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Association of Mediterranean-DASH Intervention for Neurodegenerative Delay and Mediterranean Diets With Alzheimer Disease Pathology
Open accessAbstract
Objective: Diet may reduce Alzheimer’s dementia risk and slow cognitive decline, but the understanding of the relevant neuropathologic mechanisms remains limited. The association of dietary patterns with Alzheimer’s disease (AD) pathology has been suggested using neuroimaging biomarkers. This study examined the association of MIND and Mediterranean dietary patterns with beta-amyloid load, phosphorylated tau tangles, and global AD pathology in postmortem brain tissue of older adults. Methods: Autopsied participants of the Rush Memory and Aging Project) with complete dietary information (collected through a validated food frequency questionnaire) and AD pathology data (beta-amyloid load, phosphorylated tau tangles, and global AD pathology [summarized neurofibrillary tangles, neuritic and diffuse plaques]) were included in this study. Linear regression models controlled for age at death, sex, education, APO-ε4 status, and total calories were used to investigate the dietary patterns (MIND and Mediterranean diet) and dietary components associated with AD pathology. Further effect modification was tested for APO-ε4 status and sex. Results: Among our study participants (N=581, age at death: 91.0 ± 6.3 years; mean age at first dietary assessment: 84.2 ±5.8; 73% female; 6.8 ± 3.9 years of follow-up) dietary patterns were associated with lower global AD pathology (MIND: β= -0.022, p=0.034, standardized β=-2.0; Mediterranean: β=-0.007, p=0.039, standardized β=-2.3) and specifically less beta-amyloid load (MIND: β=-0.068, p=0.050, standardized β=-2.0; Mediterranean: β=-0.040, p=0.004, standardized β=-2.9). The findings persisted when further adjusted for physical activity, smoking, and vascular disease burden. The associations were also retained when participants with mild cognitive impairment or dementia at the baseline dietary assessment were excluded. Those in the highest tertile of green leafy vegetables intake had less global AD pathology when compared to those in the lowest tertile (Tertile-3 vs. Tertile-1: β= -0.115, p=0.0038). Conclusion: The MIND and Mediterranean diets are associated with less postmortem AD pathology, primarily beta-amyloid load. Among dietary components, green leafy vegetables inversely correlate with AD pathology.
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“A US cohort of older people (n =581, mean age at first assessment =84) found MIND and Mediterranean dietary patterns, particularly consumption of green leafy vegetables, inversely correlated with beta-amyloid load, phosphorylated tau tangles and global AD pathology at post-mortem. (328)”
From Dementia prevention, intervention, and care: 2024 report of the Lancet standing Commission (2024) · cites this paper as [328]
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“Autopsy evidence indicates that MIND and Mediterranean diets are associated with less postmortem AD pathology, primarily a lower Aβ load.550”
From Antiageing strategy for neurodegenerative diseases: from mechanisms to clinical advances (2025) · cites this paper as [550]
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Reproducibility and validity of a semiquantitative food frequency questionnaire
WILLETT, W. C., SAMPSON, L., STAMPFER, M. J., ROSNER, B., BAIN, C., WITSCHI, J., HENNEKENS, C. H., & SPEIZER, F. E. (1985) · American Journal of Epidemiology · doi:10.1093/oxfordjournals.aje.a114086 · Cited by 4,274
Effects of a Mediterranean-Style Diet on Cardiovascular Risk Factors: A Randomized Trial
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Neuropathology of older persons without cognitive impairment from two community-based studies
Bennett, D. A., Schneider, J. A., Arvanitakis, Z., Kelly, J. F., Aggarwal, N. T., Shah, R. C., & Wilson, R. S. (2006) · Neurology · doi:10.1212/01.wnl.0000219668.47116.e6 · Cited by 1,336
Self-citationReligious Orders Study and Rush Memory and Aging Project
Bennett, D. A., Buchman, A. S., Boyle, P. A., Barnes, L. L., Wilson, R. S., & Schneider, J. A. (2018) · Journal of Alzheimer's Disease · doi:10.3233/jad-179939 · Cited by 1,260
Self-citationMIND diet associated with reduced incidence of Alzheimer's disease
Morris, M. C., Tangney, C. C., Wang, Y., Sacks, F. M., Bennett, D. A., & Aggarwal, N. T. (2015) · Alzheimer's & Dementia · doi:10.1016/j.jalz.2014.11.009 · Cited by 1,162
Self-citationConsumption of Fish and n-3 Fatty Acids and Risk of Incident Alzheimer Disease
Morris, M. C., Evans, D. A., Bienias, J. L., Tangney, C. C., Bennett, D. A., Wilson, R. S., Aggarwal, N., & Schneider, J. (2003) · Archives of Neurology · doi:10.1001/archneur.60.7.940 · Cited by 1,135
Self-citationMIND diet slows cognitive decline with aging
Morris, M. C., Tangney, C. C., Wang, Y., Sacks, F. M., Barnes, L. L., Bennett, D. A., & Aggarwal, N. T. (2015) · Alzheimer's & Dementia · doi:10.1016/j.jalz.2015.04.011 · Cited by 1,115
Self-citationNatural history of mild cognitive impairment in older persons
Bennett, D. A., Wilson, R. S., Schneider, J. A., Evans, D. A., Beckett, L. A., Aggarwal, N. T., Barnes, L. L., Fox, J. H., & Bach, J. (2002) · Neurology · doi:10.1212/wnl.59.2.198 · Cited by 1,037
Self-citationDiet-quality scores and plasma concentrations of markers of inflammation and endothelial dysfunction
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Dementia prevention, intervention, and care: 2024 report of the Lancet standing Commission
Livingston, G., Huntley, J., Liu, K. Y., Costafreda, S. G., Selbæk, G., Alladi, S., Ames, D., Banerjee, S., Burns, A., Brayne, C., et al. (2024) · The Lancet · doi:10.1016/s0140-6736(24)01296-0 · Cited by 3,860
2024 Alzheimer's disease facts and figures
(2024) · Alzheimer's & Dementia · doi:10.1002/alz.13809 · Cited by 2,536
2025 Alzheimer's disease facts and figures
(2025) · Alzheimer s & Dementia · doi:10.1002/alz.70235 · Cited by 642
Trial of the MIND diet for prevention of cognitive decline in older persons
Barnes, L. L., Dhana, K., Liu, X., Carey, V. J., Ventrelle, J., Johnson, K., Hollings, C. S., Bishop, L., Laranjo, N., Stubbs, B. J., et al. (2023) · New England Journal of Medicine · doi:10.1056/nejmoa2302368 · Cited by 366
Self-citationAntiageing strategy for neurodegenerative diseases: from mechanisms to clinical advances
Jiang, Q., Liu, J., Huang, S., Wang, X.-Y., Chen, X., Liu, G.-H., Ye, K., Song, W., Masters, C. L., Wang, J., et al. (2025) · Signal Transduction and Targeted Therapy · doi:10.1038/s41392-025-02145-7 · Cited by 165
Metadata
- Authors
- Agarwal, P., Leurgans, S. E., Agrawal, S., Aggarwal, N. T., Cherian, L. J., James, B. D., Dhana, K., Barnes, L. L., Bennett, D. A., & Schneider, J. A.
- Affiliations
- Rush University Medical Center (US)
- ORCID
- Venue
- Neurology
- Published
- 2023-05-30
- Volume
- 100
- Issue
- 22
- Pages
- e2259-e2268
- ISSN
- 0028-3878 (ISSN-L)
- 1526-632X
- PMC
- PMC10259273
- OpenAlex
- W4323539013
- Cited by
- 170
- References
- 50
- Citations by year
- 2026: 39 · 2025: 64 · 2024: 49 · 2023: 18
- FWCI
- 34.62
- Type
- journal article
- Language
- en
- Open access
- green
- www.ncbi.nlm.nih.gov
- Locations
- Neurology (publishedVersion)
- PubMed Central (publishedVersion)
- PubMed (publishedVersion)
- Funders
- National Institutes of Health
- National Institute on Aging (R01AG017917, R01AG054476, P30AG072975)
- Topics
- Health Sciences › Medicine › Psychiatry and Mental health › Dementia and Cognitive Impairment Research
- Health Sciences › Medicine › Public Health, Environmental and Occupational Health › Nutritional Studies and Diet
- Life Sciences › Neuroscience › Cellular and Molecular Neuroscience › Alzheimer's disease research and treatments
- Keywords
- Alzheimer disease pathology, MIND diet, Mediterranean diet, phosphorylated tau, neurofibrillary tangles, neuritic plaques, leafy vegetables, dietary habits, APOE ε4, sex differences, postmortem brain, older adults, Alzheimer's disease risk, cognitive decline, Rush Memory and Aging Project, food frequency questionnaire, effect modification
- MeSH terms
- Aged, Aged, 80 and over, Alzheimer Disease, Apolipoproteins E, Female, Humans, Male, Amyloid beta-Peptides, Diet, Mediterranean, Cognitive Dysfunction
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