NEUROLOGY 2007;69:1084-1093
[Link
to free full-text Neurology article pdf online] [Medline®
abstract]
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@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.
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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.
© 2007 American Academy of Neurology
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