valid food frequency questionnaire (FFQ). Dietary components of the MIND diet included whole grains, leafy greens and other vegetables, berries, beans, nuts, lean meats, fish, poultry, and olive oil and reduced consumption of cheese, butter, fried foods, and sweets. MIND diet scores were modeled in tertiles. The influence of baseline MIND score on change in a global cognitive function measure and in the five cognitive domains was assessed using linear mixed models adjusted for age and other potential confounders.
With adjustment for age, sex, education, APOE-ε4, caloric intake, smoking, and participation in cognitive and physical activities, the top vs lowest tertiles of MIND diet scores had a slower rate of global cognitive decline (β =.08; CI = 0.0074, 0.156) over an average of 5.9 years of follow-up.
High adherence to the MIND diet was associated with a slower rate of cognitive decline after stroke.
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Schellinger, P.D., et al., Assessment of additional endpoints for trials in acute stroke — what, when, where, in who? Int J Stroke, 2012. 7(3): p. 227–30.
Saver, J.L., Time is brain—quantified. Stroke, 2006. 37(1): p. 263–6.
Portegies, M.L., et al., Prestroke Vascular Pathology and the Risk of Recurrent Stroke and Poststroke Dementia. Stroke, 2016. 47(8): p. 2119–22.
Morris, M.C., et al., MIND diet slows cognitive decline with aging. Alzheimers Dement. 11(9): p. 1015–22.
Morris, M.C., et al., MIND diet associated with reduced incidence of Alzheimer’s disease. Alzheimers Dement. 11(9): p. 1007–14.
Scarmeas, N., et al., Physical activity, diet, and risk of Alzheimer disease. JAMA, 2009. 302(6): p. 627–37.
Tangney, C.C., et al., Adherence to a Mediterranean-type dietary pattern and cognitive decline in a community population. Am J Clin Nutr, 2011. 93(3): p. 601–7.
Bennett, D.A., et al., Overview and findings from the rush Memory and Aging Project. Curr Alzheimer Res, 2012. 9(6): p. 646–63.
Wilson, R.S., et al., Odor identification and decline in different cognitive domains in old age. Neuroepidemiology, 2006. 26(2): p. 61–7.
Morris, M.C., et al., Validity and reproducibility of a food frequency questionnaire by cognition in an older biracial sample. Am J Epidemiol, 2003. 158(12): p. 1213–7.
Panagiotakos, D.B., et al., Adherence to the Mediterranean food pattern predicts the prevalence of hypertension, hypercholesterolemia, diabetes and obesity, among healthy adults; the accuracy of the MedDietScore. Prev Med, 2007. 44(4): p. 335–40.
Epstein, D.E., et al., Determinants and consequences of adherence to the dietary approaches to stop hypertension diet in African-American and white adults with high blood pressure: results from the ENCORE trial. J Acad Nutr Diet, 2012. 112(11): p. 1763–73.
Bennett, D.A., et al., Religious Orders Study and Rush Memory and Aging Project. J Alzheimers Dis, 2018. 64(s1): p. S161–S189.
Wilson, R.S., et al., Early and late life cognitive activity and cognitive systems in old age. J Int Neuropsychol Soc, 2005. 11(4): p. 400–7.
Buchman, A.S., et al., Physical activity and motor decline in older persons. Muscle Nerve, 2007. 35(3): p. 354–62.
Kohout, F.J., et al., Two shorter forms of the CES-D (Center for Epidemiological Studies Depression) depression symptoms index. J Aging Health, 1993. 5(2): p. 179–93.
Buchman, A.S., et al., Apolipoprotein E e4 allele is associated with more rapid motor decline in older persons. Alzheimer Dis Assoc Disord, 2009. 23(1): p. 63–9.
Bennett, D.A., Secular trends in stroke incidence and survival, and the occurrence of dementia. Stroke, 2006. 37(5): p. 1144–5.
Fung, T.T., et al., Mediterranean diet and incidence of and mortality from coronary heart disease and stroke in women. Circulation, 2009. 119(8): p. 1093–100.
Tsivgoulis, G., et al., Adherence to a Mediterranean diet and prediction of incident stroke. Stroke. 46(3): p. 780–5.
Willey, J.Z., et al., Lipid profile components and risk of ischemic stroke: the Northern Manhattan Study (NOMAS). Arch Neurol, 2009. 66(11): p. 1400–6.
Estruch, R., et al., Primary prevention of cardiovascular disease with a Mediterranean diet. N Engl J Med. 368(14): p. 1279–90.
Dehghan, M., et al., Relationship between healthy diet and risk of cardiovascular disease among patients on drug therapies for secondary prevention: a prospective cohort study of 31 546 high-risk individuals from 40 countries. Circulation, 2012. 126(23): p. 2705–12.
de Lorgeril, M., et al., Mediterranean diet, traditional risk factors, and the rate of cardiovascular complications after myocardial infarction: final report of the Lyon Diet Heart Study. Circulation, 1999. 99(6): p. 779–85.
Dearborn, J.L., V.C. Urrutia, and W.N. Kernan, The case for diet: a safe and efficacious strategy for secondary stroke prevention. Front Neurol, 2015. 6: p. 1.
Wengreen, H., et al., Prospective study of Dietary Approaches to Stop Hypertension- and Mediterranean-style dietary patterns and age-related cognitive change: the Cache County Study on Memory, Health and Aging. Am J Clin Nutr, 2013. 98(5): p. 1263–71.
Morris, M.C., et al., Associations of vegetable and fruit consumption with age-related cognitive change. Neurology, 2006. 67(8): p. 1370–6.
Devore, E.E., et al., Dietary intakes of berries and flavonoids in relation to cognitive decline. Ann Neurol, 2012. 72(1): p. 135–43.
Morris, M.C., et al., Fish consumption and cognitive decline with age in a large community study. Arch Neurol, 2005. 62(12): p. 1849–53.
Urpi-Sarda, M., et al., Virgin olive oil and nuts as key foods of the Mediterranean diet effects on inflammatory biomakers related to atherosclerosis. Pharmacol Res. 65(6): p. 577–83.
Martinez-Lapiscina, E.H., et al., Mediterranean diet improves cognition: the PREDIMED-NAVARRA randomised trial. J Neurol Neurosurg Psychiatry, 2013. 84(12): p. 1318–25.
Razquin, C., et al., A 3 years follow-up of a Mediterranean diet rich in virgin olive oil is associated with high plasma antioxidant capacity and reduced body weight gain. Eur J Clin Nutr, 2009. 63(12): p. 1387–93.
Larrieu, S., et al., Nutritional factors and risk of incident dementia in the PAQUID longitudinal cohort. J Nutr Health Aging, 2004. 8(3): p. 150–4.
Morris, M.C., Nutritional determinants of cognitive aging and dementia. Proc Nutr Soc, 2012. 71(1): p. 1–13.
Gillette Guyonnet, S., et al., IANA task force on nutrition and cognitive decline with aging. J Nutr Health Aging, 2007. 11(2): p. 132–52.
Morris, M.C. and C.C. Tangney, Dietary fat composition and dementia risk. Neurobiol Aging, 2014. 35 Suppl 2: p. S59–64.
Kang, J.H., A. Ascherio, and F. Grodstein, Fruit and vegetable consumption and cognitive decline in aging women. Ann Neurol, 2005. 57(5): p. 713–20.
Nooyens, A.C., et al., Fruit and vegetable intake and cognitive decline in middle-aged men and women: the Doetinchem Cohort Study. Br J Nutr, 2011. 106(5): p. 752–61.
Chen, X., Y. Huang, and H.G. Cheng, Lower intake of vegetables and legumes associated with cognitive decline among illiterate elderly Chinese: a 3-year cohort study. J Nutr Health Aging, 2012. 16(6): p. 549–52.
Mitjavila, M.T., et al., The Mediterranean diet improves the systemic lipid and DNA oxidative damage in metabolic syndrome individuals. A randomized, controlled, trial. Clin Nutr. 32(2): p. 172–8.
Gadgil, M.D., et al., The effects of carbohydrate, unsaturated fat, and protein intake on measures of insulin sensitivity: results from the OmniHeart trial. Diabetes Care. 36(5): p. 1132–7.
Solfrizzi, V., et al., Relationships of Dietary Patterns, Foods, and Micro- and Macronutrients with Alzheimer’s Disease and Late-Life Cognitive Disorders: A Systematic Review. J Alzheimers Dis, 2017. 59(3): p. 815–849.
Tangney, C.C., et al., Relation of DASH- and Mediterranean-like dietary patterns to cognitive decline in older persons. Neurology, 2014. 83(16): p. 1410–6.
Folsom, A.R., E.D. Parker, and L.J. Harnack, Degree of concordance with DASH diet guidelines and incidence of hypertension and fatal cardiovascular disease. Am J Hypertens, 2007. 20(3): p. 225–32.
Das, R.R., et al., Prevalence and correlates of silent cerebral infarcts in the Framingham offspring study. Stroke, 2008. 39(11): p. 2929–35.
Fung, T.T., et al., Adherence to a DASH-style diet and risk of coronary heart disease and stroke in women. Arch Intern Med, 2008. 168(7): p. 713–20.
Engstad, T., K.H. Bonaa, and M. Viitanen, Validity of self-reported stroke: The Tromso Study. Stroke, 2000. 31(7): p. 1602–7.
Jackson, C.A., et al., Moderate agreement between self-reported stroke and hospital-recorded stroke in two cohorts of Australian women: a validation study. BMC Med Res Methodol, 2015. 15: p. 7.
Jamrozik, E., et al., Validity of self-reported versus hospital-coded diagnosis of stroke: a cross-sectional and longitudinal study. Cerebrovasc Dis, 2014. 37(4): p. 256–62.
Funding: Supported by grants from the NIA (R01 AG054476 and R01AG17917). The sponsors had no role in the design and conduct of the study; in the collection, analysis, and interpretation of data; in the preparation of the manuscript; or in the review or approval of the manuscript.
Conflict of Interest and Financial Disclosures: Laurel Cherian: Study concept and design, Interpretation of data, and writing of manuscript. Dr. Cherian reports no disclosures. Yamin Wang: Analysis and interpretation. Dr. Wang reports no disclosures. Keiko Fakuda: Background research and initial draft of introduction and discussion. Ms. Fakuda reports no disclosures. Sue Leurgans: Critical revision of the manuscript for important intellectual content. Dr. Leurgans reports no disclosures. Neelum Aggarwal: Study concept and design, critical revision of the manuscript for important intellectual content. Dr. Aggarwal reports no disclosures. Martha Clare Morris: Study concept and design, critical revision of the manuscript for important intellectual content. Dr. Morris reports no disclosures.
Ethical standards: The authors attest that they have provided an accurate account of the work performed as well as an objective discussion of its significance. Relevant raw data has been accurately provided. The authors attest that the work is original and has not been published elsewhere. Pertinent work from other sources has been appropriately cited. The Institutional Review Board of Rush University Medical Center approved the study, and all participants gave written informed consent.
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Cherian, L., Wang, Y., Fakuda, K. et al. Mediterranean-Dash Intervention for Neurodegenerative Delay (MIND) Diet Slows Cognitive Decline After Stroke. J Prev Alzheimers Dis 6, 267–273 (2019). https://doi.org/10.14283/jpad.2019.28
- cognitive decline