Adherence to Mediterranean diet and subsequent cognitive decline in men with cardiovascular disease

ABSTRACT

Backgrounds and aims: Evidence from recent years highlighted the importance of the Mediterranean diet for brain health. We investigated the association between adherence to Mediterranean diet and change in cognitive functions two decades later in patients with cardiovascular disease (CVD).

Methods: Participants were men with a history of CVD, who previously participated in the Bezafibrate Infarction Prevention (BIP) trial between 1990 and 1997, had a food diary record, and underwent cognitive evaluations 14.6 ± 1.9 years (T1) and 19.9 ± 1.0 years after baseline (T2) as part of the BIP Neurocognitive study (n = 200, mean age at 57.3 ± 6.3 years). Adherence to the Mediterranean diet was determined from the self-administered 4-day food diary record, with patients categorized into high, middle and poor levels of adherence if they received >5, 4–5 and <4 points, respectively. Cognitive function was assessed using the NeuroTrax computerized battery. Linear mixed models were applied.

Results: Among the 200 patients, 52 (26%) had poor adherence, 98 (49%) had middle adherence and 50 (25%) had high levels of adherence to the Mediterranean diet. Those categorized to the poor adherence level had poorer cognitive function at T1 compared to the other groups. Additionally, poor vs. high level of adherence was associated with a greater decline in overall cognitive performance [z-score = −0.23 and 95% confidence interval (CI), −0.43;−0.04; p = 0.021] and in visual spatial functions (−0.46 95% CI, −0.86;−0.06; p = 0.023).

Conclusion: This study stresses the possible role of the Mediterranean diet in men with a high vascular burden and may set the ground for future intervention to reduce their risk for cognitive decline.

KEYWORDS:

• Mediterranean diet
• cardiovascular disease
• cognitive decline
• vascular risk factors

Acknowledgments

The Computerized Cognitive Battery was provided by NeuroTrax Corporation. All authors contributed to study conception, data analysis, and interpretation. All authors contributed to revision of the manuscript. All authors have approved the final version for publication.

Disclosure statement

No potential conflict of interest was reported by the authors.

Additional information

Notes on contributors

Miri Lutski

Miri Lutski, PhD in Epidemiology and Preventive Medicine, Tel Aviv University. Currently works in the Israel Center for Disease Control, Ministry of Health, Israel. Her research focuses on chronic disease epidemiology, aging and neuroepidimiology.

Galit Weinstein

Dr. Galit Weinstein is a senior lecturer and the head of the epidemiology program at the University of Haifa, School of Public Health. Her research focuses on identifying novel genetic, behavioral and clinical risk factors as well as circulating biomarkers for brain aging, Alzheimer's disease and stroke.

Shelly Ben-Zvi

Shelly Ben-Zvi, MSc in Epidemiology and Preventive Medicine, Tel Aviv University. Currently works in a global pharmaceutical company in the clinical research field of oncology treatments.

Uri Goldbourt

Uri Goldbourt is a Professor of Epidemiology and Preventive Medicine at the Sackler Faculty of Medicine, Tel Aviv University, Israel. His main scientific interests span epidemiologic methods, hypertension, dyslipidemia in CHD, nutritional epidemiology of CHD, and epidemiology of stroke and dementia.

David Tanne

Professor David Tanne serves as the president of the Israel Neurological Association; Professor of Neurology and directs the Stroke and Cognition Institute at the Rambam Health Care Campus. His research focuses on cerebrovascular disease and stroke, vascular cognitive impairment and cerebral atherosclerosis.