The Effect of Adherence to the Mediterranean Diet on Late-Life Cognitive 
                 Disorders: A Systematic Review  
     Federica Limongi National Research Council, Neuroscience Institute Aging Branch, Padova, Italy 
     Paola Siviero National Research Council, Neuroscience Institute Aging Branch, Padova, Italy 
     Agnieszka Bozanic Department of Medicine, University of Barcelona, Barcelona, Spain 
     Marianna Noale National Research Council, Neuroscience Institute Aging Branch, Padova, Italy 
     Nicola Veronese Department of Geriatrics, University of Palermo, Palermo, Italy 
     Stefania Maggi National Research Council, Neuroscience Institute Aging Branch, Padova, Italy 
      Background: As no treatment for dementia exists, identifying its modifiable risk factors could allow 
      to implement early prevention strategies. Numerous studies have demonstrated that one factor, the 
      adherence to a Mediterranean dietary pattern  (MedDiet), has a positive effect on cognitive 
      functioning. The review is an update on this subject.  
      Methods and Results: A systematic search identified 7 randomized controlled trials (RCT) and 38 
      longitudinal studies. Adherence to the MedDiet was associated with a lower risk of cognitive 
      decline and a beneficial effect on global cognition in cognitively healthy middle-aged and elderly 
      individuals. Unlike longitudinal studies, one RCT found a protective effect against MCI incidence. 
      No association was found with dementia. The mechanisms underlying the protective effect of the 
      MedDiet against cognitive disorders are linked to its impact on cardiovascular risk factors, its 
      capacity to regulate the gut microbiota (associated with AD), and its anti-inflammatory effects. 
      Conclusions and Significance:  Notwithstanding the methodological limitations of the studies 
      examined and the need for further analyses, the results suggest that the adherence to the MedDiet 
      is associated with an improvement in cognitive health and could be included in a multifactorial 
      approach to improve late-life cognitive function. 
      
     Keywords: Mediterranean diet, cognitive decline, MCI, Alzheimer’s disease, dementia 
      
     References 
     1-Limongi F, Siviero P, Bozanic A, Noale M, Veronese N, Maggi S. The Effect of Adherence to the 
     Mediterranean Diet on Late-Life Cognitive Disorders: A Systematic Review. 2020, J Am Med Dir 
     Assoc;21(10):1402-1409.  
     2-Limongi F, Noale M, Bianchetti A, Ferrara N, Padovani A, Scarpini E, Trabucchi M, Maggi S; 
     MCI Working Group. The instruments used by the Italian  centres for cognitive disorders and 
     dementia to diagnose mild cognitive impairment (MCI). 2019, Aging Clin Exp Res;31(1):101-107.  
     3-Boccardi V, Calvani R, Limongi F, Marseglia A, Mason A, Noale M, Rogoli D, Veronese N, 
     Crepaldi G, Maggi S. Consensus paper on the "executive summary of the international conference on 
     Mediterranean diet and health: a lifelong  approach" an Italian initiative supported by the 
     Mediterranean Diet Foundation and the Menarini Foundation. 2018, Nutrition;51-52:38-45.  
     4-Limongi F, Noale M, Gesmundo A, Crepaldi G, Maggi S. Adherence to the Mediterranean Diet 
     and All-Cause Mortality Risk in an Elderly Italian Population: Data from the ILSA Study. 2017, J 
     Nutr Health Aging;21(5):505-513. 
     5-Limongi F, Siviero P, Noale M, Gesmundo A, Crepaldi G, Maggi S; Dementia Registry Study 
     Group. Prevalence and conversion to dementia of Mild Cognitive Impairment in an elderly Italian 
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     Thematic area:  
                To be selected from the following areas of diseases and disorders: 
                     -    Neurodegenerative X 
                     -    Neuromuscular  
                     -    Neurodevelopmental 
                     -    Psychiatric  
                 
                Infrastructures: 
                [If it applies, please specify here whether and which DSB infrastructures (BBMRI, EATRIS, EMMA, 
                INTRAFRONTIER, EUROBIOIMAGING, ELIXIR, PROGENIA) have been instrumental for the 
                execution of the project and for the results presented]