From: mha23x@gmail.com   
      
   Can a Good Diet Prevent Dementia?   
   David B. Reuben, MD | Disclosures   
   September 30, 2016   
       
   QUESTION   
   Can a good diet prevent dementia?   
      
      
   Response from David B. Reuben, MD    
   Professor and Archstone Foundation Endowed Chair, Department of Medicine,   
   University of California, Los Angeles; Chief, Division of Geriatrics, UCLA   
   Medical Center, Santa Monica, California   
   Dietary interventions to prevent dementia or cognitive decline are generally   
   safe, readily available, and can be easier to implement than interventions   
   such as exercise. But evidence supporting these interventions varies. Perhaps   
   the best studied is the    
   Mediterranean diet, which is high in grains, vegetables, fruit, potatoes,   
   nuts, seeds, legumes, fish, and olive oil, and low in red meat, poultry,   
   dairy, and alcohol. The dietary approach to stop hypertension (DASH) diet is   
   similar, but is higher in low-   
   fat dairy and lower in fish. The Mediterranean–DASH intervention for   
   neurodegenerative delay (MIND) diet incorporates elements of both these diets   
   but places more emphasis on berries, nuts, and beans.   
      
      
   A meta-analysis of prospective cohort studies showed that people who adhere to   
   a Mediterranean diet have lower rates of Alzheimer disease and Parkinson   
   disease.[1] Similarly, studies of community-dwelling older people who followed   
   the MIND diet showed    
   less decline in global episodic, semantic, and working memory and in   
   perceptual speed and perceptual organization at 4.7-year follow-up.[2] In   
   addition, these study participants were less likely to have developed   
   Alzheimer disease at 4.5-year follow-up.[   
   3]   
      
   Data from some randomized clinical trials support the use of these diets to   
   prevent cognitive decline and dementia. In the PREDIMED study, participants   
   55-80 years of age at high risk for cardiovascular disease were randomly   
   assigned to one of three    
   diets: a Mediterranean diet with supplemental extra-virgin olive oil, a   
   Mediterranean diet with supplemental mixed nuts, or a regular diet that   
   emphasized reduced dietary fat. There was a reduction in the composite of   
   myocardial infarction, stroke, and    
   death from cardiovascular causes—the primary endpoint—with the   
   supplemented Mediterranean diets.[4] A secondary analysis demonstrated higher   
   scores on the Mini-Mental State Examination and the clock-drawing test at 6.5   
   years.[5] In a short-term study,   
    participants randomized to a DASH diet had better psychomotor speed at   
   4-month follow-up.[6]   
      
   Diet can also be effective when it is part of a multicomponent intervention.   
   In the Finnish Geriatric Intervention Study to Prevent Cognitive Impairment   
   and Disability (FINGER),[7] 1260 participants with cardiovascular risk factors   
   for dementia and    
   cognitive performance at the mean or slightly lower than expected for age were   
   randomly assigned to a multicomponent intervention (diet, exercise, cognitive   
   training, and vascular risk monitoring) or to health advice (control   
   group).The dietary component    
   included fruit and vegetables, whole-grain cereal products, low-fat milk and   
   meat products, low sugar, margarine instead of butter, and at least two   
   portions of fish per week. The primary outcome measure was change in   
   performance on a neuropsychological    
   test battery (NTB) of 14 tests. During the 24-month follow-up period, the NTB   
   composite score was 25% higher in the intervention group than in the control   
   group, and executive functioning and processing speed were better in the   
   intervention group.    
   However, memory was no better in the intervention group than in the control   
   group.   
      
   This body of evidence is suggestive of, but not conclusive for, the benefit of   
   a healthy diet on cognition and dementia. Coupled with other benefits related   
   to hypertension and cardiovascular disease,[4,8] clinicians should consider   
   recommending these    
   diets for appropriate older people.   
      
   Developed in association with the UCLA Alzheimer's and Dementia Care Program.   
      
      
   http://www.medscape.com/viewarticle/869379   
      
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