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Backgrounds and aims:  Evidence from recent years highlighted the importance of the Mediterranean diet for brain health. We investigated the association between adherence to Mediterranean diet and change in cognitive functions two decades later in patients with cardiovascular disease (CVD). Methods:  Participants were men with a history of CVD, who previously participated in the Bezafibrate Infarction Prevention (BIP) trial between 1990 and 1997, had a food diary record, and underwent cognitive evaluations 14.6 ± 1.9 years (T1) and 19.9 ± 1.0 years after baseline (T2) as part of the BIP Neurocognitive study ( n  = 200, mean age at 57.3 ± 6.3 years). Adherence to the Mediterranean diet was determined from the self-administered 4-day food diary record, with patients categorized into high, middle and poor levels of adherence if they received &gt;5, 4–5 and &lt;4 points, respectively. Cognitive function was assessed using the NeuroTrax computerized battery. Linear mixed models were applied. Results:  Among the 200 patients, 52 (26%) had poor adherence, 98 (49%) had middle adherence and 50 (25%) had high levels of adherence to the Mediterranean diet. Those categorized to the poor adherence level had poorer cognitive function at T1 compared to the other groups. Additionally, poor vs. high level of adherence was associated with a greater decline in overall cognitive performance [ z -score = −0.23 and 95% confidence interval (CI), −0.43;−0.04;  p  = 0.021] and in visual spatial functions (−0.46 95% CI, −0.86;−0.06;  p  = 0.023). Conclusion:  This study stresses the possible role of the Mediterranean diet in men with a high vascular burden and may set the ground for future intervention to reduce their risk for cognitive decline.

Adherence to Mediterranean diet and subsequent cognitive decline in men with cardiovascular disease