This article requires a subscription to view the full text. If you have a subscription you may use the login form below to view the article. Access to this article can also be purchased.
Dr. Ballarini et al. examined the relationship between following a Mediterranean-like diet and cognitive functions and in vivo biomarkers of Alzheimer disease (AD) in 512 patients in a cross-sectional analysis of the German DZNE-Longitudinal Cognitive Impairment and Dementia Study. Higher adherence to a Mediterranean-like diet was associated with larger medial-temporal grey matter volume, better memory, and less amyloid and phosphorylated-tau (p-tau) pathology in the CSF. Higher adherence favorably moderated associations among amyloid-beta 42/40 ratio, p-tau-181, and medial-temporal atrophy. In response, Dr. Brenner cites a previous study indicating that higher dietary spermidine content mediates the effects of adherence to a Mediterranean-like diet, with favorable volumetric and cortical measures in regions vulnerable to AD. Regarding potential underlying mechanisms for these associations, Dr. Brenner notes that age-related amyloid-beta and p-tau lead to dysfunctional autophagy and mitophagy, whereas bioactive compounds in Mediterranean-like diets may enhance autophagy and mitophagy, citing a spermidine supplementation trial that reported better cognitive function in patients with mild or moderate symptoms of cognitive decline. Responding to these comments, the authors agree that bioactive compounds such as spermidine in the Mediterranean-like diet are of interest in preventing neurodegeneration and dementia in addition to citing results from the LipiDiDiet trial, which showed slower cognitive and neuroradiologic decline in prodromal AD with early and prolonged multinutrient intervention. However, because most nutrient supplementation studies have shown insufficient evidence of efficacy, they suggest that dietary recommendations should focus on dietary patterns rather than specific nutrients. This exchange highlights our evolving understanding of the biological mechanisms by which brain-healthy diets such as the Mediterranean diet may exert cognitive benefits, while also demonstrating the challenges of disentangling the specific effects of different nutrients in these diets from the broad and complex effects of dietary patterns.
Dr. Ballarini et al. examined the relationship between following a Mediterranean-like diet and cognitive functions and in vivo biomarkers of Alzheimer disease (AD) in 512 patients in a cross-sectional analysis of the German DZNE-Longitudinal Cognitive Impairment and Dementia Study. Higher adherence to a Mediterranean-like diet was associated with larger medial-temporal grey matter volume, better memory, and less amyloid and phosphorylated-tau (p-tau) pathology in the CSF. Higher adherence favorably moderated associations among amyloid-beta 42/40 ratio, p-tau-181, and medial-temporal atrophy. In response, Dr. Brenner cites a previous study indicating that higher dietary spermidine content mediates the effects of adherence to a Mediterranean-like diet, with favorable volumetric and cortical measures in regions vulnerable to AD. Regarding potential underlying mechanisms for these associations, Dr. Brenner notes that age-related amyloid-beta and p-tau lead to dysfunctional autophagy and mitophagy, whereas bioactive compounds in Mediterranean-like diets may enhance autophagy and mitophagy, citing a spermidine supplementation trial that reported better cognitive function in patients with mild or moderate symptoms of cognitive decline. Responding to these comments, the authors agree that bioactive compounds such as spermidine in the Mediterranean-like diet are of interest in preventing neurodegeneration and dementia in addition to citing results from the LipiDiDiet trial, which showed slower cognitive and neuroradiologic decline in prodromal AD with early and prolonged multinutrient intervention. However, because most nutrient supplementation studies have shown insufficient evidence of efficacy, they suggest that dietary recommendations should focus on dietary patterns rather than specific nutrients. This exchange highlights our evolving understanding of the biological mechanisms by which brain-healthy diets such as the Mediterranean diet may exert cognitive benefits, while also demonstrating the challenges of disentangling the specific effects of different nutrients in these diets from the broad and complex effects of dietary patterns.
Footnotes
Author disclosures are available upon request (journal{at}neurology.org).
- © 2022 American Academy of Neurology
AAN Members
We have changed the login procedure to improve access between AAN.com and the Neurology journals. If you are experiencing issues, please log out of AAN.com and clear history and cookies. (For instructions by browser, please click the instruction pages below). After clearing, choose preferred Journal and select login for AAN Members. You will be redirected to a login page where you can log in with your AAN ID number and password. When you are returned to the Journal, your name should appear at the top right of the page.
AAN Non-Member Subscribers
Purchase access
Letters: Rapid online correspondence
REQUIREMENTS
You must ensure that your Disclosures have been updated within the previous six months. Please go to our Submission Site to add or update your Disclosure information.
Your co-authors must send a completed Publishing Agreement Form to Neurology Staff (not necessary for the lead/corresponding author as the form below will suffice) before you upload your comment.
If you are responding to a comment that was written about an article you originally authored:
You (and co-authors) do not need to fill out forms or check disclosures as author forms are still valid
and apply to letter.
Submission specifications:
- Submissions must be < 200 words with < 5 references. Reference 1 must be the article on which you are commenting.
- Submissions should not have more than 5 authors. (Exception: original author replies can include all original authors of the article)
- Submit only on articles published within 6 months of issue date.
- Do not be redundant. Read any comments already posted on the article prior to submission.
- Submitted comments are subject to editing and editor review prior to posting.
You May Also be Interested in
Hastening the Diagnosis of Amyotrophic Lateral Sclerosis
Dr. Brian Callaghan and Dr. Kellen Quigg