The Dietary Approaches to Stop Hypertension Diet, Cognitive Function, and Cognitive Decline in American Older Women

Published:January 17, 2017DOI:



      To examine the association between long-term adherence to the Dietary Approaches to Stop Hypertension (DASH) diet with cognitive function and decline in older American women.


      Prospective cohort study.


      The Nurses' Health Study, a cohort of registered nurses residing in 11 US states.


      A total of 16,144 women from the Nurses' Health Study, aged ≥70 years, who underwent cognitive testing a total of 4 times by telephone from 1995 to 2001 (baseline), with multiple dietary assessments between 1984 and the first cognitive examination. DASH adherence for each individual was based on scoring of intakes of 9 nutrient or food components.


      Long-term DASH adherence was calculated as the average DASH adherence score from up to 5 repeated measures of diet. Primary outcomes were cognitive function calculated as the average scores of the 4 repeated measures, as well as cognitive change of the Telephone Interview for Cognitive Status score and composite scores of global cognition and verbal memory.


      Greater adherence to long-term DASH score was associated with better average cognitive function, irrespective of apolipoprotein E ε4 allele status [multivariable-adjusted differences in mean z-scores between extreme DASH quintiles = 0.04 (95% confidence interval, CI 0.01–0.07), P trend = .009 for global cognition; 0.04 (95% CI 0.01–0.07), P trend = .002 for verbal memory and 0.16 (95% CI 0.03–0.29), and P trend = .03 for Telephone Interview for Cognitive Status, P interaction >0.24]. These differences were equivalent to being 1 year younger in age. Adherence to the DASH score was not associated with change in cognitive function over 6 years.


      Our findings in the largest cohort on dietary patterns and cognitive function to date indicate that long-term adherence to the DASH diet is important to maintain cognitive function at older ages.


      To read this article in full you will need to make a payment

      Purchase one-time access:

      Academic & Personal: 24 hour online accessCorporate R&D Professionals: 24 hour online access
      One-time access price info
      • For academic or personal research use, select 'Academic and Personal'
      • For corporate R&D use, select 'Corporate R&D Professionals'


      Subscribe to Journal of the American Medical Directors Association
      Already a print subscriber? Claim online access
      Already an online subscriber? Sign in
      Institutional Access: Sign in to ScienceDirect


        • Nelson L.
        • Tabet N.
        Slowing the progression of Alzheimer's disease; what works?.
        Ageing Res Rev. 2015; 23: 193-209
        • USDA
        Scientific Report of the 2015 Dietary Guidelines Advisory Committee.
        USA, Washington2015
        • van de Rest O.
        • Berendsen A.M.
        • Haveman-Nies A.
        • de Groot C.P.
        Dietary patterns, cognitive decline, and dementia: A systematic review.
        Adv Nutr. 2015; 6: 154-168
        • Appel L.J.
        • Moore T.J.
        • Obarzanek E.
        • et al.
        A clinical trial of the effects of dietary patterns on blood pressure. DASH Collaborative Research Group.
        N Engl J Med. 1997; 336: 1117-1124
        • Blumenthal J.A.
        • Babyak M.A.
        • Hinderliter A.
        • et al.
        Effects of the DASH diet alone and in combination with exercise and weight loss on blood pressure and cardiovascular biomarkers in men and women with high blood pressure: The ENCORE study.
        Arch Intern Med. 2010; 170: 126-135
        • Kilander L.
        • Nyman H.
        • Boberg M.
        • et al.
        Hypertension is related to cognitive impairment: A 20-year follow-up of 999 men.
        Hypertension. 1998; 31: 780-786
        • Launer L.J.
        • Ross G.W.
        • Petrovitch H.
        • et al.
        Midlife blood pressure and dementia: the Honolulu-Asia aging study.
        Neurobiol Aging. 2000; 21: 49-55
        • Duron E.
        • Hanon O.
        Hypertension, cognitive decline and dementia.
        Arch Cardiovasc Dis. 2008; 101: 181-189
        • Wengreen H.
        • Munger R.G.
        • Cutler A.
        • et al.
        Prospective study of Dietary Approaches to Stop Hypertension- and Mediterranean-style dietary patterns and age-related cognitive change: The Cache County Study on Memory, Health and Aging.
        Am J Clin Nutr. 2013; 98: 1263-1271
        • Tangney C.C.
        • Li H.
        • Wang Y.
        • et al.
        Relation of DASH- and Mediterranean-like dietary patterns to cognitive decline in older persons.
        Neurology. 2014; 83: 1410-1416
        • Smith P.J.
        • Blumenthal J.A.
        • Babyak M.A.
        • et al.
        Effects of the dietary approaches to stop hypertension diet, exercise, and caloric restriction on neurocognition in overweight adults with high blood pressure.
        Hypertension. 2010; 55: 1331-1338
        • Willett W.C.
        • Sampson L.
        • Stampfer M.J.
        • et al.
        Reproducibility and validity of a semiquantitative food frequency questionnaire.
        Am J Epidemiol. 1985; 122: 51-65
        • Fung T.T.
        • Chiuve S.E.
        • McCullough M.L.
        • et al.
        Adherence to a DASH-style diet and risk of coronary heart disease and stroke in women.
        Arch Intern Med. 2008; 168: 713-720
        • Launer L.J.
        The epidemiologic study of dementia: a life-long quest?.
        Neurobiol Aging. 2005; 26: 335-340
        • Brandt J.
        • Spencer M.
        • Folstein M.
        The telephone interview for cognitive status.
        Neuropsychiatry Neuropsychol Behav Neurol. 1988; 1: 111-117
        • Albert M.
        • Smith L.A.
        • Scherr P.A.
        • et al.
        Use of brief cognitive tests to identify individuals in the community with clinically diagnosed Alzheimer's disease.
        Int J Neurosci. 1991; 57: 167-178
        • Folstein M.F.
        • Folstein S.E.
        • McHugh P.R.
        “Mini-mental state”. A practical method for grading the cognitive state of patients for the clinician.
        J Psychiatr Res. 1975; 12: 189-198
        • Morris J.C.
        • Heyman A.
        • Mohs R.C.
        • et al.
        The Consortium to Establish a Registry for Alzheimer's Disease (CERAD). Part I. Clinical and neuropsychological assessment of Alzheimer's disease.
        Neurology. 1989; 39: 1159-1165
        • Samieri C.
        • Okereke O.I.
        • Devore E.E.
        • Grodstein F.
        Long-term adherence to the Mediterranean diet is associated with overall cognitive status, but not cognitive decline, in women.
        J Nutr. 2013; 143: 493-499
        • Laird N.M.
        • Ware J.H.
        Random-effects models for longitudinal data.
        Biometrics. 1982; 38: 963-974
        • Dubois B.
        • Feldman H.H.
        • Jacova C.
        • et al.
        Revising the definition of Alzheimer's disease: a new lexicon.
        Lancet Neurol. 2010; 9: 1118-1127
        • Féart C.
        • Samieri C.
        • Rondeau V.
        • et al.
        Adherence to a mediterranean diet, cognitive decline, and risk of dementia.
        JAMA. 2009; 302: 638-648
        • Samieri C.
        • Grodstein F.
        • Rosner B.A.
        • et al.
        Mediterranean diet and cognitive function in older age.
        Epidemiology (Cambridge, Mass). 2013; 24: 490-499
        • Tangney C.C.
        • Kwasny M.J.
        • Li H.
        • et al.
        Adherence to a Mediterranean-type dietary pattern and cognitive decline in a community population.
        Am J Clin Nutr. 2011; 93: 601-607
        • Ye X.
        • Scott T.
        • Gao X.
        • et al.
        Mediterranean diet, healthy eating index 2005, and cognitive function in middle-aged and older puerto rican adults.
        J Acad Nutr Diet. 2013; 113: 276-281
        • Correa Leite M.L.
        • Nicolosi A.
        • Cristina S.
        • et al.
        Nutrition and cognitive deficit in the elderly: a population study.
        Eur J Clin Nutr. 2001; 55: 1053-1058
        • O'Brien J.
        • Okereke O.
        • Devore E.
        • et al.
        Long-term intake of nuts in relation to cognitive function in older women.
        J Nutr Health Aging. 2014; 18: 496-502
        • Lin P.H.
        • Appel L.J.
        • Funk K.
        • et al.
        The PREMIER intervention helps participants follow the Dietary Approaches to Stop Hypertension dietary pattern and the current Dietary Reference Intakes recommendations.
        J Am Diet Assoc. 2007; 107: 1541-1551
        • Grodstein F.
        Cardiovascular risk factors and cognitive function.
        Alzheimers Dement. 2007; 3: S16-S22
        • Corder E.H.
        • Saunders A.M.
        • Strittmatter W.J.
        • et al.
        Gene dose of apolipoprotein E type 4 allele and the risk of Alzheimer's disease in late onset families.
        Science. 1993; 261: 921-923
        • Saunders A.M.
        • Strittmatter W.J.
        • Schmechel D.
        • et al.
        Association of apolipoprotein E allele epsilon 4 with late-onset familial and sporadic Alzheimer's disease.
        Neurology. 1993; 43: 1467-1472
        • Feskens E.J.
        • Havekes L.M.
        • Kalmijn S.
        • et al.
        Apolipoprotein e4 allele and cognitive decline in elderly men.
        BMJ. 1994; 309: 1202-1206
        • Wilson R.S.
        • Schneider J.A.
        • Barnes L.L.
        • et al.
        The apolipoprotein E epsilon 4 allele and decline in different cognitive systems during a 6-year period.
        Arch Neurol. 2002; 59: 1154-1160
        • Barberger-Gateau P.
        • Raffaitin C.
        • Letenneur L.
        • et al.
        Dietary patterns and risk of dementia: The Three-City cohort study.
        Neurology. 2007; 69: 1921-1930
        • Martinez-Lapiscina E.H.
        • Galbete C.
        • Corella D.
        • et al.
        Genotype patterns at CLU, CR1, PICALM and APOE, cognition and Mediterranean diet: The PREDIMED-NAVARRA trial.
        Genes Nutr. 2014; 9: 393-397
        • Gardener S.L.
        • Rainey-Smith S.R.
        • Barnes M.B.
        • et al.
        Dietary patterns and cognitive decline in an Australian study of ageing.
        Mol Psychiatry. 2015; 20: 860-866
        • Cherbuin N.
        • Anstey K.J.
        The Mediterranean diet is not related to cognitive change in a large prospective investigation: The PATH Through Life study.
        Am J Geriatr Psychiatry. 2012; 20: 635-639
        • Roberts R.O.
        • Geda Y.E.
        • Cerhan J.R.
        • et al.
        Vegetables, unsaturated fats, moderate alcohol intake, and mild cognitive impairment.
        Dementia Geriatr Cogn Disord. 2010; 29: 413-423
        • Devore E.E.
        • Kang J.H.
        • Breteler M.M.
        • Grodstein F.
        Dietary intakes of berries and flavonoids in relation to cognitive decline.
        Ann Neurol. 2012; 72: 135-143
        • Hu F.B.
        • Stampfer M.J.
        • Rimm E.
        • et al.
        Dietary fat and coronary heart disease: A comparison of approaches for adjusting for total energy intake and modeling repeated dietary measurements.
        Am J Epidemiol. 1999; 149: 531-540