Nutraceutical Properties of Mediterranean Diet and Cognitive Decline: Possible Underlying Mechanisms

Article type: Review Article

Authors: Frisardi, Vincenza^{a; *} | Panza, Francesco^{b; *} | Seripa, Davide^b | Imbimbo, Bruno P.^c | Vendemiale, Gianluigi^d | Pilotto, Alberto^b | Solfrizzi, Vincenzo^a

Affiliations: [a] Department of Geriatrics, Center for Aging Brain, Memory Unit, University of Bari, Bari, Italy | [b] Geriatric Unit and Gerontology-Geriatric Research Laboratory, IRCCS Casa Sollievo della Sofferenza, San Giovanni Rotondo, Italy | [c] Research and Development Department, Chiesi Farmaceutici, Parma, Italy | [d] Department of Geriatrics, University of Foggia, Foggia, Italy

Correspondence: [*] Correspondence to: Vincenza Frisardi, MD, Department of Geriatrics, Center for Aging Brain, Memory Unit, University of Bari, Policlinico, Piazza Giulio Cesare, 11, 70124 Bari, Italy. E-mail: vfrisardi@yahoo.com. Francesco Panza, M.D., Ph.D., Geriatric Unit and Gerontology-Geriatric Research Laboratory, IRCCS Casa Sollievo della Sofferenza, Viale Cappuccini 1, 71013 San Giovanni Rotondo, Foggia, Italy. Tel.: +39 0882 416 260; Fax: +39 0882 416 264; E-mail: geriat.dot@geriatria.uniba.it.

Abstract: Recent prospective studies provided evidence that higher adherence to a Mediterranean-type diet could be associated with slower cognitive decline, reduced risk of progression from mild cognitive impairment to Alzheimer's disease (AD), reduced risk of AD, and decreased mortality in AD patients. Furthermore, the Mediterranean diet (MeDi) combines several foods, micro- and macronutrients already separately proposed as potential protective factors against dementia and predementia syndromes. At present, epidemiological evidence suggests a possible association between fish consumption, monounsaturated fatty acids, and polyunsaturated fatty acids (PUFA) (particularly, n-3 PUFA), and reduced risk of cognitive decline and dementia. Light to moderate alcohol use may be associated with a reduced risk of incident dementia and AD, while for vascular dementia, cognitive decline, and predementia syndromes, the current evidence is only suggestive of a protective effect. Finally, the limited epidemiological evidence available on fruit and vegetable consumption and cognition generally support a protective role of these macronutrients against cognitive decline, dementia, and AD. We reviewed evidence on the possible mechanisms underlying the suggested protective role of MeDi against age-related changes in cognitive function, predementia syndromes, and dementia, examining the possible role of macronutrients and food nutrients of the MeDi and their nutraceutical properties in modulating the risk of cognitive decline. Although vascular variables are likely to be in the causal pathway between MeDi and dementia syndromes and should be considered as possible mediators, other nonvascular biological mechanisms (i.e., metabolic, oxidative, and inflammatory) may be invoked to explain the complex epidemiological association between MeDi and cognitive decline.

Keywords: Alcohol consumption, Alzheimer's disease, dementia, dietary fatty acids, fruits and vegetables, Mediterranean diet, mild cognitive impairment, vascular dementia

DOI: 10.3233/JAD-2010-100942

Journal: Journal of Alzheimer's Disease, vol. 22, no. 3, pp. 715-740, 2010