Article Archive
November/December 2015

MIND Diet May Oppugn Cognitive Decline
By Melanie V. Betz, MS, RD, LDN, CSG
Today's Geriatric Medicine
Vol. 8 No. 6 P. 24

Dementia and cognitive decline are significant public health concerns. Alzheimer's dementia is the sixth leading cause of death in the United States and impacts an estimated 11% of the population aged 65 and older; prevalence increases to 33% of people aged 85 years or older.1 The US population is getting older; the number of individuals aged 65 and older is expected to increase from 14.1% of the total population in 2013 to 21.7% by 2040.2 There is an increasing need to find cost-efficient and effective interventions to prevent cognitive decline. Increased attention is being given to the role that physical activity and dietary patterns may have in slowing cognitive decline in older adults.3

The Diet
Researchers at Rush University Medical Center have identified a new dietary pattern to determine the risk of cognitive decline in older adults. Nutrient-rich foods were identified from the Mediterranean and the Dietary Approaches to Stop Hypertension (DASH) diet patterns, which have been shown to impact cognition, to develop the Mediterranean-DASH Diet Intervention for Neurodegenerative Delay (MIND) diet score.4,5 This hybrid dietary pattern awards points to reduced consumption of components known to be harmful. For example, green leafy vegetables5,6 and berries7 are specific foods known to be beneficial, whereas saturated fat is known to be harmful.8

The MIND diet has 15 components comprised of 10 beneficial brain foods (green leafy vegetables, other vegetables, nuts, berries, beans, whole grains, seafood, poultry, olive oil, and wine) and five harmful brain foods (red meat, butter/stick margarine, cheese, pastries/sweets, and fried/fast food). Target intake frequencies of each component translate into one point for a best possible score of 15. See Table 1 for such thresholds/frequencies for each component.

The MIND diet was found to be effective in slowing cognitive decline in older adults. Rush University researchers found that participants in the highest MIND diet score tertile (median score 9.5; range 8.5 to 12.5) had significantly slower rates of decline in global cognition score (β = 0.0366, SE=0.0101, p=0.003) compared with those in tertile 1 (median score 6; range 2.5 to 6.5). The rate reduction equated to being 7.5 years younger. Interestingly, participants with intakes that were classified in tertile 2 (median score 7.4; range 7 to 8) also had slower cognitive decline (β = 0.0243, SE=0.0099, p=0.01).9 Participants in the highest tertile of the MIND diet score also had a lower incidence of Alzheimer's dementia (HR=0.47; 95% CI 0.26-0.76). Participants in tertile 2 also had a reduced risk of Alzheimer's dementia (HR=0.65, 95% CI 0.44-0.98).10 The benefits of the MIND diet are thought to be related to the promotion of foods high in antioxidants and anti-inflammatory properties.9

MIND Diet in Action
For many patients, the MIND diet is relatively easy to implement. The following are some simple changes to help follow the MIND diet:

• Add garbanzo, black, or kidney beans to salads.

• Snack on walnuts, almonds, or pistachios.

• Include berries at lunch or as a snack daily.

• Use olive oil and vinegar for salad dressing instead of commercial dressings.

• Sprinkle nuts over pasta dishes, cereal, yogurt, or oatmeal.

• Make your own salad dressing by puréeing berries with olive oil and other spices.

• Swap steak and hamburger for white meat chicken or turkey, salmon, or tuna.

• Use beans as a primary source of protein in at least two meals per week.

• Sauté vegetables in olive oil instead of butter.

• Choose fruit or berries for dessert instead of cake or cookies.

• Experiment with different greens such as kale, spinach, collard/mustard greens, or Swiss chard.

In addition, see Table 2 for a sample three-day MIND diet meal plan.

As with any lifestyle change, modifying dietary patterns can be difficult for patients. However, focusing on making changes only a few at a time can help promote successful and lasting change. The MIND diet lends itself to working on one category at a time. The MIND diet focuses primarily on encouraging foods rather than limiting them, which may help with compliance.

In addition to preventing cognitive decline, the MIND diet promotes healthful eating in many other ways. The diet promotes foods known to be helpful for other common health conditions including hypertension, diabetes, and cardiovascular disease. The promotion of lower calorie options such as vegetables, berries, and lean protein could also help promote weight loss. Constipation is a common experience for geriatric patients. However, the MIND diet encourages high-fiber foods such as vegetables, berries, nuts, and beans and may aid with this common problem.

As with any nutrition advice, it is important to provide patients with detailed information regarding type, amount, and frequency of recommended intake. Involving a dietitian will help ensure foods are incorporated appropriately. For example, increasing nuts and olive oil could contribute to excess calories if not eaten in appropriate portions, fish should not be fried, and wine consumption should be no more than one glass per day. Medical history must be reviewed before recommending the MIND diet as it is not appropriate for some common medical conditions. For example, the high potassium and phosphorus content of the MIND diet would not be appropriate for patients with kidney disease, and a general recommendation to eat more whole grains, berries, and beans may not be appropriate for patients with diabetes. Care should be taken to ensure foods are incorporated properly.

Final Thoughts
The MIND diet offers an exciting new link between dietary patterns and cognitive health. It is a simple and cost-effective way to help maintain cognition in the aging population and should be considered as a potential intervention for older adults. Further research needs to be conducted to determine other foods that may impact cognition and the impact of diet at a young age on cognitive decline later in life.

— Melanie V. Betz, MS, RD, LDN, CSG, is a clinical dietitian at Rush University Medical Center in Chicago, with a clinical focus on medical nutrition therapy for geriatric patients and those in inpatient rehabilitation.

1. Alzheimer's Association. 2015 Alzheimer's disease facts and figures. Alzheimers Dement. 2015;11(3):332-384.

2. Administration on Aging: Aging statistics. Administration for Community Living website.

3. Morris MC, Evans DA, Tangney CC, Bienias JL, Wilson RS. Associations of vegetable and fruit consumption with age-related cognitive change. Neurology. 2006;67(8):1370-1376.

4. Tangney CC, Li H, Wang Y, et al. Relation of DASH- and Mediterranean-like dietary patterns on cognitive decline in older persons. Neurology. 2014;83(16):1410-1416.

5. Tangney CC, Kwasny MJ, Li H, Wilson RS, Evans DA, Morris MC. Adherence to a Mediterranean-type dietary pattern and cognitive decline in a community population. Am J Clin Nutr. 2011;93(3):601-607.

6. Kang JH, Ascherio A, Grodstein F. Fruit and vegetable consumption and cognitive decline in aging women. Ann Neurol. 2005;57(5):713-720.

7. Devore EE, Kang JH, Breteler MM, Grodstein F. Dietary intakes of berries and flavonoids in relation to cognitive decline. Ann Neurol. 2012;72(1):135-143.

8. Kalmijn S, van Boxtel MP, Ocké M, Verschuren WM, Kromhout D, Launer LJ. Dietary intake of fatty acids and fish in relation to cognitive performance at middle age. Neurology. 2004;62(2):275-280.

9. Morris MC, Tangney CC, Wang Y, et al. MIND diet slows cognitive decline with aging. Alzheimers Dement. 2015;11(9):1015-1022.

10. Morris MC, Tangney CC, Wang Y, Sacks FM, Bennett DA, Aggarwal NT. MIND diet associated with reduced incidence of Alzheimer's disease. Alzheimers Dement. 2015;11(9):1007-1014.