@article {156,
	title = {Adherence to a Mediterranean diet, cognitive decline, and risk of dementia.},
	journal = {JAMA},
	volume = {302},
	year = {2009},
	month = {2009 Aug 12},
	pages = {638-48},
	abstract = {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 (> or = 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 (beta = -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: beta = -0.03; 95\% CI, -0.05 to -0.001; P = .04; for FCSRT: beta = 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.},
	keywords = {Aged, Aged, 80 and over, Apolipoproteins E, Body Mass Index, Cognition, Cognition Disorders, Confounding Factors (Epidemiology), Dementia, Depression, Diet, Mediterranean, Educational Status, Energy Intake, Female, France, Genotype, Humans, Male, Marital Status, Neuropsychological Tests, Odds Ratio, Primary Prevention, Prospective Studies, Research Design, Residence Characteristics, Risk Factors},
	issn = {1538-3598},
	doi = {10.1001/jama.2009.1146},
	author = {F{\'e}art, Catherine and Samieri, C{\'e}cilia and Rondeau, Virginie and Amieva, H{\'e}l{\`e}ne and Portet, Florence and Dartigues, Jean-Fran{\c c}ois and Scarmeas, Nikolaos and Barberger-Gateau, Pascale}
}
