Skip to main content

Advertisement

Log in

DASH and Mediterranean-Type Dietary Patterns to Maintain Cognitive Health

  • Dietary Patterns and Behavior (LM Steffen, Section Editor)
  • Published:
Current Nutrition Reports Aims and scope Submit manuscript

Abstract

There is growing consensus that as the U.S. population ages, nearly a third will experience stroke, dementia, or even both. Thus, interest in the role that diet may play in preserving cognitive abilities continues to grow, especially in absence of truly effective treatments for dementia, of which Alzheimer’s disease (AD) is the most common form. The purpose of this review is to examine whether two a priori dietary patterns influence the rate of cognitive decline or the onset of dementia. Evidence from neuropathology reports of those who have died with AD or with mild cognitive impairment (MCI) or without cognitive impairment suggests that often the pathological hallmarks of AD—amyloid deposition and presence of tangles—are present along with vascular lesions. Hypertension and stroke are strongly associated with incident dementia. Thus, it is possible that lifestyle approaches designed to prevent or reduce cardiovascular risk factors, conditions, or diseases also may provide added benefits for brain health.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Similar content being viewed by others

Notes

  1. Accordance should be used to evaluate how closely one’s diet approximates the Mediterranean diet pyramid in populations that have not received formal education on this diet pattern, though many living in this region might argue this. In those who have received formal education of what is to be eaten, the better term is ‘adherence’.

References

Papers of particular interest, published recently, have been highlighted as: • Of importance •• Of major importance

  1. Appel LJ, Brands MW, Daniels SR, Karanja N, Elmer PJ, Sacks FM, et al. Dietary approaches to prevent and treat hypertension: a scientific statement from the American Heart Association. Hypertension. 2006;47:296–308.

    Article  CAS  PubMed  Google Scholar 

  2. Ard JD, Grambow SC, Liu D, Slentz CA, Kraus WE, Svetkey LP. PREMIER s. The effect of the PREMIER interventions on insulin sensitivity. Diabetes Care. 2004;27:340–7.

    Article  PubMed  Google Scholar 

  3. Saczynski JS, Jonsdottir MK, Garcia ME, Jonsson PV, Peila R, Eiriksdottir G, et al. Cognitive impairment: an increasingly important complication of type 2 diabetes: the age, gene/environment susceptibility–Reykjavik study. Am J Epidemiol. 2008;168:1132–9.

    Article  PubMed  Google Scholar 

  4. Kivipelto M, Ngandu T, Fratiglioni L, Viitanen M, Kareholt I, Winblad B, et al. Obesity and vascular risk factors at midlife and the risk of dementia and Alzheimer disease. Arch Neurol. 2005;62:1556–60.

    Article  PubMed  Google Scholar 

  5. Novak V, Hajjar I. The relationship between blood pressure and cognitive function. Nat Rev Cardiol. 2010;7:686–98.

    PubMed Central  PubMed  Google Scholar 

  6. Mitrou PN, Kipnis V, Thiebaut AC, Reedy J, Subar AF, Wirfalt E, et al. 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;167:2461–8.

    Article  PubMed  Google Scholar 

  7. Martinez-Gonzalez MA, de la Fuente-Arrillaga C, Nunez-Cordoba JM, Basterra-Gortari FJ, Beunza JJ, Vazquez Z, et al. Adherence to Mediterranean diet and risk of developing diabetes: prospective cohort study. BMJ. 2008;336:1348–51.

    Article  CAS  PubMed  Google Scholar 

  8. Gardener H, Wright CB, Gu Y, Demmer RT, Boden-Albala B, Elkind MS, et al. Mediterranean-style diet and risk of ischemic stroke, myocardial infarction, and vascular death: the Northern Manhattan Study. Am J Clin Nutr. 2011;94:1458–64.

    Article  CAS  PubMed  Google Scholar 

  9. Lourida I, Soni M, ThompsonCoon J, Purandare N, Lang IA, Ukoumunne OC, et al. Mediterranean diet, cognitive function, and dementia: a systematic review. Epidemiology. 2013;24:479–89. This excellent systematic review addresses many issues surrounding the role of a Mediterranean diet and cognitive health. Their critique largely focuses on how cognitive outcomes are measured (specific tests) what covariates are included, whether reliability and validity of diet measures was reported, etc.

    Article  PubMed  Google Scholar 

  10. Obarzanek E, Vollmer WM, Lin PH, Cooper LS, Young DR, Ard JD, et al. Effects of individual components of multiple behavior changes: the PREMIER trial. Am J Health Behav. 2007;31:545–60.

    Article  PubMed  Google Scholar 

  11. Sacks FM, Campos H. Dietary therapy in hypertension. N Engl J Med. 2010;362:2102–12.

    Article  CAS  PubMed  Google Scholar 

  12. Keys A. How to eat well and stay well the Mediterranean way. New York: Doubleday; 1975.

    Google Scholar 

  13. Willett WC, Sacks F, Trichopoulou A, Drescher G, Ferro-Luzzi A, Helsing E, et al. Mediterranean diet pyramid: a cultural model for healthy eating. Am J Clin Nutr. 1995;61:1402S–6S.

    CAS  PubMed  Google Scholar 

  14. de Souza RJ, Swain JF, Appel LJ, Sacks FM. Alternatives for macronutrient intake and chronic disease: a comparison of the OmniHeart diets with popular diets and with dietary recommendations. Am J Clin Nutr. 2008;88:1–11.

    PubMed Central  PubMed  Google Scholar 

  15. Leuenberger V, Gache P, Sutter K, Rieder Nakhle A. High blood pressure and alcohol consumption. Rev Med Suisse. 2006;2:2041–2.

    CAS  PubMed  Google Scholar 

  16. Simopoulos AP. The Mediterranean diets: What is so special about the diet of Greece? The scientific evidence. J Nutr. 2001;131:3065S–73S.

    CAS  PubMed  Google Scholar 

  17. Hoffman R, Gerber M. Evaluating and adapting the Mediterranean diet for non-Mediterranean populations: a critical appraisal. Nutr Rev. 2013;71:573–84. This paper is an excellent review of the changes and differences in the Mediterranean foods that constitute this healthy lifestyle. How such foods are prepared and grown gives us insight into how crude our dietary indices may be because such differences are missed.

    Article  PubMed  Google Scholar 

  18. Bach-Faig A, Berry EM, Lairon D, Reguant J, Trichopoulou A, Dernini S, et al. Mediterranean diet pyramid today. Science and cultural updates. Public Health Nutr. 2011;14:2274–84.

    Article  PubMed  Google Scholar 

  19. Folsom AR, Parker ED, Harnack LJ. Degree of concordance with DASH diet guidelines and incidence of hypertension and fatal cardiovascular disease. Am J Hypertens. 2007;20:225–32.

    Article  PubMed Central  PubMed  Google Scholar 

  20. Epstein DE, Sherwood A, Smith PJ, Craighead L, Caccia C, Lin P, et al. Determinants and consequences of adherence to the dietary approaches to stop hypertension diet in African-American and white adults with high blood pressure: results from the ENCORE trial. J Acad Nutr Diet. 2012;112:1763–73. This is a key paper describing the dietary treatments and how DASH adherence was assessed in a trial designed to improve cardiovascular outcomes in a high risk US population in which repeat cognitive testing has occurred over a short 4 month period. The trial involved two active treatments--- a DASH dietary modification or a DASH dietary modification plus weight loss against usual care.

    Article  PubMed Central  PubMed  Google Scholar 

  21. Fung TT, Chiuve SE, McCullough ML, Rexrode KM, Logroscino G, Hu FB. Adherence to a DASH-style diet and risk of coronary heart disease and stroke in women. Arch Intern Med. 2008;168:713–20.

    Article  PubMed  Google Scholar 

  22. Trichopoulou A, Costacou T, Bamia C, Trichopoulos D. Adherence to a Mediterranean diet and survival in a Greek population. N Engl J Med. 2003;348:2599–608.

    Article  PubMed  Google Scholar 

  23. Fung TT, Rexrode KM, Mantzoros CS, Manson JE, Willett WC, Hu FB. Mediterranean diet and incidence of and mortality from coronary heart disease and stroke in women. Circulation. 2009;119:1093–100.

    Article  PubMed Central  PubMed  Google Scholar 

  24. Panagiotakos DB, Pitsavos C, Arvaniti F, Stefanadis C. Adherence to the Mediterranean food pattern predicts the prevalence of hypertension, hypercholesterolemia, diabetes and obesity, among healthy adults; the accuracy of the MedDietScore. Prev Med. 2007;44:335–40.

    Article  PubMed  Google Scholar 

  25. Estruch R, Ros E, Salas-Salvado J, Covas MI, Corella D, Aros F, et al. Primary prevention of cardiovascular disease with a Mediterranean diet. N Engl J Med. 2013;368:1279–90. This paper described a large parallel group randomized clinical trial of 2 Medit interventions versus low fat control on cardiovascular outcomes. It is an important primary prevention trial, in which repeated diet measurements of adherence are reported.

    Article  CAS  PubMed  Google Scholar 

  26. Schroder H, Fito M, Estruch R, Martinez-Gonzalez MA, Corella D, Salas-Salvado J, et al. A short screener is valid for assessing Mediterranean diet adherence among older Spanish men and women. J Nutr. 2011;141:1140–5.

    Article  CAS  PubMed  Google Scholar 

  27. Brookmeyer R, Johnson E, Ziegler-Graham K, Arrighi HM. Forecasting the global burden of Alzheimer’s disease. Alzheimers Dement. 2007;3:186–91.

    Article  PubMed  Google Scholar 

  28. Panza F, Frisardi V, Capurso C, D'Introno A, Colacicco AM, Imbimbo BP, et al. Late-life depression, mild cognitive impairment, and dementia: possible continuum? Am J Geriatr Psychiatr. 2010;18:98–116.

    Article  Google Scholar 

  29. Panza F, D'Introno A, Colacicco AM, Capurso C, Del Parigi A, Caselli RJ, et al. Current epidemiology of mild cognitive impairment and other predementia syndromes. Am J Geriatr Psychiatr. 2005;13:633–44.

    Article  Google Scholar 

  30. Morris MC, Evans DA, Hebert LE, Bienias JL. Methodological issues in the study of cognitive decline. Am J Epidemiol. 1999;149:789–93.

    Article  CAS  PubMed  Google Scholar 

  31. Smith PJ, Blumenthal JA, Babyak MA, Craighead L, Welsh-Bohmer KA, Browndyke JN, et al. Effects of the dietary approaches to stop hypertension diet, exercise, and caloric restriction on neurocognition in overweight adults with high blood pressure. Hypertension. 2010;55:1331–8. This paper describes a trial designed to improve cardiovascular outcomes in a high-risk U.S. population sample in which repeat cognitive testing has occurred over a short 4-month period. The trial involved two active treatments—a DASH dietary modification or a DASH dietary modification plus weight loss against usual care. Cognitive improvements were noted in both DASH interventions.

    Article  CAS  PubMed Central  PubMed  Google Scholar 

  32. Tangney C, Li H, Barnes LL, Schneider J, Bennett D, Morris M. Accordance to dietary approaches to stop hypertension (DASH) is associated with slower cognitive decline. Alzheimers Dement. 2013;9:P135. In this abstract, the investigators describe the associations between DASH accordance scores and cognitive changes in more than 800 older adults in the MAP cohort. All cognitive domains were inversely associated with DASH scores. Individual DASH scores also were examined.

    Article  Google Scholar 

  33. Norton MC, Dew J, Smith H, Fauth E, Piercy KW, Breitner JC, et al. Lifestyle behavior pattern is associated with different levels of risk for incident dementia and Alzheimer's disease: the Cache County study. J Am Geriatr Soc. 2012;60:405–12.

    Article  PubMed Central  PubMed  Google Scholar 

  34. Wengreen H, Munger RG, Cutler A, Quach A, Bowles A, Corcoran C, et al. Prospective study of dietary approaches to stop hypertension– and Mediterranean-style dietary patterns and age-related cognitive change: the cache county study on memory, health and aging. Am J Clin Nutr. 2013;98:1272–81. This is a key paper of a U.S. cohort of 3,861 men and women in whom both DASH and Medit scores were assessed in relation to repeated cognitive measures. Higher scores of each pattern were consistently associated higher cognitive function over an 11-year period.

    Article  Google Scholar 

  35. KesseGuyot E, Andreeva VA, Lassale C, Ferry M, Jeandel C, Hercberg S, et al. the SU.VI.MAX Research Group. Mediterranean diet and cognitive function: a French study1-4. Am J Clin Nutr. 2013;97:369–76.

    Article  CAS  Google Scholar 

  36. Scarmeas N, Stern Y, Mayeux R, Luchsinger JA. Mediterranean diet, Alzheimer disease, and vascular mediation. Arch Neurol. 2006;63:1709–17.

    Article  PubMed Central  PubMed  Google Scholar 

  37. Scarmeas N, Luchsinger JA, Schupf N, Brickman AM, Cosentino S, Tang MX, et al. Physical activity, diet, and risk of Alzheimer disease. JAMA. 2009;302:627–37. Both greater physical activity and great accordance to a Medit pattern were independently associated with lower risk of Alzheimer’s disease in two N.Y. cohorts.

    Article  CAS  PubMed Central  PubMed  Google Scholar 

  38. Scarmeas N, Stern Y, Mayeux R, Manly JJ, Schupf N, Luchsinger JA. Mediterranean diet and mild cognitive impairment. Arch Neurol. 2009;66:216–25.

    PubMed Central  PubMed  Google Scholar 

  39. Gu Y, Luchsinger JA, Stern Y, Scarmeas N. Mediterranean diet, inflammatory and metabolic biomarkers, and risk of Alzheimer's disease. J Alzheimers Dis. 2010;22:483–92.

    CAS  PubMed Central  PubMed  Google Scholar 

  40. Feart C, Samieri C, Rondeau V, Amieva H, Portet F, Dartigues JF, et al. Adherence to a Mediterranean diet, cognitive decline, and risk of dementia. JAMA. 2009;302:638–48.

    Article  CAS  PubMed Central  PubMed  Google Scholar 

  41. Tsivgoulis G, Judd S, Letter AJ, Alexandrov AV, Howard GDH, Nahab F, et al. Adherence to a Mediterranean diet and risk of incident cognitive impairment. Neurology. 2013;80:1684–92.

    Article  PubMed  Google Scholar 

  42. Samieri C, Grodstein F, Rosner BA, Kang JH, Cook NR, Manson JE, et al. Mediterranean diet and cognitive function in older age. Epidemiology. 2013;24:490–9. In a cognitive substudy of 6,174 older women from the Women’s Health study, diet information was obtained in 1998 and the alternate MeDi scores calculated. Five years later, a series of cognitive tests were administered, followed by assessments 2 years later and again in 4 years. The aMeDi scores were not associated with cognitive changes.

    Article  PubMed  Google Scholar 

  43. Samieri C, Okereke OI, Devore EE, Grodstein F. Long-term adherence to the Mediterranean diet is associated with overall cognitive status, but not cognitive decline, in women. J Nutr. 2013;143:493–9.

    Google Scholar 

  44. Tangney CC, Kwasny MJ, Li H, Wilson RS, Evans DA, Morris MC. Adherence to a Mediterranean-type dietary pattern and cognitive decline in a community population. Am J Clin Nutr. 2011;93:601–7. In a Chicago-based cohort of 3,780 older persons (60% black, 40% male), diet was assessed with a FFQ and MedDiet scores constructed. These scores were inversely related to global cognitive changes.

    Article  CAS  PubMed  Google Scholar 

  45. Vercambre M, Grodstein F, Berr C, Kang JH. Mediterranean Diet and Cognitive Decline in Women with Cardiovascular Disease or Risk Factors. J Acad Nutr Diet. 2012;112:816–23. In this all female cohort, the Womens’ Antioxidant Cardiovascular study, two different Medit scores were calculated for 2,504 persons aged 65 years or more. Neither score was related to cognitive decline over 5.4 years.

    Article  PubMed Central  PubMed  Google Scholar 

  46. Roberts RO, Geda YE, Cerhan JR, Knopman DS, Cha RH, Christianson TJ, et al. Vegetables, unsaturated fats, moderate alcohol intake, and mild cognitive impairment. Dement Geriatr Cogn Disord. 2010;29:413–23.

    Article  CAS  PubMed  Google Scholar 

  47. Appel LJ, Moore TJ, Obarzanek E, Vollmer WM, Svetkey LP, Sacks FM, et al. A clinical trial of the effects of dietary patterns on blood pressure. DASH Collaborative Research Group. N Engl J Med. 1997;336:1117–24.

    Article  CAS  PubMed  Google Scholar 

  48. Lin PH, Appel LJ, Funk K, Craddick S, Chen C, Elmer P, et al. The PREMIER intervention helps participants follow the Dietary Approaches to Stop Hypertension dietary pattern and the current Dietary Reference Intakes recommendations. J Am Diet Assoc. 2007;107:1541–51.

    Article  CAS  PubMed  Google Scholar 

  49. Scarmeas N, Stern Y, Tang MX, Mayeux R, Luchsinger JA. Mediterranean diet and risk for Alzheimer's disease. Ann Neurol. 2006;59:912–21.

    Article  PubMed Central  PubMed  Google Scholar 

  50. 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;11:1054–62.

    Article  CAS  PubMed  Google Scholar 

  51. Cherbuin N, Kumar R, Anstey K. Caloric intake, but not the Mediterranean diet, is associated with cognition and mild cognitive impairment. Alzheimers Dement. 2011;7:S691.

    Article  Google Scholar 

  52. Cherbuin N, Anstey KJ. The Mediterranean diet is not related to cognitive change in a large prospective investigation: the PATH Through Life study. Am J Geriatr Psychiatr. 2012;20:635–9.

    Article  Google Scholar 

  53. Gardener S, Gu Y, Rainey-Smith SR, Keogh JB, Clifton PM, Mathieson SL, et al. Adherence to a Mediterranean diet and Alzheimer's disease risk in an Australian population. Transl Psychiatry. 2012;2:e164.

    Article  CAS  PubMed Central  PubMed  Google Scholar 

  54. Martínez-Lapiscina EH, Clavero P, Toledo E, Estruch R, Salas-Salvadó J, Julián BS, Sanchez-Tainta A, Ros E, Valls-Pedret C, Martinez-Gonzalez MA. Mediterranean diet improves cognition: The PREDIMED-NAVARRA randomised trial. J Neurol Neurosurg Psychiatry 2013;

  55. Godin G, Shephard RJ. A simple method to assess exercise behavior in the community. Can J Appl Sport Sci. 1985;10:141–6.

    CAS  PubMed  Google Scholar 

  56. Rumawas ME, Dwyer JT, McKeown NM, Meigs JB, Rogers G, Jacques PF. The development of the Mediterranean-style dietary pattern score and its application to the American diet in the Framingham Offspring Cohort. J Nutr. 2009;139:1150–6.

    Article  CAS  PubMed  Google Scholar 

Download references

Acknowledgments

The author thanks her colleagues, Dr. Martha C. Morris, Hong Li, Dr. Denis A. Evans, Dr. Julie Schneider, and Dr. David Bennett for all their helpful discussions and expertise. Moreover, my gratitude goes to all the participants of the CHAP and MAP cohorts for their time and effort.

Compliance with Ethics Guidelines

Conflict of Interest

Christy C. Tangney declares that she has no conflict of interest.

Human and Animal Rights and Informed Consent

This article does not contain any studies with human or animal subjects performed by any of the authors.

Author information

Authors and Affiliations

Authors

Corresponding author

Correspondence to Christy C. Tangney.

Rights and permissions

Reprints and permissions

About this article

Cite this article

Tangney, C.C. DASH and Mediterranean-Type Dietary Patterns to Maintain Cognitive Health. Curr Nutr Rep 3, 51–61 (2014). https://doi.org/10.1007/s13668-013-0070-2

Download citation

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s13668-013-0070-2

Keywords

Navigation