Adherence to a Mediterranean diet and risk of incident cognitive impairment

Georgios Tsivgoulis, Suzanne Judd, Abraham J. Letter, Andrei V. Alexandrov, George Howard, Fadi Nahab, Frederick W. Unverzagt, Claudia Moy, Virginia J. Howard, Brett Kissela, Virginia G. Wadley

Research output: Contribution to journalArticle

76 Scopus citations


Objective: We sought to determine the relationship of greater adherence to Mediterranean diet (MeD) and likelihood of incident cognitive impairment (ICI) and evaluate the interaction of race and vascular risk factors. Methods: A prospective, population-based, cohort of individuals enrolled in the Reasons for Geographic and Racial Differences in Stroke (REGARDS) Study 2003-2007, excluding participants with history of stroke, impaired cognitive status at baseline, and missing data on Food Frequency Questionnaires (FFQ), was evaluated. Adherence to a MeD (scored as 0-9) was computed from FFQ. Cognitive status was evaluated at baseline and annually during a mean follow-up period of 4.0 ± 1.5 years using Six-item-Screener. Results: ICI was identified in 1,248 (7%) out of 17,478 individuals fulfilling the inclusion criteria. Higher adherence to MeD was associated with lower likelihood of ICI before (odds ratio [lsqb]OR [rsqb] 0.89; 95%confidence interval [lsqb]CI[rsqb] 0.79-1.00) and after adjustment for potential confounders (OR 0.87; 95% CI 0.76-1.00) including demographic characteristics, environmental factors, vascular risk factors, depressive symptoms, and self-reported health status. There was no interaction between race (p = 0.2928) and association of adherence to MeD with cognitive status. However, we identified a strong interaction of diabetes mellitus (p = 0.0134) on the relationship of adherence to MeD with ICI; high adherence to MeD was associated with a lower likelihood of ICI in nondiabetic participants (OR 0.81; 95%CI 0.70-0.94; p = 0.0066) but not in diabetic individuals (OR 1.27; 95% CI 0.95-1.71; p = 0.1063). Conclusions: Higher adherence to MeD was associated with a lower likelihood of ICI independent of potential confounders. This association was moderated by presence of diabetes mellitus.

Original languageEnglish (US)
Pages (from-to)1684-1692
Number of pages9
Issue number18
StatePublished - Apr 30 2013


ASJC Scopus subject areas

  • Clinical Neurology

Cite this

Tsivgoulis, G., Judd, S., Letter, A. J., Alexandrov, A. V., Howard, G., Nahab, F., Unverzagt, F. W., Moy, C., Howard, V. J., Kissela, B., & Wadley, V. G. (2013). Adherence to a Mediterranean diet and risk of incident cognitive impairment. Neurology, 80(18), 1684-1692.