Department of Geriatrics, Center for Aging Brain, Memory Unit, University of Bari, Bari, Italy.
Curr Alzheimer Res. 2011 Aug;8(5):520-42. doi: 10.2174/156720511796391809.
There is a critical need to potentially individualize new strategies able to prevent and to slow down the progression of predementia and dementia syndromes. Only recently higher adherence to a Mediterranean-type diet was associated with decreased cognitive decline although the Mediterranean diet (MeDi) combines several foods, micro- and macronutrients already separately proposed as potential protective factors against dementia and predementia syndromes. In fact, elevated saturated fatty acids could have negative effects on age-related cognitive decline and mild cognitive impairment (MCI). Furthermore, at present, epidemiological evidence suggested a possible association among fish consumption, monounsaturated fatty acids and polyunsaturated fatty acids (PUFA) (particularly, n-3 PUFA) and reduced risk of cognitive decline and dementia. Light to moderate alcohol use may be associated with a reduced risk of incident dementia and Alzheimer's disease (AD), while for vascular dementia, cognitive decline, and predementia syndromes the current evidence is only suggestive of a protective effect. Finally, the limited epidemiological evidence available on fruit and vegetable consumption and cognition generally supported a protective role of these macronutrients against cognitive decline, dementia, and AD. Moreover, recent prospective studies provided evidence that higher adherence to a Mediterranean-type diet could be associated with slower cognitive decline, reduced risk of progression from MCI to AD, reduced risk of AD, and decreased all-causes mortality in AD patients. These findings suggested that adherence to the MeDi may affect not only the risk for AD, but also for predementia syndromes and their progression to overt dementia. Nonetheless, at present, no definitive dietary recommendations are possible. However, high levels of consumption of fats from fish, vegetable oils, non-starchy vegetables, low glycemic fruits, and diet low in foods with added sugars and with moderate wine intake should be encouraged. In fact, this dietary advice is in accordance with recommendations for lowering the risk of cardiovascular disease, obesity, diabetes, and hypertension and might open new ways for the prevention and management of cognitive decline and dementia.
目前迫切需要制定新的策略，以预防和减缓痴呆前期和痴呆综合征的进展，个体化治疗尤为重要。最近有研究表明，更高的地中海饮食依从性与认知能力下降减少相关，尽管地中海饮食（MeDi）结合了多种食物、微量和常量营养素，这些营养素已被分别提出作为预防痴呆和痴呆前期综合征的潜在保护因素。事实上，升高的饱和脂肪酸可能对与年龄相关的认知能力下降和轻度认知障碍（MCI）有负面影响。此外，目前的流行病学证据表明，鱼类消费、单不饱和脂肪酸和多不饱和脂肪酸（PUFA）（特别是 n-3 PUFA）之间可能存在关联，并且与认知能力下降和痴呆的风险降低有关。轻中度饮酒可能与痴呆和阿尔茨海默病（AD）发病风险降低有关，而对于血管性痴呆、认知能力下降和痴呆前期综合征，目前的证据仅提示有保护作用。最后，关于水果和蔬菜消费与认知能力的有限流行病学证据普遍支持这些宏量营养素对认知能力下降、痴呆和 AD 的保护作用。此外，最近的前瞻性研究提供了证据，表明更高的地中海饮食依从性可能与认知能力下降速度较慢、从 MCI 进展为 AD 的风险降低、AD 风险降低以及 AD 患者全因死亡率降低有关。这些发现表明，遵守 MeDi 不仅可能影响 AD 的风险，还可能影响痴呆前期综合征及其向明显痴呆的进展。尽管如此，目前还不可能提出明确的饮食建议。然而，应鼓励增加鱼类、植物油、非淀粉类蔬菜、低血糖水果和低糖添加糖食物的摄入，并适度饮酒。事实上，这种饮食建议符合降低心血管疾病、肥胖、糖尿病和高血压风险的建议，并且可能为预防和管理认知能力下降和痴呆开辟新途径。
