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Adherence to a Mediterranean Diet, Cognitive Decline, and Risk of Dementia
Catherine Féart, PhD;
Cécilia Samieri, MPH;
Virginie Rondeau, PhD;
Hélène Amieva, PhD;
Florence Portet, MD, PhD;
Jean-François Dartigues, MD, PhD;
Nikolaos Scarmeas, MD;
Pascale Barberger-Gateau, MD, PhD
JAMA. 2009;302(6):638-648.
Context Higher adherence to a Mediterranean-type diet is linked to lower risk for mortality and chronic diseases, but its association with cognitive decline is unclear.
Objective To investigate the association of a Mediterranean diet with change in cognitive performance and risk for dementia in elderly French persons.
Design, Setting, and Participants Prospective cohort study of 1410 adults ( 65 years) from Bordeaux, France, included in the Three-City cohort in 2001-2002 and reexamined at least once over 5 years. Adherence to a Mediterranean diet (scored as 0 to 9) was computed from a food frequency questionnaire and 24-hour recall.
Main Outcome Measures Cognitive performance was assessed on 4 neuropsychological tests: the Mini-Mental State Examination (MMSE), Isaacs Set Test (IST), Benton Visual Retention Test (BVRT), and Free and Cued Selective Reminding Test (FCSRT). Incident cases of dementia (n = 99) were validated by an independent expert committee of neurologists.
Results Adjusting for age, sex, education, marital status, energy intake, physical activity, depressive symptomatology, taking 5 medications/d or more, apolipoprotein E genotype, cardiovascular risk factors, and stroke, higher Mediterranean diet score was associated with fewer MMSE errors (β = –0.006; 95% confidence interval [CI], –0.01 to –0.0003; P = .04 for 1 point of the Mediterranean diet score). Performance on the IST, BVRT, or FCSRT over time was not significantly associated with Mediterranean diet adherence. Greater adherence as a categorical variable (score 6-9) was not significantly associated with fewer MMSE errors and better FCSRT scores in the entire cohort, but among individuals who remained free from dementia over 5 years, the association for the highest compared with the lowest group was significant (adjusted for all factors, for MMSE: β = –0.03; 95% CI, –0.05 to –0.001; P = .04; for FCSRT: β = 0.21; 95% CI, 0.008 to 0.41; P =.04). Mediterranean diet adherence was not associated with the risk for incident dementia (fully adjusted model: hazard ratio, 1.12; 95% CI, 0.60 to 2.10; P = .72), although power to detect a difference was limited.
Conclusions Higher adherence to a Mediterranean diet was associated with slower MMSE cognitive decline but not consistently with other cognitive tests. Higher adherence was not associated with risk for incident dementia.
Author Affiliations: Research Center INSERM U897, Université Victor Segalen Bordeaux 2, Bordeaux, France (Drs Féart, Rondeau, Amieva, Dartigues, and Barberger-Gateau and Ms Samieri); INSERM U888, Université Montpellier 1, Montpellier, France (Dr Portet); and Department of Neurology, Columbia University Medical Center, New York, New York (Dr Scarmeas).
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