Abstract Details

To evaluate relationships between Mediterranean diet score and cognitive outcomes in multiple sclerosis (MS)

Persons with MS (n=563; 71% women; aged 44.2±11.3 years) completed the Mediterranean Diet Adherence Screener (MEDAS, scores 0-14) and an analogue of the BICAMS cognitive battery composed of Symbol Digit Modalities Test, Hopkins Verbal Learning Test, Revised, and CANTAB Paired Associate Learning. Normative z-scores were averaged into a composite cognitive z-score. Multiple regression investigated the independent contribution of MEDAS to cognition adjusting for demographic (age, sex, race, ethnicity, socioeconomic status) and health-related (BMI, exercise, sleep disturbance, hypertension, diabetes, hyperlipidemia, smoking) factors. Logistic regression predicted risk for cognitive impairment (<5^th percentile on 2-3 tasks) with MEDAS adjusting for aforementioned covariates.

Mean (SD) cognitive z-score was -0.67 (0.95). Higher MEDAS independently predicted better cognition (B=0.08 [95%CI: 0.05, 0.11], β=0.20, p<0.001). . Cognitive impairment was observed in 108 patients (19.2%). Higher MEDAS independently predicted 20% lower risk for cognitive impairment (Odds Ratio=0.80 [95% CI: 0.73, 0.89], p<0.001). MEDAS was by far the best health-related predictor of cognitive z-score and cognition impairment. Effect modifications indicated stronger relationships between diet and cognition (z-score and impairment) among persons with progressive (versus relapsing) disease.

After controlling for important potential confounders, we note a significant association between Mediterranean diet score and cognition in a representative sample of people with MS. The strength of the relationship in progressive disease suggests the possibility of a neuroprotective mechanism. Longitudinal studies and interventional clinical trials are needed.