Mediterranean diet and Alzheimer disease mortality
Abstract
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.
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REFERENCES
1.
Jacques PF, Tucker KL. Are dietary patterns useful for understanding the role of diet in chronic disease? Am J Clin Nutr 2001;73:1–2.
2.
Trichopoulou A, Costacou T, Bamia C, Trichopoulos D. Adherence to a Mediterranean diet and survival in a Greek population. N Engl J Med 2003;348:2599–2608.
3.
Scarmeas N, Stern Y, Mayeux R, Luchsinger JA. Mediterranean diet, Alzheimer disease, and vascular mediation. Arch Neurol 2006;63:1709–1717.
4.
Scarmeas N, Stern Y, Tang MX, Mayeux R, Luchsinger JA. Mediterranean diet and risk for Alzheimer's disease. Ann Neurol 2006;59:912–921.
5.
Trichopoulou A, Orfanos P, Norat T et al. Modified Mediterranean diet and survival: EPIC-elderly prospective cohort study. Br Med J 2005;330:991.
6.
Knoops KT, de Groot LC, Kromhout D, et al. Mediterranean diet, lifestyle factors, and 10-year mortality in elderly European men and women: the HALE project. JAMA 2004;292:1433–1439.
7.
Luchsinger JA, Tang MX, Shea S, Mayeux R. Caloric intake and the risk of Alzheimer disease. Arch Neurol 2002;59:1258–1263.
8.
Luchsinger JA, Tang MX, Shea S, Mayeux R. Antioxidant vitamin intake and risk of Alzheimer disease. Arch Neurol 2003;60:203–208.
9.
Luchsinger JA, Tang MX, Siddiqui M, Shea S, Mayeux R. Alcohol intake and risk of dementia. J Am Geriatr Soc 2004;52:540–546.
10.
Scarmeas N, Levy G, Tang MX, Manly J, Stern Y. Influence of leisure activity on the incidence of Alzheimer's disease. Neurology 2001;57:2236–2242.
11.
Stern Y, Andrews H, Pittman J, et al. Diagnosis of dementia in a heterogeneous population. Development of a neuropsychological paradigm-based diagnosis of dementia and quantified correction for the effects of education. Arch Neurol 1992;49:453–460.
12.
Census of Population and Housing. Summary tape file1, technical documentation. Washington, DC: Bureau of the Census, 1991.
13.
McKhann G, Drachman D, Folstein M, Katzman R, Price D, Stadlan EM. Clinical diagnosis of Alzheimer's disease: report of the NINCDS-ADRDA Work Group under the auspices of Department of Health and Human Services Task Force on Alzheimer's Disease. Neurology 1984;34:939–944.
14.
Hughes CP, Berg L, Danziger WL, Coben LA, Martin RL. A new clinical scale for the staging of dementia. Br J Psychiatry 1982;140:566–572.
15.
Willett WC, Sampson L, Stampfer MJ, et al. Reproducibility and validity of a semiquantitative food frequency questionnaire. Am J Epidemiol 1985;122:51–65.
16.
Willett W, Stampfer M. Implications of total energy intake for epidemiological analyses. In: Willett W, ed. Nutritional epidemiology. New York: Oxford University Press, 1998:122:273–301.
17.
Kuczmarski R, Carroll M, Flegal K, Troiano R. Varying body mass index cutoff points to describe overweight prevalence among U.S. adults: NHANES III (1988 to 1994). Obes Res 1997;5:542–548.
18.
Scarmeas N, Albert SM, Manly JJ, Stern Y. Education and rates of cognitive decline in incident Alzheimer's disease. J Neurol Neurosurg Psychiatry 2006;77:308–316.
19.
Luchsinger JA, Tang MX, Shea S, Mayeux R. Hyperinsulinemia and risk of Alzheimer disease. Neurology 2004;63:1187–1192.
20.
de Lorgeril M, Salen P, Martin JL, Monjaud I, Delaye J, Mamelle N. Mediterranean diet, traditional risk factors, and the rate of cardiovascular complications after myocardial infarction: final report of the Lyon Diet Heart Study. Circulation 1999;99:779–785.
21.
Singh RB, Dubnov G, Niaz MA, et al. Effect of an Indo-Mediterranean diet on progression of coronary artery disease in high risk patients (Indo-Mediterranean Diet Heart Study): a randomised single-blind trial. Lancet 2002;360:1455–1461.
22.
Burns A, Lewis G, Jacoby R, Levy R. Factors affecting survival in Alzheimer's disease. Psychol Med 1991;21:363–370.
23.
Moritz DJ, Fox PJ, Luscombe FA, Kraemer HC. Neurological and psychiatric predictors of mortality in patients with Alzheimer disease in California. Arch Neurol 1997;54:878–885.
24.
Larson EB, Shadlen MF, Wang L, et al. Survival after initial diagnosis of Alzheimer disease. Ann Intern Med 2004;140:501–509.
25.
Scarmeas N, Albert M, Brandt J, et al. Motor signs predict poor outcomes in Alzheimer disease. Neurology 2005;64:1696–1703.
26.
Gambassi G, Landi F, Lapane KL, Sgadari A, Mor V, Bernabei R. Predictors of mortality in patients with Alzheimer's disease living in nursing homes. J Neurol Neurosurg Psychiatry 1999;67:59–65.
27.
White H, Pieper C, Schmader K. The association of weight change in Alzheimer's disease with severity of disease and mortality: a longitudinal analysis. J Am Geriatr Soc 1998;46:1223–1227.
28.
Nielsen H, Lolk A, Pedersen I, Autzen M, Sennef C, Kragh-Sorensen P. The accuracy of early diagnosis and predictors of death in Alzheimer's disease and vascular dementia—a follow-up study. Acta Psychiatr Scand 1991;84:277–282.
29.
Wang SY, Fukagawa N, Hossain M, Ooi WL. Longitudinal weight changes, length of survival, and energy requirements of long-term care residents with dementia. J Am Geriatr Soc 1997;45:1189–1195.
30.
Cronin-Stubbs D, Beckett LA, Scherr PA, et al. Weight loss in people with Alzheimer's disease: a prospective population based analysis. Br Med J 1997;314:178–179.
31.
White H. Weight change in Alzheimer's disease. J Nutr Health Aging 1998;2:110–112.
32.
Wolf-Klein GP, Silverstone FA. Weight loss in Alzheimer's disease: an international review of the literature. Int Psychogeriatr 1994;6:135–142.
33.
Shatenstein B, Kergoat MJ, Nadon S. Weight change, nutritional risk and its determinants among cognitively intact and demented elderly Canadians. Can J Public Health 2001;92:143–149.
34.
Faxen-Irving G, Basun H, Cederholm T. Nutritional and cognitive relationships and long-term mortality in patients with various dementia disorders. Age Ageing 2005;34:136–141.
35.
Evans DA, Smith LA, Scherr PA, Albert MS, Funkenstein HH, Hebert LE. Risk of death from Alzheimer's disease in a community population of older persons. Am J Epidemiol 1991;134:403–412.
36.
Hier DB, Warach JD, Gorelick PB, Thomas J. Predictors of survival in clinically diagnosed Alzheimer's disease and multi-infarct dementia. Arch Neurol 1989;46:1213–1216.
37.
Volicer BJ, Hurley A, Fabiszewski KJ, Montgomery P, Volicer L. Predicting short-term survival for patients with advanced Alzheimer's disease. J Am Geriatr Soc 1993;41:535–540.
38.
Stern Y, Tang MX, Denaro J, Mayeux R. Increased risk of mortality in Alzheimer's disease patients with more advanced educational and occupational attainment. Ann Neurol 1995;37:590–595.
39.
Heyman A, Peterson B, Fillenbaum G, Pieper C. The consortium to establish a registry for Alzheimer's disease (CERAD). Part XIV: demographic and clinical predictors of survival in patients with Alzheimer's disease. Neurology 1996;46:656–660.
40.
Reisberg B, Ferris SH, Franssen EH, et al. Mortality and temporal course of probable Alzheimer's disease: a 5-year prospective study. Int Psychogeriatr 1996;8:291–311.
41.
Aguero-Torres H, Fratiglioni L, Guo Z, Viitanen M, Winblad B. Prognostic factors in very old demented adults: a seven-year follow-up from a population-based survey in Stockholm. J Am Geriatr Soc 1998;46:444–452.
42.
Brookmeyer R, Corrada MM, Curriero FC, Kawas C. Survival following a diagnosis of Alzheimer disease. Arch Neurol 2002;59:1764–1767.
43.
Helmer C, Joly P, Letenneur L, Commenges D, Dartigues JF. Mortality with dementia: results from a French prospective community-based cohort. Am J Epidemiol 2001;154:642–648.
44.
Wolfson C, Wolfson DB, Asgharian M, et al. A reevaluation of the duration of survival after the onset of dementia. N Engl J Med 2001;344:1111–1116.
45.
van Dijk PT, van de Sande HJ, Dippel DW, Habbema JD. The nature of excess mortality in nursing home patients with dementia. J Gerontol 1992;47:M28–M34.
46.
Jagger C, Clarke M, Stone A. Predictors of survival with Alzheimer's disease: a community-based study. Psychol Med 1995;25:171–177.
47.
Stern Y, Tang MX, Albert MS, et al. Predicting time to nursing home care and death in individuals with Alzheimer disease. JAMA 1997;277:806–812.
48.
Geerlings MI, Deeg DJ, Schmand B, Lindeboom J, Jonker C. Increased risk of mortality in Alzheimer's disease patients with higher education? A replication study. Neurology 1997;49:798–802.
49.
Chandra V, Bharucha NE, Schoenberg BS. Patterns of mortality from types of dementia in the United States, 1971 and 1973–1978. Neurology 1986;36:204–208.
50.
Waring SC, Doody RS, Pavlik VN, Massman PJ, Chan W. Survival among patients with dementia from a large multi-ethnic population. Alzheimer Dis 2005;19:178–183.
51.
Lee JH, Tang MX, Schupf N, et al. Mortality and apolipoprotein E in Hispanic, African-American, and Caucasian elders. Am J Med Genet 2001;103:121–127.
52.
Honig LS, Schupf N, Lee JH, Tang MX, Mayeux R. Shorter telomeres are associated with mortality in those with APOE epsilon4 and dementia. Ann Neurol 2006;60:181–187.
53.
Schachter F, Faure-Delanef L, Guenot F, et al. Genetic associations with human longevity at the APOE and ACE loci. Nat Genet 1994;6:29–32.
54.
Scarmeas N, Brandt J, Albert M, et al. Association between the APOE genotype and psychopathologic symptoms in Alzheimer's disease. Neurology 2002;58:1182–1188.
55.
Scarmeas N, Hadjigeorgiou GM, Papadimitriou A, et al. Motor signs during the course of Alzheimer disease. Neurology 2004;63:975–982.
56.
Stern Y, Brandt J, Albert M, et al. The absence of an apolipoprotein epsilon4 allele is associated with a more aggressive form of Alzheimer's disease. Ann Neurol 1997;41:615–620.
57.
Scarmeas N, Anderson KE, Hilton J, et al. APOE-dependent PET patterns of brain activation in Alzheimer disease. Neurology 2004;63:913–915.
58.
Scarmeas N, Habeck C, Anderson KE, et al. Altered PET functional brain responses in cognitively intact elderly persons at risk for Alzheimer disease (carriers of the {epsilon}4 allele). Am J Geriatr Psychiatry 2004;12:596–605.
59.
Scarmeas N, Stern Y. Imaging studies and APOE genotype in persons at risk for Alzheimer's disease. Curr Psychiatry Rep 2006;8:11–17.
60.
Dal Forno G, Carson KA, Brookmeyer R, Troncoso J, Kawas CH, Brandt J. APOE genotype and survival in men and women with Alzheimer's disease. Neurology 2002;58:1045–1050.
61.
Koivisto AM, Lempiainen P, Koivisto K, et al. Apolipoprotein E phenotype alone does not influence survival in Alzheimer's disease: a population-based longitudinal study. Neuroepidemiology 2000;19:327–332.
62.
Kouris-Blazos A, Gnardellis C, Wahlqvist ML, Trichopoulos D, Lukito W, Trichopoulou A. Are the advantages of the Mediterranean diet transferable to other populations? A cohort study in Melbourne, Australia. Br J Nutr 1999;82:57–61.
63.
Trichopoulou A, Orfanos P, Norat T, et al. Modified Mediterranean diet and survival: EPIC-elderly prospective cohort study. Br Med J 2005;330:991.
64.
Knopman DS, DeKosky ST, Cummings JL, et al. Practice parameter: diagnosis of dementia (an evidence-based review). Report of the Quality Standards Subcommittee of the American Academy of Neurology. Neurology 2001;56:1143–1153.
65.
Morris CH, Hope RA, Fairburn CG. Eating habits in dementia. A descriptive study. Br J Psychiatry 1989;154:801–806.
66.
Cooper JK, Mungas D. Serotonin response in sweet-food craving Alzheimer's disease subjects. Aging (Milano) 1992;4:165–169.
67.
Mungas D, Cooper JK, Weiler PG, Gietzen D, Franzi C, Bernick C. Dietary preference for sweet foods in patients with dementia. J Am Geriatr Soc 1990;38:999–1007.
68.
Bianchetti A, Scuratti A, Zanetti O, et al. Predictors of mortality and institutionalization in Alzheimer disease patients 1 year after discharge from an Alzheimer dementia unit. Dementia 1995;6:108–112.
69.
Molsa PK, Marttila RJ, Rinne UK. Long-term survival and predictors of mortality in Alzheimer's disease and multi-infarct dementia. Acta Neurol Scand 1995;91:159–164.
70.
Claus JJ, van Gool WA, Teunisse S, et al. Predicting survival in patients with early Alzheimer's disease. Dement Geriatr Cogn Disord 1998;9:284–293.
71.
Schaufele M, Bickel H, Weyerer S. Predictors of mortality among demented elderly in primary care. Int J Geriatr Psychiatry 1999;14:946–956.
72.
Drachman DA, O'Donnell BF, Lew RA, Swearer JM. The prognosis in Alzheimer's disease. “How far” rather than “how fast” best predicts the course. Arch Neurol 1990;47:851–856.
73.
Kraemer HC, Tinklenberg J, Yesavage JA. “How far” vs “how fast” in Alzheimer's disease. The question revisited. Arch Neurol 1994;51:275–279.
74.
Fabiszewski KJ, Volicer B, Volicer L. Effect of antibiotic treatment on outcome of fevers in institutionalized Alzheimer patients. JAMA 1990;263:3168–3172.
75.
Finucane TE, Christmas C, Travis K. Tube feeding in patients with advanced dementia: a review of the evidence. JAMA 1999;282:1365–1370.
76.
Meier DE, Ahronheim JC, Morris J, Baskin-Lyons S, Morrison RS. High short-term mortality in hospitalized patients with advanced dementia: lack of benefit of tube feeding. Arch Intern Med 2001;161:594–599.
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