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Table of Contents
Vol. 29, No. 5, 2010
Issue release date: June 2010
Free Access
Dement Geriatr Cogn Disord 2010;29:413–423
(DOI:10.1159/000305099)

Vegetables, Unsaturated Fats, Moderate Alcohol Intake, and Mild Cognitive Impairment

Roberts R.O.a · Geda Y.E.a, c · Cerhan J.R.a · Knopman D.S.d · Cha R.H.b · Christianson T.J.H.b · Pankratz V.S.b · Ivnik R.J.c · Boeve B.F.d · O’Connor H.M.e · Petersen R.C.a, d
Divisions of aEpidemiology and bBiomedical Statistics and Informatics, Department of Health Sciences Research, Departments of cPsychiatry and Psychology and dNeurology, and eOffice for Human Research Protection, College of Medicine, Mayo Clinic, Rochester, Minn., USA
email Corresponding Author

Abstract

Background/Aims: To investigate associations of the Mediterranean diet (MeDi) components and the MeDi score with mild cognitive impairment (MCI). Methods: Participants (aged 70–89 years) were clinically evaluated to assess MCI and dementia, and completed a 128-item food frequency questionnaire. Results: 163 of 1,233 nondemented persons had MCI. The odds ratio of MCI was reduced for high vegetable intake [0.66 (95% CI = 0.44–0.99), p = 0.05] and for high mono- plus polyunsaturated fatty acid to saturated fatty acid ratio [0.52 (95% CI = 0.33–0.81), p = 0.007], adjusted for confounders. The risk of incident MCI or dementia was reduced in subjects with a high MeDi score [hazard ratio = 0.75 (95% CI = 0.46–1.21), p = 0.24]. Conclusion: Vegetables, unsaturated fats, and a high MeDi score may be beneficial to cognitive function.


 goto top of outline Key Words

  • Mild cognitive impairment
  • Dietary intake
  • Moderate alcohol intake
  • Unsaturated fatty acids
  • Mediterranean diet
  • Longitudinal
  • Prevalence studies
  • Incidence studies
  • Population-based

 goto top of outline Abstract

Background/Aims: To investigate associations of the Mediterranean diet (MeDi) components and the MeDi score with mild cognitive impairment (MCI). Methods: Participants (aged 70–89 years) were clinically evaluated to assess MCI and dementia, and completed a 128-item food frequency questionnaire. Results: 163 of 1,233 nondemented persons had MCI. The odds ratio of MCI was reduced for high vegetable intake [0.66 (95% CI = 0.44–0.99), p = 0.05] and for high mono- plus polyunsaturated fatty acid to saturated fatty acid ratio [0.52 (95% CI = 0.33–0.81), p = 0.007], adjusted for confounders. The risk of incident MCI or dementia was reduced in subjects with a high MeDi score [hazard ratio = 0.75 (95% CI = 0.46–1.21), p = 0.24]. Conclusion: Vegetables, unsaturated fats, and a high MeDi score may be beneficial to cognitive function.

Copyright © 2010 S. Karger AG, Basel


 goto top of outline References
  1. Petersen RC: Mild cognitive impairment as a diagnostic entity. J Intern Med 2004;256:183–194.
  2. Morris JC, McKeel DW Jr, Storandt M, Rubin EH, Price JL, Grant EA, Ball MJ, Berg L: Very mild Alzheimer’s disease: informant-based clinical, psychometric, and pathologic distinction from normal aging. Neurology 1991;41:469–478.
  3. Middleton LE, Yaffe K: Promising strategies for the prevention of dementia. Arch Neurol 2009;66:1210–1215.
  4. Hooijmans CR, Kiliaan AJ: Fatty acids, lipid metabolism and Alzheimer pathology. Eur J Pharmacol 2008;585:176–196.
  5. Panagiotakos DB, Pitsavos CH, Chrysohoou C, Skoumas J, Papadimitriou L, Stefanadis C, Toutouzas PK: Status and management of hypertension in Greece: role of the adoption of a Mediterranean diet: the ATTICA Study. J Hypertens 2003;21:1483–1489.
  6. Psaltopoulou T, Naska A, Orfanos P, Trichopoulos D, Mountokalakis T, Trichopoulou A: Olive oil, the Mediterranean diet, and arterial blood pressure: the Greek European Prospective Investigation into Cancer and Nutrition (EPIC) Study. Am J Clin Nutr 2004;80:1012–1018.
  7. Sofi F, Macchi C, Abbate R, Gensini GF, Casini A: Effectiveness of the Mediterranean diet: can it help delay or prevent Alzheimer’s disease? J Alzheimers Dis 2010, E-pub ahead of print.
  8. Trichopoulou A, Costacou T, Bamia C, Trichopoulos D: Adherence to a Mediterranean diet and survival in a Greek population. N Engl J Med 2003;348:2599–2608.
  9. Scarmeas N, Stern Y, Tang MX, Mayeux R, Luchsinger JA: Mediterranean diet and risk for Alzheimer’s disease. Ann Neurol 2006;59:912–921.
  10. Scarmeas N, Stern Y, Mayeux R, Manly JJ, Schupf N, Luchsinger JA: Mediterranean diet and mild cognitive impairment. Arch Neurol 2009;66:216–225.
  11. Solfrizzi V, Capurso C, D’Introno A, Colacicco AM, Capurso A, Panza F: Whole-diet approach and risk of chronic disease: limits and advantages. J Am Geriatr Soc 2006;54:1800–1802.
  12. Roberts RO, Geda YE, Knopman DS, Cha RH, Pankratz VS, Boeve BF, Ivnik RJ, Tangalos EG, Petersen RC, Rocca WA: The Mayo Clinic Study of Aging: design and sampling, participation, baseline measures and sample characteristics. Neuroepidemiology 2008;30:58–69.
  13. Melton LJ 3rd: History of the Rochester Epidemiology Project. Mayo Clin Proc 1996;71:266–274.
  14. Pfeffer RI, Kurosaki TT, Harrah CH Jr, Chance JM, Filos S: Measurement of functional activities in older adults in the community. J Gerontol 1982;37:323–329.
  15. Kokmen E, Smith GE, Petersen RC, Tangalos E, Ivnik RC: The Short Test of Mental Status. Correlations with standardized psychometric testing. Arch Neurol 1991;48:725–728.
  16. Ivnik RJ, Malec JF, Smith GE, Tangalos EG, Petersen RC, Kokmen E, Kurland LT: Mayo’s Older Americans Normative Studies: WAIS-R, WMS-R and AVLT norms for ages 56 through 97. Clin Neuropsychol 1992;6:1–104.

    External Resources

  17. Reitan RM: Validity of the Trail Making Test as an indicator of organic brain damage. Percept Mot Skills 1958;8:271–276.

    External Resources

  18. Lucas JA, Ivnik RJ, Smith GE, Bohac DL, Tangalos EG, Graff-Radford NR, Petersen RC: Mayo’s Older Americans Normative Studies: category fluency norms. J Clin Exp Neuropsychol 1998;20:194–200.
  19. Wechsler DA: Wechsler Adult Intelligence Scale-Revised. New York, Psychological Corporation, 1987.
  20. Ivnik RJ, Malec JF, Smith GE: Normative data for AVLT percent retention as a function of age and original learning for persons above age 54. Arch Clin Neuropsychol 1992;7:338.

    External Resources

  21. American Psychiatric Association: Diagnostic and Statistical Manual of Mental Disorders, ed 4. Washington, American Psychiatric Association, 1994.
  22. Block G, Coyle LM, Hartman AM, Scoppa SM: Revision of dietary analysis software for the Health Habits and History Questionnaire. Am J Epidemiol 1994;139:1190–1196.
  23. Willett W, Stampfer MJ: Total energy intake: implications for epidemiologic analyses. Am J Epidemiol 1986;124:17–27.
  24. Kaufer DI, Cummings JL, Ketchel P, Smith V, MacMillan A, Shelley T, Lopez OL, DeKosky ST: Validation of the NPI-Q, a brief clinical form of the Neuropsychiatric Inventory. J Neuropsychiatry Clin Neurosci 2000;12:233–239.
  25. Geda YE, Roberts RO, Knopman DS, Christianson TJ, Pankratz VS, Ivnik RJ, Boeve BF, Tangalos EG, Petersen RC, Rocca WA: Physical exercise, aging, and mild cognitive impairment: a population-based study. Arch Neurol 2010;67:80–86.
  26. Michels KB, Bingham SA, Luben R, Welch AA, Day NE: The effect of correlated measurement error in multivariate models of diet. Am J Epidemiol 2004;160:59–67.
  27. Little RJA: Survey nonresponse adjustments for estimates of means. Int Stat Rev 1986;54:139–157.

    External Resources

  28. Kessler RC, Little RJ, Groves RM: Advances in strategies for minimizing and adjusting for survey nonresponse. Epidemiol Rev 1995;17:192–204.
  29. Trichopoulou A, Orfanos P, Norat T, Bueno-de-Mesquita B, Ocke MC, Peeters PH, van der Schouw YT, Boeing H, Hoffmann K, Boffetta P, Nagel G, Masala G, Krogh V, Panico S, Tumino R, Vineis P, Bamia C, Naska A, Benetou V, Ferrari P, Slimani N, Pera G, Martinez-Garcia C, Navarro C, Rodriguez-Barranco M, Dorronsoro M, Spencer EA, Key TJ, Bingham S, Khaw KT, Kesse E, Clavel-Chapelon F, Boutron-Ruault MC, Berglund G, Wirfalt E, Hallmans G, Johansson I, Tjonneland A, Olsen A, Overvad K, Hundborg HH, Riboli E, Trichopoulos D: Modified Mediterranean diet and survival: EPIC-elderly prospective cohort study. BMJ 2005;330:991.
  30. Solfrizzi V, Frisardi V, Capurso C, D’Introno A, Colacicco AM, Chiloiro R, Dellegrazie F, Di Palo A, Capurso A, Panza F: Whole-diet approach: working on a criterion validity for age-related cognitive decline and mild cognitive impairment. J Am Geriatr Soc 2009;57:1944–1946.
  31. Psaltopoulou T, Kyrozis A, Stathopoulos P, Trichopoulos D, Vassilopoulos D, Trichopoulou A: Diet, physical activity and cognitive impairment among elders: the EPIC-Greece cohort (European Prospective Investigation into Cancer and Nutrition). Public Health Nutr 2008;11:1054–1062.
  32. Morris MC, Evans DA, Tangney CC, Bienias JL, Wilson RS: Associations of vegetable and fruit consumption with age-related cognitive change. Neurology 2006;67:1370–1376.
  33. Engelhart MJ, Geerlings MI, Ruitenberg A, van Swieten JC, Hofman A, Witteman JC, Breteler MM: Dietary intake of antioxidants and risk of Alzheimer disease. JAMA 2002;287:3223–3229.
  34. Requejo AM, Ortega RM, Robles F, Navia B, Faci M, Aparicio A: Influence of nutrition on cognitive function in a group of elderly, independently living people. Eur J Clin Nutr 2003;57(suppl 1):S54–S57.
  35. Ruitenberg A, van Swieten JC, Witteman JC, Mehta KM, van Duijn CM, Hofman A, Breteler MM: Alcohol consumption and risk of dementia: the Rotterdam Study. Lancet 2002;359:281–286.
  36. Truelsen T, Thudium D, Gronbaek M: Amount and type of alcohol and risk of dementia: The Copenhagen City Heart Study. Neurology 2002;59:1313–1319.
  37. Solfrizzi V, D’Introno A, Colacicco AM, Capurso C, Del Parigi A, Baldassarre G, Scapicchio P, Scafato E, Amodio M, Capurso A, Panza F, Italian Longitudinal Study on Aging Working Group: Alcohol consumption, mild cognitive impairment, and progression to dementia. Neurology 2007;68:1790–1799.
  38. Anttila T, Helkala EL, Viitanen M, Kareholt I, Fratiglioni L, Winblad B, Soininen H, Tuomilehto J, Nissinen A, Kivipelto M: Alcohol drinking in middle age and subsequent risk of mild cognitive impairment and dementia in old age: a prospective population based study. BMJ 2004;329:539.
  39. Galanis DJ, Joseph C, Masaki KH, Petrovitch H, Ross GW, White L: A longitudinal study of drinking and cognitive performance in elderly Japanese American men: the Honolulu-Asia Aging Study. Am J Public Health 2000;90:1254–1259.
  40. Luchsinger JA, Tang MX, Shea S, Mayeux R: Caloric intake and the risk of Alzheimer disease. Arch Neurol 2002;59:1258–1263.
  41. Mitrou PN, Kipnis V, Thiebaut AC, Reedy J, Subar AF, Wirfalt E, Flood A, Mouw T, Hollenbeck AR, Leitzmann MF, Schatzkin A: Mediterranean dietary pattern and prediction of all-cause mortality in a US population: results from the NIH-AARP Diet and Health Study. Arch Intern Med 2007;167:2461–2468.
  42. Feart C, Samieri C, Rondeau V, Amieva H, Portet F, Dartigues JF, Scarmeas N, Barberger-Gateau P: Adherence to a Mediterranean diet, cognitive decline, and risk of dementia. JAMA 2009;302:638–648.
  43. Scarmeas N, Stern Y, Mayeux R, Luchsinger JA: Mediterranean diet, Alzheimer disease, and vascular mediation. Arch Neurol 2006;63:1709–1717.
  44. Scarmeas N, Luchsinger JA, Mayeux R, Stern Y: Mediterranean diet and Alzheimer disease mortality. Neurology 2007;69:1084–1093.
  45. Trichopoulou A, Lagiou P, Kuper H, Trichopoulos D: Cancer and Mediterranean dietary traditions. Cancer Epidemiol Biomarkers Prev 2000;9:869–873.
  46. Chrysohoou C, Panagiotakos DB, Pitsavos C, Das UN, Stefanadis C: Adherence to the Mediterranean diet attenuates inflammation and coagulation process in healthy adults: the ATTICA Study. J Am Coll Cardiol 2004;44:152–158.
  47. Shahar D, Fraser D, Shai I, Vardi H: Development of a food frequency questionnaire (FFQ) for an elderly population based on a population survey. J Nutr 2003;133:3625–3629.

 goto top of outline Author Contacts

Dr. Rosebud O. Roberts
Division of Epidemiology, Department of Health Sciences Research, Mayo Clinic
200 First Street SW
Rochester, MN 55905 (USA)
Tel. +1 507 284 5656, Fax +1 507 284 1516, E-Mail roberts.rosebud@mayo.edu


 goto top of outline Article Information

Accepted: March 19, 2010
Published online: May 22, 2010
Number of Print Pages : 11
Number of Figures : 1, Number of Tables : 5, Number of References : 47


 goto top of outline Publication Details

Dementia and Geriatric Cognitive Disorders

Vol. 29, No. 5, Year 2010 (Cover Date: June 2010)

Journal Editor: Chan-Palay V. (New York, N.Y.)
ISSN: 1420-8008 (Print), eISSN: 1421-9824 (Online)

For additional information: http://www.karger.com/DEM


Copyright / Drug Dosage / Disclaimer

Copyright: All rights reserved. No part of this publication may be translated into other languages, reproduced or utilized in any form or by any means, electronic or mechanical, including photocopying, recording, microcopying, or by any information storage and retrieval system, without permission in writing from the publisher or, in the case of photocopying, direct payment of a specified fee to the Copyright Clearance Center.
Drug Dosage: The authors and the publisher have exerted every effort to ensure that drug selection and dosage set forth in this text are in accord with current recommendations and practice at the time of publication. However, in view of ongoing research, changes in goverment regulations, and the constant flow of information relating to drug therapy and drug reactions, the reader is urged to check the package insert for each drug for any changes in indications and dosage and for added warnings and precautions. This is particularly important when the recommended agent is a new and/or infrequently employed drug.
Disclaimer: The statements, opinions and data contained in this publication are solely those of the individual authors and contributors and not of the publishers and the editor(s). The appearance of advertisements or/and product references in the publication is not a warranty, endorsement, or approval of the products or services advertised or of their effectiveness, quality or safety. The publisher and the editor(s) disclaim responsibility for any injury to persons or property resulting from any ideas, methods, instructions or products referred to in the content or advertisements.

Abstract

Background/Aims: To investigate associations of the Mediterranean diet (MeDi) components and the MeDi score with mild cognitive impairment (MCI). Methods: Participants (aged 70–89 years) were clinically evaluated to assess MCI and dementia, and completed a 128-item food frequency questionnaire. Results: 163 of 1,233 nondemented persons had MCI. The odds ratio of MCI was reduced for high vegetable intake [0.66 (95% CI = 0.44–0.99), p = 0.05] and for high mono- plus polyunsaturated fatty acid to saturated fatty acid ratio [0.52 (95% CI = 0.33–0.81), p = 0.007], adjusted for confounders. The risk of incident MCI or dementia was reduced in subjects with a high MeDi score [hazard ratio = 0.75 (95% CI = 0.46–1.21), p = 0.24]. Conclusion: Vegetables, unsaturated fats, and a high MeDi score may be beneficial to cognitive function.



 goto top of outline Author Contacts

Dr. Rosebud O. Roberts
Division of Epidemiology, Department of Health Sciences Research, Mayo Clinic
200 First Street SW
Rochester, MN 55905 (USA)
Tel. +1 507 284 5656, Fax +1 507 284 1516, E-Mail roberts.rosebud@mayo.edu


 goto top of outline Article Information

Accepted: March 19, 2010
Published online: May 22, 2010
Number of Print Pages : 11
Number of Figures : 1, Number of Tables : 5, Number of References : 47


 goto top of outline Publication Details

Dementia and Geriatric Cognitive Disorders

Vol. 29, No. 5, Year 2010 (Cover Date: June 2010)

Journal Editor: Chan-Palay V. (New York, N.Y.)
ISSN: 1420-8008 (Print), eISSN: 1421-9824 (Online)

For additional information: http://www.karger.com/DEM


Copyright / Drug Dosage

Copyright: All rights reserved. No part of this publication may be translated into other languages, reproduced or utilized in any form or by any means, electronic or mechanical, including photocopying, recording, microcopying, or by any information storage and retrieval system, without permission in writing from the publisher or, in the case of photocopying, direct payment of a specified fee to the Copyright Clearance Center.
Drug Dosage: The authors and the publisher have exerted every effort to ensure that drug selection and dosage set forth in this text are in accord with current recommendations and practice at the time of publication. However, in view of ongoing research, changes in goverment regulations, and the constant flow of information relating to drug therapy and drug reactions, the reader is urged to check the package insert for each drug for any changes in indications and dosage and for added warnings and precautions. This is particularly important when the recommended agent is a new and/or infrequently employed drug.
Disclaimer: The statements, opinions and data contained in this publication are solely those of the individual authors and contributors and not of the publishers and the editor(s). The appearance of advertisements or/and product references in the publication is not a warranty, endorsement, or approval of the products or services advertised or of their effectiveness, quality or safety. The publisher and the editor(s) disclaim responsibility for any injury to persons or property resulting from any ideas, methods, instructions or products referred to in the content or advertisements.

References

  1. Petersen RC: Mild cognitive impairment as a diagnostic entity. J Intern Med 2004;256:183–194.
  2. Morris JC, McKeel DW Jr, Storandt M, Rubin EH, Price JL, Grant EA, Ball MJ, Berg L: Very mild Alzheimer’s disease: informant-based clinical, psychometric, and pathologic distinction from normal aging. Neurology 1991;41:469–478.
  3. Middleton LE, Yaffe K: Promising strategies for the prevention of dementia. Arch Neurol 2009;66:1210–1215.
  4. Hooijmans CR, Kiliaan AJ: Fatty acids, lipid metabolism and Alzheimer pathology. Eur J Pharmacol 2008;585:176–196.
  5. Panagiotakos DB, Pitsavos CH, Chrysohoou C, Skoumas J, Papadimitriou L, Stefanadis C, Toutouzas PK: Status and management of hypertension in Greece: role of the adoption of a Mediterranean diet: the ATTICA Study. J Hypertens 2003;21:1483–1489.
  6. Psaltopoulou T, Naska A, Orfanos P, Trichopoulos D, Mountokalakis T, Trichopoulou A: Olive oil, the Mediterranean diet, and arterial blood pressure: the Greek European Prospective Investigation into Cancer and Nutrition (EPIC) Study. Am J Clin Nutr 2004;80:1012–1018.
  7. Sofi F, Macchi C, Abbate R, Gensini GF, Casini A: Effectiveness of the Mediterranean diet: can it help delay or prevent Alzheimer’s disease? J Alzheimers Dis 2010, E-pub ahead of print.
  8. Trichopoulou A, Costacou T, Bamia C, Trichopoulos D: Adherence to a Mediterranean diet and survival in a Greek population. N Engl J Med 2003;348:2599–2608.
  9. Scarmeas N, Stern Y, Tang MX, Mayeux R, Luchsinger JA: Mediterranean diet and risk for Alzheimer’s disease. Ann Neurol 2006;59:912–921.
  10. Scarmeas N, Stern Y, Mayeux R, Manly JJ, Schupf N, Luchsinger JA: Mediterranean diet and mild cognitive impairment. Arch Neurol 2009;66:216–225.
  11. Solfrizzi V, Capurso C, D’Introno A, Colacicco AM, Capurso A, Panza F: Whole-diet approach and risk of chronic disease: limits and advantages. J Am Geriatr Soc 2006;54:1800–1802.
  12. Roberts RO, Geda YE, Knopman DS, Cha RH, Pankratz VS, Boeve BF, Ivnik RJ, Tangalos EG, Petersen RC, Rocca WA: The Mayo Clinic Study of Aging: design and sampling, participation, baseline measures and sample characteristics. Neuroepidemiology 2008;30:58–69.
  13. Melton LJ 3rd: History of the Rochester Epidemiology Project. Mayo Clin Proc 1996;71:266–274.
  14. Pfeffer RI, Kurosaki TT, Harrah CH Jr, Chance JM, Filos S: Measurement of functional activities in older adults in the community. J Gerontol 1982;37:323–329.
  15. Kokmen E, Smith GE, Petersen RC, Tangalos E, Ivnik RC: The Short Test of Mental Status. Correlations with standardized psychometric testing. Arch Neurol 1991;48:725–728.
  16. Ivnik RJ, Malec JF, Smith GE, Tangalos EG, Petersen RC, Kokmen E, Kurland LT: Mayo’s Older Americans Normative Studies: WAIS-R, WMS-R and AVLT norms for ages 56 through 97. Clin Neuropsychol 1992;6:1–104.

    External Resources

  17. Reitan RM: Validity of the Trail Making Test as an indicator of organic brain damage. Percept Mot Skills 1958;8:271–276.

    External Resources

  18. Lucas JA, Ivnik RJ, Smith GE, Bohac DL, Tangalos EG, Graff-Radford NR, Petersen RC: Mayo’s Older Americans Normative Studies: category fluency norms. J Clin Exp Neuropsychol 1998;20:194–200.
  19. Wechsler DA: Wechsler Adult Intelligence Scale-Revised. New York, Psychological Corporation, 1987.
  20. Ivnik RJ, Malec JF, Smith GE: Normative data for AVLT percent retention as a function of age and original learning for persons above age 54. Arch Clin Neuropsychol 1992;7:338.

    External Resources

  21. American Psychiatric Association: Diagnostic and Statistical Manual of Mental Disorders, ed 4. Washington, American Psychiatric Association, 1994.
  22. Block G, Coyle LM, Hartman AM, Scoppa SM: Revision of dietary analysis software for the Health Habits and History Questionnaire. Am J Epidemiol 1994;139:1190–1196.
  23. Willett W, Stampfer MJ: Total energy intake: implications for epidemiologic analyses. Am J Epidemiol 1986;124:17–27.
  24. Kaufer DI, Cummings JL, Ketchel P, Smith V, MacMillan A, Shelley T, Lopez OL, DeKosky ST: Validation of the NPI-Q, a brief clinical form of the Neuropsychiatric Inventory. J Neuropsychiatry Clin Neurosci 2000;12:233–239.
  25. Geda YE, Roberts RO, Knopman DS, Christianson TJ, Pankratz VS, Ivnik RJ, Boeve BF, Tangalos EG, Petersen RC, Rocca WA: Physical exercise, aging, and mild cognitive impairment: a population-based study. Arch Neurol 2010;67:80–86.
  26. Michels KB, Bingham SA, Luben R, Welch AA, Day NE: The effect of correlated measurement error in multivariate models of diet. Am J Epidemiol 2004;160:59–67.
  27. Little RJA: Survey nonresponse adjustments for estimates of means. Int Stat Rev 1986;54:139–157.

    External Resources

  28. Kessler RC, Little RJ, Groves RM: Advances in strategies for minimizing and adjusting for survey nonresponse. Epidemiol Rev 1995;17:192–204.
  29. Trichopoulou A, Orfanos P, Norat T, Bueno-de-Mesquita B, Ocke MC, Peeters PH, van der Schouw YT, Boeing H, Hoffmann K, Boffetta P, Nagel G, Masala G, Krogh V, Panico S, Tumino R, Vineis P, Bamia C, Naska A, Benetou V, Ferrari P, Slimani N, Pera G, Martinez-Garcia C, Navarro C, Rodriguez-Barranco M, Dorronsoro M, Spencer EA, Key TJ, Bingham S, Khaw KT, Kesse E, Clavel-Chapelon F, Boutron-Ruault MC, Berglund G, Wirfalt E, Hallmans G, Johansson I, Tjonneland A, Olsen A, Overvad K, Hundborg HH, Riboli E, Trichopoulos D: Modified Mediterranean diet and survival: EPIC-elderly prospective cohort study. BMJ 2005;330:991.
  30. Solfrizzi V, Frisardi V, Capurso C, D’Introno A, Colacicco AM, Chiloiro R, Dellegrazie F, Di Palo A, Capurso A, Panza F: Whole-diet approach: working on a criterion validity for age-related cognitive decline and mild cognitive impairment. J Am Geriatr Soc 2009;57:1944–1946.
  31. Psaltopoulou T, Kyrozis A, Stathopoulos P, Trichopoulos D, Vassilopoulos D, Trichopoulou A: Diet, physical activity and cognitive impairment among elders: the EPIC-Greece cohort (European Prospective Investigation into Cancer and Nutrition). Public Health Nutr 2008;11:1054–1062.
  32. Morris MC, Evans DA, Tangney CC, Bienias JL, Wilson RS: Associations of vegetable and fruit consumption with age-related cognitive change. Neurology 2006;67:1370–1376.
  33. Engelhart MJ, Geerlings MI, Ruitenberg A, van Swieten JC, Hofman A, Witteman JC, Breteler MM: Dietary intake of antioxidants and risk of Alzheimer disease. JAMA 2002;287:3223–3229.
  34. Requejo AM, Ortega RM, Robles F, Navia B, Faci M, Aparicio A: Influence of nutrition on cognitive function in a group of elderly, independently living people. Eur J Clin Nutr 2003;57(suppl 1):S54–S57.
  35. Ruitenberg A, van Swieten JC, Witteman JC, Mehta KM, van Duijn CM, Hofman A, Breteler MM: Alcohol consumption and risk of dementia: the Rotterdam Study. Lancet 2002;359:281–286.
  36. Truelsen T, Thudium D, Gronbaek M: Amount and type of alcohol and risk of dementia: The Copenhagen City Heart Study. Neurology 2002;59:1313–1319.
  37. Solfrizzi V, D’Introno A, Colacicco AM, Capurso C, Del Parigi A, Baldassarre G, Scapicchio P, Scafato E, Amodio M, Capurso A, Panza F, Italian Longitudinal Study on Aging Working Group: Alcohol consumption, mild cognitive impairment, and progression to dementia. Neurology 2007;68:1790–1799.
  38. Anttila T, Helkala EL, Viitanen M, Kareholt I, Fratiglioni L, Winblad B, Soininen H, Tuomilehto J, Nissinen A, Kivipelto M: Alcohol drinking in middle age and subsequent risk of mild cognitive impairment and dementia in old age: a prospective population based study. BMJ 2004;329:539.
  39. Galanis DJ, Joseph C, Masaki KH, Petrovitch H, Ross GW, White L: A longitudinal study of drinking and cognitive performance in elderly Japanese American men: the Honolulu-Asia Aging Study. Am J Public Health 2000;90:1254–1259.
  40. Luchsinger JA, Tang MX, Shea S, Mayeux R: Caloric intake and the risk of Alzheimer disease. Arch Neurol 2002;59:1258–1263.
  41. Mitrou PN, Kipnis V, Thiebaut AC, Reedy J, Subar AF, Wirfalt E, Flood A, Mouw T, Hollenbeck AR, Leitzmann MF, Schatzkin A: Mediterranean dietary pattern and prediction of all-cause mortality in a US population: results from the NIH-AARP Diet and Health Study. Arch Intern Med 2007;167:2461–2468.
  42. Feart C, Samieri C, Rondeau V, Amieva H, Portet F, Dartigues JF, Scarmeas N, Barberger-Gateau P: Adherence to a Mediterranean diet, cognitive decline, and risk of dementia. JAMA 2009;302:638–648.
  43. Scarmeas N, Stern Y, Mayeux R, Luchsinger JA: Mediterranean diet, Alzheimer disease, and vascular mediation. Arch Neurol 2006;63:1709–1717.
  44. Scarmeas N, Luchsinger JA, Mayeux R, Stern Y: Mediterranean diet and Alzheimer disease mortality. Neurology 2007;69:1084–1093.
  45. Trichopoulou A, Lagiou P, Kuper H, Trichopoulos D: Cancer and Mediterranean dietary traditions. Cancer Epidemiol Biomarkers Prev 2000;9:869–873.
  46. Chrysohoou C, Panagiotakos DB, Pitsavos C, Das UN, Stefanadis C: Adherence to the Mediterranean diet attenuates inflammation and coagulation process in healthy adults: the ATTICA Study. J Am Coll Cardiol 2004;44:152–158.
  47. Shahar D, Fraser D, Shai I, Vardi H: Development of a food frequency questionnaire (FFQ) for an elderly population based on a population survey. J Nutr 2003;133:3625–3629.