A brief dietary assessment predicts executive dysfunction in an elderly cohort: results from the Einstein Aging Study

Authors: SUNDERMANN, ERIN - Albert Einstein College Of Medicine; KATZ, MINDY - Albert Einstein College Of Medicine; LIPTON, RICHARD - Albert Einstein College Of Medicine; LICHTENSTEIN, ALICE - Jean Mayer Human Nutrition Research Center On Aging At Tufts University; DERBY, CAROL - Albert Einstein College Of Medicine

Submitted to: Journal of the American Geriatrics Society
Publication Type: Peer Reviewed Journal
Publication Acceptance Date: 1/22/2016
Publication Date: 10/27/2016
Citation: Sundermann, E.E., Katz, M.J., Lipton, R.B., Lichtenstein, A.H., Derby, C.A. 2016. A brief dietary assessment predicts executive dysfunction in an elderly cohort: results from the Einstein Aging Study. Journal of the American Geriatrics Society. 64(11):e131-e136.

Interpretive Summary: Few studies have examined the association between diet quality and different aspects of cognitive function in older adults. We examined the relationship between diet quality on executive function, episodic memory, and global cognition in the Einstein Aging Study (EAS) cohort and determined whether race modified these relationships. The EAS cohort is a group of systematically recruited, community-dwelling, English-speaking residents of Bronx County, NY who were 70 years or older and free of dementia at the time of enrollment. The majority of participants were women, and about a quarter were Black. Data from the Rapid Eating and Activity Assessment for Patients (REAP) questionnaire was used to address the issue of dietary quality and cognitive function using a cross-sectional design. REAP scores were divided into two categories: a less healthy diet or more healthy diet. A healthy diet was associated with reduced odds of having impaired executive function among Whites, as were healthier scores on the saturated fat sub-scale. Among Blacks, REAP scores were not associated with cognitive domains. These data suggest that a healthy diet was associated with reduced risk of executive dysfunction. Diet is a promising target for prevention of cognitive decline. Observed race differences may be due to increased vascular risk among Blacks or to differences in generalizability of the REAP.

Technical Abstract: Objectives: To examine the association between diet and executive function, episodic memory and global verbal cognition in the Einstein Aging Study (EAS) cohort and determine whether race modifies this relationship. Design: Cross-sectional. Setting: Community. Participants: EAS participants without dementia who completed the Rapid Eating and Activity Assessment for Patients (REAP) (N = 492). Measurements: The previously-validated REAP is based on the 2000 U.S. dietary guidelines. REAP scores were dichotomized as less-healthy (median) diet. Nine neurocognitive tests underwent principle component analysis, revealing three significant orthogonal components: episodic memory, executive function, and global cognition. Impaired cognitive function in each domain was defined as 2 standard deviations (SD) or more below the mean on any task or a total score of 1.5 SD or more below the mean. Using logistic regression, the association between diet and cognitive impairment was assessed, adjusting for age, education, sex, cardiovascular comorbidities, hypertension, body mass index, diabetes mellitus, depressive symptoms, race, and the interaction between race and diet group. RESULTS: The sample was 60% female and 74% white and had a mean age of 80. In the entire sample, impaired executive function was associated with the interaction between race and diet group (P = .08), whereas other cognitive domains were not. In race-stratified analyses, healthier diet was associated with lower odds of impaired executive function in whites (odds ratio (OR) = 0.44, 95% confidence interval (CI) = 0.21-0.93, P = .03), as were healthier scores on the saturated fat subscale (OR = 0.34, 95% CI = 0.16-0.71, P = .004). In blacks, REAP scores were not associated with cognitive domains. Conclusion: Healthy diet was associated with lower risk of executive dysfunction in whites. Race differences may be due to greater vascular risk in blacks or differences in generalizability of the REAP.