Skip to main content
    • Aa
    • Aa
  • Access
  • Cited by 46
  • Cited by
    This article has been cited by the following publications. This list is generated based on data provided by CrossRef.

    Clements, Sarah J. and Carding, Simon R. 2016. Molecular Basis of Nutrition and Aging.

    Haring, Bernhard Wu, Chunyuan Mossavar-Rahmani, Yasmin Snetselaar, Linda Brunner, Robert Wallace, Robert B. Neuhouser, Marian L. and Wassertheil-Smoller, Sylvia 2016. No Association between Dietary Patterns and Risk for Cognitive Decline in Older Women with 9-Year Follow-Up: Data from the Women’s Health Initiative Memory Study. Journal of the Academy of Nutrition and Dietetics, Vol. 116, Issue. 6, p. 921.

    Knight, Alissa Bryan, Janet and Murphy, Karen 2016. The Mediterranean diet and age-related cognitive functioning: A systematic review of study findings and neuropsychological assessment methodology. Nutritional Neuroscience, p. 1.

    Knight, Alissa Bryan, Janet and Murphy, Karen 2016. Is the Mediterranean diet a feasible approach to preserving cognitive function and reducing risk of dementia for older adults in Western countries? New insights and future directions. Ageing Research Reviews, Vol. 25, p. 85.

    Kouvari, Matina Tyrovolas, Stefanos and Panagiotakos, Demosthenes B. 2016. Red meat consumption and healthy ageing: A review. Maturitas, Vol. 84, p. 17.

    Medina-RemÓn, Alexander Kirwan, Richard Lamuela-Raventós, Rosa M. and Estruch, Ramón 2016. Dietary Patterns and the Risk of Obesity, Type 2 Diabetes Mellitus, Cardiovascular Diseases, Asthma, and Mental Health Problems. Critical Reviews in Food Science and Nutrition, p. 00.

    Staubo, Sara C. Aakre, Jeremiah A. Vemuri, Prashanthi Syrjanen, Jeremy A. Mielke, Michelle M. Geda, Yonas E. Kremers, Walter K. Machulda, Mary M. Knopman, David S. Petersen, Ronald C. Jack, Clifford R. and Roberts, Rosebud O. 2016. Mediterranean diet, micronutrients and macronutrients, and MRI measures of cortical thickness. Alzheimer's & Dementia,

    Feart, Catherine and Barberger-Gateau, Pascale 2015. Diet and Nutrition in Dementia and Cognitive Decline.

    Galbete, Cecilia Toledo, E. Toledo, J. B. Bes-Rastrollo, M. Buil-Cosiales, P. Marti, A. Guillén-Grima, F. and Martínez-González, M. A. 2015. Mediterranean diet and cognitive function: The sun project. The journal of nutrition, health & aging, Vol. 19, Issue. 3, p. 305.

    Gardener, S L Rainey-Smith, S R Barnes, M B Sohrabi, H R Weinborn, M Lim, Y Y Harrington, K Taddei, K Gu, Y Rembach, A Szoeke, C Ellis, K A Masters, C L Macaulay, S L Rowe, C C Ames, D Keogh, J B Scarmeas, N and Martins, R N 2015. Dietary patterns and cognitive decline in an Australian study of ageing. Molecular Psychiatry, Vol. 20, Issue. 7, p. 860.

    Ghelfi, Francesca and Titta, Lucilla 2015. Connecting Indian Wisdom and Western Science.

    Hardman, Roy J. Kennedy, Greg Macpherson, Helen Scholey, Andrew B. and Pipingas, Andrew 2015. A randomised controlled trial investigating the effects of Mediterranean diet and aerobic exercise on cognition in cognitively healthy older people living independently within aged care facilities: the Lifestyle Intervention in Independent Living Aged Care (LIILAC) study protocol [ACTRN12614001133628]. Nutrition Journal, Vol. 14, Issue. 1,

    Knight, Alissa Bryan, Janet Wilson, Carlene Hodgson, Jonathan and Murphy, Karen 2015. A randomised controlled intervention trial evaluating the efficacy of a Mediterranean dietary pattern on cognitive function and psychological wellbeing in healthy older adults: the MedLey study. BMC Geriatrics, Vol. 15, Issue. 1,

    Krause, Debra Margetts, Christine and Roupas, Peter 2015. Diet and Nutrition in Dementia and Cognitive Decline.

    Macpherson, Helen Lee, Jaime Villalon, Lorena Pase, Matthew Pipingas, Andrew and Scholey, Andrew 2015. The Mediterranean Diet.

    Simeon, Vittorio Chiodini, Paolo Mattiello, Amalia Sieri, Sabina Panico, Camilla Brighenti, Furio Krogh, Vittorio and Panico, Salvatore 2015. Dietary glycemic load and risk of cognitive impairment in women: findings from the EPIC-Naples cohort. European Journal of Epidemiology, Vol. 30, Issue. 5, p. 425.

    Smyth, A. Dehghan, M. O'Donnell, M. Anderson, C. Teo, K. Gao, P. Sleight, P. Dagenais, G. Probstfield, J. L. Mente, A. and Yusuf, S. 2015. Healthy eating and reduced risk of cognitive decline: A cohort from 40 countries. Neurology, Vol. 84, Issue. 22, p. 2258.

    Trichopoulou, Antonia Kyrozis, Andreas Rossi, Marta Katsoulis, Michalis Trichopoulos, Dimitrios La Vecchia, Carlo and Lagiou, Pagona 2015. Mediterranean diet and cognitive decline over time in an elderly Mediterranean population. European Journal of Nutrition, Vol. 54, Issue. 8, p. 1311.

    Tsai, Hsin-Jen 2015. Dietary patterns and cognitive decline in Taiwanese aged 65 years and older. International Journal of Geriatric Psychiatry, Vol. 30, Issue. 5, p. 523.

    Zhu, N. Jacobs, David R. Meyer, K. A. He, K. Launer, L. Reis, J. P. Yaffe, K. Sidney, S. Whitmer, R. A. and Steffen, L. M. 2015. Cognitive function in a middle aged cohort is related to higher quality dietary pattern 5 and 25 years earlier: The cardia study. The journal of nutrition, health & aging, Vol. 19, Issue. 1, p. 33.


Diet, physical activity and cognitive impairment among elders: the EPIC–Greece cohort (European Prospective Investigation into Cancer and Nutrition)

  • T Psaltopoulou (a1), A Kyrozis (a2), P Stathopoulos (a1), D Trichopoulos (a3) (a4), D Vassilopoulos (a2) and A Trichopoulou (a1) (a4)
  • DOI:
  • Published online: 01 October 2008

To identify dietary and lifestyle variables that may affect cognitive function in the elderly.


Population-based prospective cohort study.


General community residing in Athens and the surrounding Attica region of Greece.


A total of 732 men and women, 60 years or older, participating in the EPIC–Greece cohort (European Prospective Investigation into Cancer and Nutrition) and residing in the Attica region had sociodemographic, anthropometric, medical, dietary and lifestyle variables ascertained at enrolment (1993–1999). Six to 13 years later, cognitive function was evaluated through the Mini-Mental State Examination (MMSE) score and affective state through the Geriatric Depression Scale (GDS).


MMSE score was positively associated with years of formal education, height and physical activity and inversely with age, diabetes mellitus and GDS score (P < 0·05 for all). Among dietary variables, intake of PUFA was inversely associated with cognitive function and this association was largely accounted for by a similar association with seed oils. Adherence to the Mediterranean diet, as well as intake of olive oil, MUFA and SFA exhibited weakly positive but not significant associations.


Physical activity and early life factors as reflected in height are significant predictors of cognitive function in the elderly. Seed oil consumption may adversely affect cognition, whereas other nutritional factors do not appear to have a quantitatively large effect.

  • View HTML
    • Send article to Kindle

      To send this article to your Kindle, first ensure is added to your Approved Personal Document E-mail List under your Personal Document Settings on the Manage Your Content and Devices page of your Amazon account. Then enter the ‘name’ part of your Kindle email address below. Find out more about sending to your Kindle.

      Note you can select to send to either the or variations. ‘’ emails are free but can only be sent to your device when it is connected to wi-fi. ‘’ emails can be delivered even when you are not connected to wi-fi, but note that service fees apply.

      Find out more about the Kindle Personal Document Service.

      Diet, physical activity and cognitive impairment among elders: the EPIC–Greece cohort (European Prospective Investigation into Cancer and Nutrition)
      Available formats
      Send article to Dropbox

      To send this article to your Dropbox account, please select one or more formats and confirm that you agree to abide by our usage policies. If this is the first time you use this feature, you will be asked to authorise Cambridge Core to connect with your Dropbox account. Find out more about sending content to Dropbox.

      Diet, physical activity and cognitive impairment among elders: the EPIC–Greece cohort (European Prospective Investigation into Cancer and Nutrition)
      Available formats
      Send article to Google Drive

      To send this article to your Google Drive account, please select one or more formats and confirm that you agree to abide by our usage policies. If this is the first time you use this feature, you will be asked to authorise Cambridge Core to connect with your Google Drive account. Find out more about sending content to Google Drive.

      Diet, physical activity and cognitive impairment among elders: the EPIC–Greece cohort (European Prospective Investigation into Cancer and Nutrition)
      Available formats
Corresponding author
Linked references
Hide All

This list contains references from the content that can be linked to their source. For a full set of references and notes please see the PDF or HTML where available.

1.S Gauthier , B Reisberg , M Zaudig (2006) Mild cognitive impairment. Lancet 367, 12621270.

4.CE Hou , K Yaffe , EJ Perez-Stable & BL Miller (2006) Frequency of dementia etiologies in four ethnic groups. Dementia Geriatr Cogn Dis 22, 4247.

7.C Napoli & W Palinski (2005) Neurodegenerative diseases: insights into pathogenic mechanisms from atherosclerosis. Neurobiol Aging 26, 293302.

8.DT Nash & H Fillit (2006) Cardiovascular disease risk factors and cognitive impairment. Am J Cardiol 97, 12621265.

9.MJ Stampfer (2006) Cardiovascular disease and Alzheimer’s disease: common links. J Intern Med 260, 211223.

10.L White & L Launer (2006) Relevance of cardiovascular risk factors and ischemic cerebrovascular disease to the pathogenesis of Alzheimer disease: a review of accrued findings from the Honolulu–Asia Aging Study. Alzheimer Dis Assoc Disord 20, S79S83.

11.DV Espino , MJ Lichtenstein , RF Palmer & HP Hazuda (2001) Ethnic differences in Mini-Mental State Examination (MMSE) scores: where you live makes a difference. J Am Geriatr Soc 49, 538548.

13.AU Monsch , NS Foldi , DE Ermini-Funfschilling , M Berres , KI Taylor , E Seifritz , HB Stahelin & R Spiegel (1995) Improving the diagnostic accuracy of the Mini-Mental State Examination. Acta Neurol Scand 92, 145150.

14.R Stewart , J Johnson , M Richards , C Brayne & A Mann (2002) The distribution of Mini-Mental State Examination scores in an older UK African-Caribbean population compared to MRC CFA study norms. Int J Geriatr Psychiatry 17, 745751.

16.AJ de Craen , TJ Heeren & J Gussekloo (2003) Accuracy of the 15-item Geriatric Depression Scale (GDS-15) in a community sample of the oldest old. Int J Geriatr Psychiatry 18, 6366.

18.DP Osborn , AE Fletcher , L Smeeth , S Stirling , M Nunes , E Breeze , E Siu-Woon Ng , CJ Bulpitt , D Jones & A Tulloch (2002) Geriatric Depression Scale scores in a representative sample of 14 545 people aged 75 and over in the United Kingdom: results from the MRC Trial of Assessment and Management of Older People in the Community. Int J Geriatr Psychiatry 17, 375382.

19.JA Yesavage , TL Brink , TL Rose , O Lum , V Huang , M Adey & VO Leirer (1982) Development and validation of a geriatric depression screening scale: a preliminary report. J Psychiatr Res 17, 3749.

21.A Trichopoulou , T Costacou , C Bamia & D Trichopoulos (2003) Adherence to a Mediterranean diet and survival in a Greek population. New Engl J Med 348, 25992608.

22.S Bingham & E Riboli (2004) Diet and cancer – the European Prospective Investigation into Cancer and Nutrition. Nat Rev Cancer 4, 206215.

24.C Gnardellis , A Trichopoulou , K Katsouyanni , E Polychronopoulos , EB Rimm & D Trichopoulos (1995) Reproducibility and validity of an extensive semiquantitative food frequency questionnaire among Greek school teachers. Epidemiology 6, 7477.

28.W Willett & M Stampfer (1998) Implications of total energy intake for epidemiological analyses. In Nutritional Epidemiology, 2nd ed., pp. 273301 [W Willett, editor]. New York: Oxford University Press.

29.A Trichopoulou , C Gnardellis , A Lagiou , V Benetou & D Trichopoulos (2000) Body mass index in relation to energy intake and expenditure among adults in Greece. Epidemiology 11, 333336.

30.BE Ainsworth , WL Haskell , AS Leon , DR Jacobs Jr, HJ Montoye , JF Sallis & RS Paffenbarger Jr (1993) Compendium of physical activities: classification of energy costs of human physical activities. Med Sci Sports Exerc 25, 7180.

31.RM Crum , JC Anthony , SS Bassett & MF Folstein (1993) Population-based norms for the Mini-Mental State Examination by age and educational level. JAMA 269, 23862391.

32.MF Folstein , SE Folstein & PR McHugh (1975) ‘Mini-mental state’. A practical method for grading the cognitive state of patients for the clinician. J Psychiatr Res 12, 189198.

33.HL Park , JE O’Connell & RG Thomson (2003) A systematic review of cognitive decline in the general elderly population. Int J Geriatr Psychiatry 18, 11211134.

34.TN Tombaugh & NJ McIntyre (1992) The Mini-Mental State Examination: a comprehensive review. J Am Geriatr Soc 40, 922935.

35.F Pasquier , A Boulogne , D Leys & P Fontaine (2006) Diabetes mellitus and dementia. Diabetes Metab 32, 403414.

36.E van den Berg , RP Kessels , LJ Kappelle , EH de Hann & GJ Biessels (2006) Type 2 diabetes, cognitive function and dementia: vascular and metabolic determinants. Drugs Today (Barc) 42, 741754.

37.M Ganguli , Y Du , HH Dodge , GG Ratcliff & CC Chang (2006) Depressive symptoms and cognitive decline in late life: a prospective epidemiological study. Arch Gen Psychiatry 63, 153160.

38.RC Green , LA Cupples , A Kurz (2003) Depression as a risk factor for Alzheimer disease: the MIRAGE Study. Arch Neurol 60, 753759.

40.JA Cervilla , M Prince , S Joels , S Lovestone & A Mann (2000) Long-term predictors of cognitive outcome in a cohort of older people with hypertension. Br J Psychiatry 177, 6671.

41.F Forette , ML Seux , JA Staessen (1998) Prevention of dementia in randomised double-blind placebo-controlled Systolic Hypertension in Europe (Syst-Eur) trial. Lancet 352, 13471351.

42.I Skoog & D Gustafson (2006) Update on hypertension and Alzheimer’s disease. Neurol Res 28, 605611.

43.D Gunnell (2002) Can adult anthropometry be used as a ‘biomarker’ for prenatal and childhood exposures? Int J Epidemiol 31, 390394.

44.RD Abbott , LR White , GW Ross , H Petrovitch , KH Masaki , DA Snowdon & JD Curb (1998) Height as a marker of childhood development and late-life cognitive function: the Honolulu–Asia Aging Study. Pediatrics 102, 602609.

45.MS Beeri , M Davidson , JM Silverman , S Noy , J Schmeidler & U Goldbourt (2005) Relationship between body height and dementia. Am J Geriatr Psychiatry 13, 116123.

46.SK Jeong , JM Kim , SS Kweon , MH Shin , MW Seo & YH Kim (2005) Does arm length indicate cognitive and functional reserve? Int J Geriatr Psychiatry 20, 406412.

47.AS Buchman , JA Schneider , RS Wilson , JL Bienias & DA Bennett (2006) Body mass index in older persons is associated with Alzheimer disease pathology. Neurology 67, 19491954.

48.D Gustafson (2006) Adiposity indices and dementia. Lancet Neurol 5, 713720.

49.L Fratiglioni , S Paillard-Borg & B Winblad (2004) An active and socially integrated lifestyle in late life might protect against dementia. Lancet Neurol 3, 343353.

50.NT Lautenschlager & OP Almeida (2006) Physical activity and cognition in old age. Curr Opin Psychiatry 19, 190193.

51.CW Cotman & NC Berchtold (2002) Exercise: a behavioral intervention to enhance brain health and plasticity. Trends Neurosci 25, 295301.

52.D Juan , DH Zhou , J Li , JY Wang , C Gao & M Chen (2004) A 2-year follow-up study of cigarette smoking and risk of dementia. Eur J Neurol 11, 277282.

53.A Ott , K Andersen , ME Dewey (2004) Effect of smoking on global cognitive function in nondemented elderly. Neurology 62, 920924.

54.OP Almeida , GK Hulse , D Lawrence & L Flicker (2002) Smoking as a risk factor for Alzheimer’s disease: contrasting evidence from a systematic review of case–control and cohort studies. Addiction 97, 1528.

55.L Letenneur , S Larrieu & P Barberger-Gateau (2004) Alcohol and tobacco consumption as risk factors of dementia: a review of epidemiological studies. Biomed Pharmacother 58, 9599.

57.MF Allam , MJ Campbell , A Hofman , AS Del Castillo & R Fernandez-Crehuet Navajas (2004) Smoking and Parkinson’s disease: systematic review of prospective studies. Mov Disord 19, 614621.

58.N Scarmeas , Y Stern , MX Tang , R Mayeux & JA Luchsinger (2006) Mediterranean diet and risk for Alzheimer’s disease. Ann Neurol 59, 912921.

59.V Solfrizzi , C Capurso & F Panza (2006) Adherence to a Mediterranean dietary pattern and risk of Alzheimer’s disease. Ann Neurol 60, 620.

60.V Solfrizzi , AM Colacicco , A D’Introno , C Capurso , F Torres , C Rizzo , A Capurso & F Panza (2006) 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 27, 16941704.

61.V Solfrizzi , AM Colacicco , A D’Introno , C Capurso , A Del Parigi , SA Capurso , G Argentieri , A Capurso & F Panza (2006) Dietary fatty acids intakes and rate of mild cognitive impairment. The Italian Longitudinal Study on Aging. Exp Gerontol 41, 619627.

62.V Solfrizzi , A D’Introno , AM Colacicco , C Capurso , A Del Parigi , S Capurso , A Gadaleta , A Capurso & F Panza (2005) Dietary fatty acids intake: possible role in cognitive decline and dementia. Exp Gerontol 40, 257270.

63.MC Morris , DA Evans , JL Bienias , CC Tangney & RS Wilson (2004) Dietary fat intake and 6-year cognitive change in an older biracial community population. Neurology 62, 15731579.

64.S Kalmijn , EJ Feskens , LJ Launer & D Kromhout (1997) Polyunsaturated fatty acids, antioxidants, and cognitive function in very old men. Am J Epidemiol 145, 3341.

67.MJ Engelhart , MI Geerlings , A Ruitenberg , JC Van Swieten , A Hofman , JC Witteman & MM Breteler (2002) Diet and risk of dementia: does fat matter?: The Rotterdam Study. Neurology 59, 19151921.

68.AM Issa , WA Mojica , SC Morton , S Traina , SJ Newberry , LG Hilton , RH Garland & CH Maclean (2006) The efficacy of omega-3 fatty acids on cognitive function in aging and dementia: a systematic review. Dementia Geriatr Cogn Disord 21, 8896.

69.S Kalmijn , LJ Launer , A Ott , JC Witteman , A Hofman & MM Breteler (1997) Dietary fat intake and the risk of incident dementia in the Rotterdam Study. Ann Neurol 42, 776782.

70.S Kalmijn , MP van Boxtel , M Ocke , WM Verschuren , D Kromhout & LJ Launer (2004) Dietary intake of fatty acids and fish in relation to cognitive performance at middle age. Neurology 62, 275280.

71.MC Morris , DA Evans , JL Bienias , CC Tangney , DA Bennett , RS Wilson , N Aggarwal & J Schneider (2003) Consumption of fish and n-3 fatty acids and risk of incident Alzheimer disease. Arch Neurol 60, 940946.

72.PD Reaven , BJ Grasse & DL Tribble (1994) Effects of linoleate-enriched and oleate-enriched diets in combination with alpha-tocopherol on the susceptibility of LDL and LDL subfractions to oxidative modification in humans. Arterioscler Thromb Vasc Biol 14, 557566.

Recommend this journal

Email your librarian or administrator to recommend adding this journal to your organisation's collection.

Public Health Nutrition
  • ISSN: 1368-9800
  • EISSN: 1475-2727
  • URL: /core/journals/public-health-nutrition
Please enter your name
Please enter a valid email address
Who would you like to send this to? *