Cardiovascular Factors and Cognitive Impairment: A Role for Unsaturated Fatty Acids and Mediterranean Diet?

Abstract

We read with great interest the recent article by Nash and Fillit 1 Nash D.T. Fillit H. Cardiovascular disease risk factors and cognitive impairment. Am J Cardiol. 2006; 97: 1262-1265 Abstract Full Text Full Text PDF PubMed Scopus (69) Google Scholar that reviewed recent evidence on the suggested role of cardiovascular disease risk factors in the occurrence and progression of cognitive impairment. Many of the risk factors for cardiovascular and cerebrovascular disease, including serum total cholesterol, hypertension, atherosclerosis, and apolipoprotein-E genotype, have also been shown to increase the risk of dementia. 2 Panza F. D’Introno A. Colacicco A.M. Capurso C. Parigi A.D. Capurso S.A. Caselli R.J. Pilotto A. Scafato E. Capurso A. Solfrizzi V. Cognitive frailty: predementia syndrome and vascular risk factors. Neurobiol Aging. 2006; 27: 933-940 Abstract Full Text Full Text PDF PubMed Scopus (128) Google Scholar In the Italian Longitudinal Study on Aging (ILSA), in 2,963 older patients of a population-based study, vascular risk factors influenced incident mild cognitive impairment and the rate of progression to dementia. 3 Solfrizzi V. Panza F. Colacicco A.M. D’Introno A. Capurso C. Torres F. Grigoletto F. Maggi S. Del Parigi A. Reiman E.M. Caselli R.J. Scafato E. Farchi G. Capurso A. Italian Longitudinal Study on Aging Working Group: vascular risk factors, incidence of MCI, and rates of progression to dementia. Neurology. 2004; 63: 1882-1891 Crossref PubMed Scopus (429) Google Scholar Of these vascular-related factors, the level of interest has recently increased regarding the possible affect of diet. Antioxidants, dietary fatty acids, and micronutrients appear to have a role, and evidence is at least suggestive that diets rich in fruits and vegetables and other dietary approaches may have a beneficial effect on the risk of dementia. Nash and Fillit 1 Nash D.T. Fillit H. Cardiovascular disease risk factors and cognitive impairment. Am J Cardiol. 2006; 97: 1262-1265 Abstract Full Text Full Text PDF PubMed Scopus (69) Google Scholar reviewed the recent evidence linked to nonpharmacologic approaches to cognitive impairment, citing the findings of the ILSA that demonstrated that dietary monounsaturated fatty acid (MUFA) intake was significantly associated with a reduction in the odds ratio of developing cognitive impairment. 4 Solfrizzi V. Panza F. Torres F. Mastroianni F. Del Parigi A. Venezia A. Capurso A. High monounsaturated fatty acids intake protects against age-related cognitive decline. Neurology. 1999; 52: 1563-1569 Crossref PubMed Google Scholar The findings of this study were recently confirmed in a 8.5-year follow-up study, in which high MUFAs, polyunsaturated fatty acids, and total energy intake were significantly associated with better cognitive performance over time. 5 Solfrizzi V. Colacicco A.M. D’Introno A. Capurso C. Torres F. Rizzo C. Capurso A. Panza F. Dietary intake of unsaturated fatty acids and age-related cognitive decline: a 8.5-year follow-up of the Italian Longitudinal Study on Aging. Neurobiol Aging. 2006; 27: 1694-1704 Abstract Full Text Full Text PDF PubMed Scopus (199) Google Scholar Furthermore, after a median follow-up of 8.5 years, we found in the ILSA a significant association between MUFAs and all-cause mortality and a marginally significant difference in survival for unsaturated fatty acid/saturated fatty acid ratio categories. 6 Solfrizzi V. D’Introno A. Colacicco A.M. Capurso C. Palasciano R. Capurso S. Torres F. Capurso A. Panza F. Unsaturated fatty acids intake and all-causes mortality: a 8.5-year follow-up of the Italian Longitudinal Study on Aging. Exp Gerontol. 2005; 40: 335-343 Crossref PubMed Scopus (29) Google Scholar Finally, recent findings from the ILSA have demonstrated that although dietary fatty acid intakes were not associated with incident mild cognitive impairment, high polyunsaturated fatty acid intake appeared to have borderline nonsignificant trend for a protective effect against the development of mild cognitive impairment. 7 Solfrizzi V. Colacicco A.M. D’Introno A. Capurso C. Parigi A.D. Capurso S.A. Argentieri G. Capurso A. Panza F. Italian Longitudinal Study on AgingDietary polyunsaturated fatty acids intakes and rate of mild cognitive impairment. Exp Gerontol. 2006; 41: 619-627 Crossref PubMed Scopus (64) Google Scholar Very recently, Scarmeas and colleagues 8 Scarmeas N. Stern Y. Tang M.X. Mayeux R. Luchsinger J.A. Mediterranean diet and risk for Alzheimer’s disease. Ann Neurol. 2006; 58: 912-921 Crossref Scopus (820) Google Scholar reported the results of a community-based study involving 2,258 nondemented patients in New York, in which adherence to a traditional Mediterranean diet was associated with a significant reduction in the risk of Alzheimer’s disease. They reported that the typical dietary pattern of the Mediterranean diet is characterized by a high intake of vegetables, fruits and nuts, legumes, cereals, fish, and MUFAs, relatively low intakes of meat and dairy products, and moderate consumption of alcohol. These findings and those from the ILSA strongly suggest that the preservation of certain dietary and lifestyle traditions may have important health consequences and that the advantages of the Mediterranean diet are transferable from the prevention of cardiovascular disease to the prevention of cognitive impairment.