MIND Diet Preserves Cognition Even in the Presence of Alzheimer’s Pathology

Megan Brooks

Medscape

Gerry Gajadharsingh writes:

“Although the Covid pandemic is at the forefront of most people’s minds at the moment the Alzheimer’s crisis has not disappeared.

 On June 7, 2021, FDA provided accelerated approval for the newest medication, aducanumab, which helps to reduce amyloid deposits in the brain and may help slow the progression of Alzheimer’s, although it has not yet been shown to affect clinical symptoms or outcomes, such as progression of cognitive decline or dementia.

Most medicines work best for people in the early or middle stages of Alzheimer’s. However, it is important to understand that none of the medications available at this time will cure Alzheimer’s.

Treating the symptoms of Alzheimer’s can provide people with comfort, dignity, and independence for a longer period of time and can encourage and assist their caregivers as well. Galantamine, rivastigmine, and donepezil are cholinesterase inhibitors that are prescribed for mild to moderate Alzheimer’s symptoms. These drugs may help reduce or control some cognitive and behavioural symptoms.

 A medication known as memantine, an N-methyl D-aspartate (NMDA) antagonist, is prescribed to treat moderate to severe Alzheimer’s disease. This drug’s main effect is to decrease symptoms, which could enable some people to maintain certain daily functions a little longer than they would without the medication.

 So, whilst there are drugs none of them seem to work that brilliantly. Most researchers are concluding that the causes of Alzheimer’s and other degenerative brain diseases have multiple factors and therefore it seems more likely that multiple interventions especially intervening with lifestyle will prove to be very important.

 Below is the latest research looking at how diet can improve the memory and thinking skills of older adults even in the presence of Alzheimer’s disease pathology.

 For those of you who read my blogs, you will know I’m a fan of an integrated approach to medicine including sensible dietary change. The challenge as always, is motivating people to change behaviour and diet is no exception. I have previously blogged on how following the principles of Metabolic Balance or indeed a proper bespoke Metabolic Balance plan leads to a lowering of inflammatory load, increased consumption of a wide variety of essential amino acids, adequate dietary fats and better glucose regulation, all of which can lead to improvement in multiple symptoms.”

Adherence to the MIND diet can improve memory and thinking skills of older adults, even in the presence of Alzheimer’s disease pathology, new data from the Rush Memory and Aging Project (MAP) show.

“The MIND diet was associated with better cognitive functions independently of brain pathologies related to Alzheimer’s disease, suggesting that diet may contribute to cognitive resilience, which ultimately indicates that it is never too late for dementia prevention,” lead author Klodian Dhana, MD, PhD, with the Rush Institute of Healthy Aging, Rush University, Chicago, Illinois, told Medscape Medical News.

The study was published online September 14 in the Journal of Alzheimer’s Disease.

Impact on Brain Pathology

“While previous investigations determined that the MIND diet is associated with a slower cognitive decline, the current study furthered the diet and brain health evidence by assessing the impact of brain pathology in the diet-cognition relationship,” Dhana said.

The MIND diet was pioneered by the late Martha Clare Morris, ScD, a Rush nutritional epidemiologist, who died last year of cancer at age 64. A hybrid of the Mediterranean and DASH (Dietary Approaches to Stop Hypertension) diets, the MIND diet includes green leafy vegetables, fish, nuts, berries, beans, and whole grains and limits consumption of fried and fast foods, sweets, and pastries.

The current study focused on 569 older adults who died while participating in the MAP study, which began in 1997. Participants in the study were mostly White and were without known dementia. All of the participants agreed to undergo annual clinical evaluations. They also agreed to undergo brain autopsy after death.

Beginning in 2004, participants completed annual food frequency questionnaires, which were used to calculate a MIND diet score based on how often the participants ate specific foods.

The researchers used a series of regression analyses to examine associations of the MIND diet, dementia-related brain pathologies, and global cognition near the time of death. Analyses were adjusted for age, sex, education, APOEe4, late-life cognitive activities, and total energy intake.

The results show that a higher MIND diet score was associated with better global cognitive functioning around the time of death (β = 0.119; P = .003).

Notably, say the researchers, neither the strength nor the significance of association changed markedly when AD pathology and other brain pathologies were included in the model (β = 0.111; P = .003).

The relationship between better adherence to the MIND diet and better cognition remained significant when the analysis was restricted to individuals without mild cognitive impairment at baseline (β = 0.121; SE = 0.042 P = .005) as well as to persons in whom a post-mortem diagnosis of AD was made on the basis of NIA-Reagan consensus recommendations (β = 0.114; P = .023).

The limitations of the study include the reliance on self-reported diet information and a sample made up of mostly White volunteers who agreed to annual evaluations and post-mortem organ donation, thus limiting generalizability.

Strengths of the study include the prospective design with annual assessment of cognitive function using standardized tests and collection of the dietary information using validated questionnaires. Also, the neuropathologic evaluations were performed by examiners blinded to clinical data.

“Diet changes can impact cognitive functioning and risk of dementia, for better or worse. There are fairly simple diet and lifestyle changes a person could make that may help to slow cognitive decline with aging and contribute to brain health,” Dhana said in a news release.

Builds Resilience 

Weighing in on the study, Heather Snyder, PhD, vice president of medical and scientific relations for the Alzheimer’s Association, said this “interesting study sheds light on the impact of nutrition on cognitive function.

“The findings add to the growing literature that lifestyle factors ― like access to a heart-healthy diet ― may help the brain be more resilient to disease-specific changes,” Snyder told Medscape Medical News.

“The Alzheimer’s Association’s US POINTER study is investigating how lifestyle interventions, including nutrition guidance, like the MIND diet, may impact a person’s risk of cognitive decline. An ancillary study of the US POINTER will include brain imaging to investigate how these lifestyle interventions impact the biology of the brain,” Snyder noted.

The research was supported by the National Institute on Aging of the National Institutes of Health. Dhana and Snyder have disclosed no relevant financial relationships.