NEUROLOGY 2007;69:1084-1093
© 2007 American Academy of Neurology
Mediterranean diet and Alzheimer disease mortality
Nikolaos Scarmeas, MD,
Jose A. Luchsinger, MD,
Richard Mayeux, MD and
Yaakov Stern, PhD
From the Taub Institute for Research in Alzheimer's Disease and the Aging Brain (N.S., J.A.L., R.M., Y.S.), Gertrude H. Sergievsky Center (N.S., R.M., Y.S.), and Departments of Neurology (N.S., R.M., Y.S.) and Medicine (J.A.L.), Columbia University Medical Center, New York.
Address correspondence and reprint requests to Dr. N. Scarmeas, Columbia University Medical Center, 622 W. 168 St., PH 19th fl., New York, NY 10032 ns257{at}columbia.edu
Background: We previously reported that the Mediterranean diet (MeDi) is related to lower risk for Alzheimer disease (AD). Whether MeDi is associated with subsequent AD course and outcomes has not been investigated.
Objectives: To examine the association between MeDi and mortality in patients with AD.
Methods: A total of 192 community-based individuals in New York who were diagnosed with AD were prospectively followed every 1.5 years. Adherence to the MeDi (0- to 9-point scale with higher scores indicating higher adherence) was the main predictor of mortality in Cox models that were adjusted for period of recruitment, age, gender, ethnicity, education, APOE genotype, caloric intake, smoking, and body mass index.
Results: Eighty-five patients with AD (44%) died during the course of 4.4 (±3.6, 0.2 to 13.6) years of follow-up. In unadjusted models, higher adherence to MeDi was associated with lower mortality risk (for each additional MeDi point hazard ratio 0.79; 95% CI 0.69 to 0.91; p = 0.001). This result remained significant after controlling for all covariates (0.76; 0.65 to 0.89; p = 0.001). In adjusted models, as compared with AD patients at the lowest MeDi adherence tertile, those at the middle tertile had lower mortality risk (0.65; 0.38 to 1.09; 1.33 years' longer survival), whereas subjects at the highest tertile had an even lower risk (0.27; 0.10 to 0.69; 3.91 years' longer survival; p for trend = 0.003).
Conclusion: Adherence to the Mediterranean diet (MeDi) may affect not only risk for Alzheimer disease (AD) but also subsequent disease course: Higher adherence to the MeDi is associated with lower mortality in AD. The gradual reduction in mortality risk for higher MeDi adherence tertiles suggests a possible dose-response effect.
Abbreviations: AD = Alzheimer disease; BMI = body mass index; CDR = Clinical Dementia Rating; HCFA = Health Care Finance Administration; MeDi = Mediterranean diet; WHICAP = Washington Heights and Inwood Columbia Aging Project.
Editorial, see page 1072
Supported by federal NIA grants AG07232, AG07702, AG15294-06, 1K08AG20856-01, RR00645, the Charles S. Robertson Memorial Gift for Research in AD, the Blanchette Hooker Rockefeller Foundation, the New York City Council Speaker's Fund for Public Health Research, and the Taub Institute for Research on AD and the Aging Brain.
Disclosure: The authors report no conflicts of interest.
Received November 21, 2006. Accepted in final form April 9, 2007.
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