mediterranean diet and cognitive function · and cognitive decline in a community population...

Mediterranean Diet and Cognitive FunctionALYSSA PETERS

UWGB DIETETIC INTERN 2018-19

Peters, A (2014, 2015). Grandma [Photographs]. Retrieved from personal camera

Progression

Mild Cognitive Impairment

Mild Dementia

Moderate Dementia

Severe Dementia

Medical Care Corporation (2016). MCI and Dementia [Infograph]. Retrieved from https://www.mccare.com/education/mcidementia.html.

Does not interfere with activities of

daily living

Interferes with activities of daily living

Reactive oxygen species

OxidativeStress

Antioxidant properties

Adherence to a Mediterranean diet and Alzheimer’s disease risk in an Australian population. Gardener S, Gu Y, Rainey-Smith SR et al. Translational Psychiatry. 2 0 1 2

Oldways Preservation and Exchange Trust (2009). Mediterranean Diet Pyramid [Photograph]. Retrieved from https://oldwayspt.org/traditional-diets/mediterranean-diet

Mediterranean diet improves cognition: the

PREDIMED-NAVARRA randomized trial

Martínez-Lapiscina E, Clavero P, Toledo E, et al. Journal of Neurology, Neurosurgery, and

Psychiatry. 2013

Mediterranean diet improves cognition: the PREDIMED-NAVARRA randomized trial

PurposeAssess the effects of MedDiet on cognition and dementia incidence

Design• Randomized control trial

• 6.5 years

• 522 participants

Martínez-Lapiscina E, Clavero P, Toledo E, et al. Journal of Neurology, Neurosurgery and Psychiatry. 2013

Community-dwelling men and women residing in Spain

Inclusion

• Age > 55 years

• High vascular risk d/t T2D or 3 of the following:

• Current smoking

• Hypertension

• Dyslipidemia

• Overweight

• Family history of premature CVD

Exclusion

• Current CVD or previous history

• Severe chronic illness

• Illiteracy

Mediterranean diet improves cognition: the PREDIMED-NAVARRA randomized trial. Martínez-Lapiscina E, Clavero P, Toledo E, et al. Journal of Neurology, Neurosurgery and Psychiatry. 2013

Intervention◦ MedDiet + EVOO (1L/week)

◦ MedDiet + Mixed Nuts (30g of raw, unprocessed/day)

◦ Low-Fat Control Diet: education given on low-fat diet (diet plan)

137-item FFQ

14-item adherence questionnaireUSDA (n.d.). Olive Oil [Photograph]. Retrieved from https://www.flickr.com/photos/usdagov/6896388410

Shutterstock (n.d.). Walnuts [Photograph]. Retrieved from https://theconversation.com/its-good-to-eat-walnuts-but-is-it-true-that-they-prevent-heart-disease-57439


Clock Drawing Test (CDT)•Language comprehension

•Visuospatial abilities

•Working memory

•Attention and abstract thinking


Frontiers in Neuroscience (n.d.). Progressive Deterioration [Photograph]. Retrieved from https://curiosity.com/topics/screen-for-dementia-with-the-stroke-of-a-clock-curiosity/

Mini mental state exam (MMSE)

•Orientation to time and place

•Attention and calculation

•Recall

•Language and visual construction


MedWorks Media (n.d.). Mini-Mental State Examination [Infograph]. Retrieved from https://medworksmedia.com/product/mini-mental-state-examination-mmse/

MedDiet + EVOO (n=244)

MedDiet + Nuts(n=166)

Control/Low-fat(n=132)

MMSE27.73 (27.27 to

28.19)27.68 (27.20 to

28.16)27.11 (26.61 to 27.61)

Adjusted diff. versus control

(95% CI)

+0.62 (+0.18 to +1.05

0.005+0.57 (+0.11 to

+1.03)0.015 0 (reference)

CDT 5.31 (4.98-5.64) 5.13 (4.78-5.47) 4.80 (4.44-5.16)

Adjusted diff. versus control

(95% CI)+0.51 (+0.20 to

+0.82)0.001

+0.33 (+0.003 to +0.67)

0.048 0 (reference)

Adjusted for sex, age, education, family history of cognitive impairment or dementia, Apoe4 genotype, hypertension, dyslipidemia, diabetes, smoking


Mediterranean diet improves cognition:

the PREDIMED-NAVARRA

randomized trial

Diagnosis

• EVOO: 18

• Nuts: 19

• Low-fat/Control: 23

60 cases of MCI

• EVOO: 12

• Nuts: 6

• Low-fat/Control: 17

35 cases of Dementia



Strengths

• Long-term, Randomized

• Foods with strong antioxidant and anti-inflammatory properties

• Several confounders were controlled

Limitations

• Sample size

• Single blinded

• High risk of CVD

• FFQ-self reported

• Intervention done at home


/

Conclusion

I-A (strong)

Overall, MedDiet with EVOO or mixed nuts

showed better cognitive performance

over 6.5 years

Evidence for protective effects of

MedDiet on cognitive function



Adherence to a Mediterranean-type dietary pattern and

cognitive decline in a community population

Tangney C, Kwasny M, Li H, et al. The American Journal of Clinical Nutrition. 2011

Adherence to a Mediterranean-type dietary pattern and cognitive decline in a community population

PurposeAssess association between adherence to a Mediterranean diet and cognitive change in older adults

Design• Observational-Prospective Cohort

• 7.6 years

• 3,790 participants



Inclusion

• Age > 65 years

• 2 or more cognitive assessments (4 possible) during home interview

Exclusion

• History of

• Heart Disease

• Stroke


Participants of the Chicago Health and Aging Project (CHAP)


• Non-refined cereals (3 items)

• Potatoes (3 items)

• Fruit (11 items)

• Vegetable (16 items)

• Legumes, nuts and beans (7 items)

• Fish (3 items)

• Olive oil (2 items)


• Red meat/meat products (11 items)

• Poultry (4 items)

• Full-fat cheese and other dairy (6 items)

MedDiet FFQ

MedDiet ScoreMAX OF 55



Components Servings per week for max score of 5

Nonrefined cereals and breads

>32

Potatoes >18

Fruit >22

Vegetables >33

Legumes, nuts, beans >6

Fish >6

Olive Oil ≥7

Red meats ≤1

Poultry ≤3

Full-fat dairy ≤10

Wine only (mL) <300

Alcohol (mL) <300



Results

Type of Test All (n=3790)

Lowest 12-25(n=1163)

Middle 26-29(n=1251)

Highest 30-45(n=1376)

Global Cognitive Score 0.18 ± 0.73 0.04 ± 0.75 0.13 ± 0.74 0.36 ± 0.65

Mini-Mental State Exam

26.5 ± 4.1 25.9 ± 4.3 26.2 ± 4.3 27.3 ± 3.3

Global Cognitive Score

Rate of Change

Solid + Dashed: Middle tertile

B = -0.0171, P = 0.0002

B = -0.0079, P = 0.075

Adherence to a Mediterranean-type dietary pattern and cognitive decline in a community population Tangney C, Kwasny M, Li H, et al. The American Journal of Clinical Nutrition. 2011

Solid Line: Highest tertile


Strengths

• Long-term, prospective design

• Biracial community sample

• FFQ’s assessed at baseline and next interview cycle (3 y)

• Several confounders controlled

Limitations

• FFQ self-administered

• MedDiet scoring

• APOE4 genotype


Conclusion

II-B (fair)

Highest tertilesignificantly

associated with slower rate of Global

Cognitive Score

Adherence to MedDiet, may afford

some protection against cognitive

decline



Adherence to a Mediterranean diet and Alzheimer’s disease risk

in an Australian population

Gardener S, Gu Y, Rainey-Smith SR et al. Translational Psychiatry. 2012

Adherence to a Mediterranean diet and Alzheimer’s disease risk in an Australian population

PurposeInvestigate the association between adherence to a Mediterranean diet (MeDi) and risk for Alzheimer’s disease (AD) and mild cognitive impairment (MCI).

Design• Cross-Sectional Study

• 970 participants

Gardener S, Gu Y, Rainey-Smith SR et al. Translational Psychiatry. 2 0 1 2

Volunteers of the Australian Imaging, Biomarkers and Lifestyle Study of Ageing (AIBL)

Inclusion

• Age > 60 years

• Volunteers of study

Exclusion

• History of…

• Insulin Dependent DM

• Uncontrolled DM

• Regular alcohol use



MeDi Score (0-9)

1 point for mild to moderate alcohol consumption

>5 to <25 g per day for females >10 to <50g per day for males

1 point for ratio of MUFA: SFA (above median)

1 point for detrimental components (below median)

Meat, Dairy Products

1 point for each beneficial component (above median)

Fruits, Vegetables, Legumes, Cereals, Fish


Adherence to a Mediterranean diet

and Alzheimer’s disease risk in an

Australian population

Neuropsychological Test BatteryMMSE

Logical Memory

Verbal Fluency

Attention and Working Memory

Executive Function

Language

Visuospatial Function





All (n=970) AD (n=149) MCI (n=98) HC (n=723) P-value

MMSE 27.07 19.10 26.16 28.86 <0.05

MeDi 4.40 3.79 4.02 4.57 <0.001

Results



Strengths

• Large sample, ethnicity

• Cognition tests

• Several confounders controlled

Limitations

• FFQ

• MedDiet scoring

• Australian population


Conclusion

II-D (fair)

AD and MCI subjects had a lower mean

MeDi score compared to HC

Lower adherence to MeDi is associated with MCI and AD.



ReviewEvidence for protective effects of MedDiet on cognitive function

Adherence to MedDiet may afford some protection against cognitive decline

Lower adherence to MeDi is associated with MCI and AD

Gardener S, Gu Y, Rainey-Smith SR et al. Adherence to a Mediterranean diet and Alzheimer's disease risk in an Australian population. Translational Psychiatry. 2012 Oct; 2(10): e164. Doi: 10.1038/tp.2012.91Tangney C, Kwasny M, Li H, et al. Adherence to a Mediterranean-type dietary pattern and cognitive decline in a community population. The American Journal of Clinical Nutrition. 2011; 93(3): 601-607. Doi: 10.3945/ajcn.110.007369 Martínez-Lapiscina E, Clavero P, Toledo E, et al. Mediterranean diet improves cognition: the PREDIMED-NAVARRA randomised trial. Journal of Neurology, Neurosurgery, and Psychiatry. 2013; 00: 1-8. Doi: 10.1136/jnnp-2012-304792.

https://dx.doi.org/10.1038/tp.2012.91

Nutrition Relevance

Oxidative stress increases cognitive impairment

Antioxidants inhibit effects of oxidative stress

Mediterranean Diet plentiful in antioxidants


Thoughts

Limited Research

Whole Diet Approach

Other Factors

-Genotype

Peters, A (2014, 2015). Grandma [Photographs]. Retrieved from personal camera

References➢Diagnosis Of Alzheimer's Disease - Neuropsychological Testing (n.d). Retreived from https://www.mentalhelp.net/articles/diagnosis-of-alzheimer-s-disease-neuropsychological-testing/

➢Frontiers in Neuroscience (n.d.). Progressive Deterioration [Photograph]. Retrieved from https://curiosity.com/topics/screen-for-dementia-with-the-stroke-of-a-clock-curiosity/

➢Gardener S, Gu Y, Rainey-Smith SR et al. Adherence to a Mediterranean diet and Alzheimer's disease risk in an Australian population. Translational Psychiatry. 2012 Oct; 2(10): e164. Doi: 10.1038/tp.2012.91

➢Harrison J, Minassian SL, Jenkins L, Black RS, Koller M, Grundman M. A Neuropsychological Test Battery for Use in Alzheimer Disease Clinical Trials. Arch Neurol. 2007;64(9):1323–1329. doi:10.1001/archneur.64.9.1323

➢Martínez-Lapiscina E, Clavero P, Toledo E, et al. Mediterranean diet improves cognition: the PREDIMED-NAVARRA randomised trial. Journal of Neurology, Neurosurgery, and Psychiatry. 2013; 00: 1-8. Doi: 10.1136/jnnp-2012-304792.

https://www.mentalhelp.net/articles/diagnosis-of-alzheimer-s-disease-neuropsychological-testing/

https://curiosity.com/topics/screen-for-dementia-with-the-stroke-of-a-clock-curiosity/

https://dx.doi.org/10.1038/tp.2012.91

References➢Medical Care Corporation (2016). MCI and Dementia [Infograph]. Retrieved from https://www.mccare.com/education/mcidementia.html.

➢MedWorks Media (n.d.). Mini-Mental State Examination [Infograph]. Retrieved from https://medworksmedia.com/product/mini-mental-state-examination-mmse/

➢Oldways Preservation and Exchange Trust (2009). Mediterranean Diet Pyramid [Photograph]. Retrieved from https://oldwayspt.org/traditional-diets/mediterranean-diet

➢Shutterstock (n.d.). Walnuts [Photograph]. Retrieved from https://theconversation.com/its-good-to-eat-walnuts-but-is-it-true-that-they-prevent-heart-disease-57439

➢Tangney C, Kwasny M, Li H, et al. Adherence to a Mediterranean-type dietary pattern and cognitive decline in a community population. The American Journal of Clinical Nutrition. 2011; 93(3): 601-607. Doi: 10.3945/ajcn.110.007369

➢USDA (n.d.). Olive Oil [Photograph]. Retrieved from https://www.flickr.com/photos/usdagov/6896388410

➢https://www.alz.org/alzheimers-dementia/what-is-alzheimers

https://www.mccare.com/education/mcidementia.html

https://medworksmedia.com/product/mini-mental-state-examination-mmse/

https://oldwayspt.org/traditional-diets/mediterranean-diet

https://www.alz.org/alzheimers-dementia/what-is-alzheimers

Thank You!

Alyssa PetersMediterranean Diet and Cognitive Function

uwgbresearchreviews.weebly.com

mediterranean diet and cognitive function · and cognitive decline in a community population...

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