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February 14, 2023; 100 (7) Research Article

Association of Dietary Intake of Flavonols With Changes in Global Cognition and Several Cognitive Abilities

View ORCID ProfileThomas Monroe Holland, View ORCID ProfilePuja Agarwal, Yamin Wang, View ORCID ProfileKlodian Dhana, View ORCID ProfileSue E. Leurgans, Kyla Shea, Sarah L. Booth, Kumar B. Rajan, Julie A. Schneider, Lisa L. Barnes
First published November 22, 2022, DOI: https://doi.org/10.1212/WNL.0000000000201541
Thomas Monroe Holland
From the Rush Institute for Healthy Aging (T.M.H., K.D., K.B.R.), Rush University Medical Center, Chicago, IL; Department of Clinical Nutrition (T.M.H., P.A.), Rush University Medical Center, Chicago, IL; Rush Alzheimer's Disease Center (P.A., Y.W., S.E.L., J.A.S., L.L.B.), Rush University Medical Center, Chicago, IL; Department of Neurological Sciences (S.E.L., J.A.S., L.L.B.), Rush University Medical Center, Chicago, IL; and Jean Mayer USDA Human Nutrition Research Center on Aging (K.S., S.L.B.), Tufts University, Boston, MA.
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Puja Agarwal
From the Rush Institute for Healthy Aging (T.M.H., K.D., K.B.R.), Rush University Medical Center, Chicago, IL; Department of Clinical Nutrition (T.M.H., P.A.), Rush University Medical Center, Chicago, IL; Rush Alzheimer's Disease Center (P.A., Y.W., S.E.L., J.A.S., L.L.B.), Rush University Medical Center, Chicago, IL; Department of Neurological Sciences (S.E.L., J.A.S., L.L.B.), Rush University Medical Center, Chicago, IL; and Jean Mayer USDA Human Nutrition Research Center on Aging (K.S., S.L.B.), Tufts University, Boston, MA.
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Yamin Wang
From the Rush Institute for Healthy Aging (T.M.H., K.D., K.B.R.), Rush University Medical Center, Chicago, IL; Department of Clinical Nutrition (T.M.H., P.A.), Rush University Medical Center, Chicago, IL; Rush Alzheimer's Disease Center (P.A., Y.W., S.E.L., J.A.S., L.L.B.), Rush University Medical Center, Chicago, IL; Department of Neurological Sciences (S.E.L., J.A.S., L.L.B.), Rush University Medical Center, Chicago, IL; and Jean Mayer USDA Human Nutrition Research Center on Aging (K.S., S.L.B.), Tufts University, Boston, MA.
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Klodian Dhana
From the Rush Institute for Healthy Aging (T.M.H., K.D., K.B.R.), Rush University Medical Center, Chicago, IL; Department of Clinical Nutrition (T.M.H., P.A.), Rush University Medical Center, Chicago, IL; Rush Alzheimer's Disease Center (P.A., Y.W., S.E.L., J.A.S., L.L.B.), Rush University Medical Center, Chicago, IL; Department of Neurological Sciences (S.E.L., J.A.S., L.L.B.), Rush University Medical Center, Chicago, IL; and Jean Mayer USDA Human Nutrition Research Center on Aging (K.S., S.L.B.), Tufts University, Boston, MA.
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Sue E. Leurgans
From the Rush Institute for Healthy Aging (T.M.H., K.D., K.B.R.), Rush University Medical Center, Chicago, IL; Department of Clinical Nutrition (T.M.H., P.A.), Rush University Medical Center, Chicago, IL; Rush Alzheimer's Disease Center (P.A., Y.W., S.E.L., J.A.S., L.L.B.), Rush University Medical Center, Chicago, IL; Department of Neurological Sciences (S.E.L., J.A.S., L.L.B.), Rush University Medical Center, Chicago, IL; and Jean Mayer USDA Human Nutrition Research Center on Aging (K.S., S.L.B.), Tufts University, Boston, MA.
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Kyla Shea
From the Rush Institute for Healthy Aging (T.M.H., K.D., K.B.R.), Rush University Medical Center, Chicago, IL; Department of Clinical Nutrition (T.M.H., P.A.), Rush University Medical Center, Chicago, IL; Rush Alzheimer's Disease Center (P.A., Y.W., S.E.L., J.A.S., L.L.B.), Rush University Medical Center, Chicago, IL; Department of Neurological Sciences (S.E.L., J.A.S., L.L.B.), Rush University Medical Center, Chicago, IL; and Jean Mayer USDA Human Nutrition Research Center on Aging (K.S., S.L.B.), Tufts University, Boston, MA.
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Sarah L. Booth
From the Rush Institute for Healthy Aging (T.M.H., K.D., K.B.R.), Rush University Medical Center, Chicago, IL; Department of Clinical Nutrition (T.M.H., P.A.), Rush University Medical Center, Chicago, IL; Rush Alzheimer's Disease Center (P.A., Y.W., S.E.L., J.A.S., L.L.B.), Rush University Medical Center, Chicago, IL; Department of Neurological Sciences (S.E.L., J.A.S., L.L.B.), Rush University Medical Center, Chicago, IL; and Jean Mayer USDA Human Nutrition Research Center on Aging (K.S., S.L.B.), Tufts University, Boston, MA.
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Kumar B. Rajan
From the Rush Institute for Healthy Aging (T.M.H., K.D., K.B.R.), Rush University Medical Center, Chicago, IL; Department of Clinical Nutrition (T.M.H., P.A.), Rush University Medical Center, Chicago, IL; Rush Alzheimer's Disease Center (P.A., Y.W., S.E.L., J.A.S., L.L.B.), Rush University Medical Center, Chicago, IL; Department of Neurological Sciences (S.E.L., J.A.S., L.L.B.), Rush University Medical Center, Chicago, IL; and Jean Mayer USDA Human Nutrition Research Center on Aging (K.S., S.L.B.), Tufts University, Boston, MA.
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Julie A. Schneider
From the Rush Institute for Healthy Aging (T.M.H., K.D., K.B.R.), Rush University Medical Center, Chicago, IL; Department of Clinical Nutrition (T.M.H., P.A.), Rush University Medical Center, Chicago, IL; Rush Alzheimer's Disease Center (P.A., Y.W., S.E.L., J.A.S., L.L.B.), Rush University Medical Center, Chicago, IL; Department of Neurological Sciences (S.E.L., J.A.S., L.L.B.), Rush University Medical Center, Chicago, IL; and Jean Mayer USDA Human Nutrition Research Center on Aging (K.S., S.L.B.), Tufts University, Boston, MA.
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Lisa L. Barnes
From the Rush Institute for Healthy Aging (T.M.H., K.D., K.B.R.), Rush University Medical Center, Chicago, IL; Department of Clinical Nutrition (T.M.H., P.A.), Rush University Medical Center, Chicago, IL; Rush Alzheimer's Disease Center (P.A., Y.W., S.E.L., J.A.S., L.L.B.), Rush University Medical Center, Chicago, IL; Department of Neurological Sciences (S.E.L., J.A.S., L.L.B.), Rush University Medical Center, Chicago, IL; and Jean Mayer USDA Human Nutrition Research Center on Aging (K.S., S.L.B.), Tufts University, Boston, MA.
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Association of Dietary Intake of Flavonols With Changes in Global Cognition and Several Cognitive Abilities
Thomas Monroe Holland, Puja Agarwal, Yamin Wang, Klodian Dhana, Sue E. Leurgans, Kyla Shea, Sarah L. Booth, Kumar B. Rajan, Julie A. Schneider, Lisa L. Barnes
Neurology Feb 2023, 100 (7) e694-e702; DOI: 10.1212/WNL.0000000000201541

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Abstract

Background and Objectives Previous research has examined the association between cognition and flavonoids: bioactives found in foods, known to possess anti-inflammatory and antioxidant properties. We extend this research by investigating associations of dietary intakes of total flavonols and constituents (kaempferol, quercetin, myricetin, and isorhamnetin) on the change in cognitive performance in global cognition, episodic memory, semantic memory, visuospatial ability, perceptual speed, and working memory.

Methods The study was conducted using 961 participants (aged 60–100 years) of the Rush Memory and Aging Project, a prospective cohort of community-dwelling Chicagoans who were followed for an average of 6.9 years. Diet was assessed using a validated semiquantitative food frequency questionnaire. Cognitive performance was assessed annually with a battery of 19 standardized tests. Flavonol intake was analyzed as a continuous variable using linear mixed-effects models. Cognitive domain scores were regressed on baseline calorie-adjusted flavonol variables.

Results Higher dietary intakes of total flavonols and flavonol constituents were associated with a slower rate of decline in global cognition and multiple cognitive domains. In continuous models adjusted for age, sex, education, APOE ɛ4, late-life cognitive activity, physical activity, and smoking, total flavonol intake was associated with slower decline in global cognition β estimate = 0.004 (95% CI 0.001–0.006), episodic memory β = 0.004 (95% CI 0.002–0.006), semantic memory β = 0.003 (95% CI 0.001–0.007), perceptual speed β = 0.003 (95% CI 0.001–0.004), and working memory β = 0.003 (95% CI 0.001–0.005) and marginally associated with visuospatial ability β = 0.001 (95% CI −0.001 to 0.003). Analyses of individual flavonol constituents demonstrated that intakes of kaempferol and quercetin were associated with slower global cognitive decline (β = 0.01 [95% CI 0.006–0.02] and β = 0.004 [95% CI 0.0005–0.007]), respectively. Myricetin and isorhamnetin were not associated with global cognition.

Discussion Results suggest that dietary intakes of total flavonols and several flavonol constituents may be associated with slower decline in global cognition and multiple cognitive abilities with older age.

Glossary

MAP=
Memory and Aging Project;
FFQ=
food frequency questionnaire;
RADC=
Rush Alzheimer's Disease Center

Footnotes

  • Go to Neurology.org/N for full disclosures. Funding information and disclosures deemed relevant by the authors, if any, are provided at the end of the article.

  • Submitted and externally peer reviewed. The handling editor was Linda Hershey, MD, PhD, FAAN.

  • Received October 21, 2021.
  • Accepted in final form September 26, 2022.
  • © 2022 American Academy of Neurology
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  • Reader Response: Association of Dietary Intake of Flavonols With Changes in Global Cognition and Several Cognitive Abilities
    • Steven Brenner, Retired Neurologist, Saint Louis University Neurology Dept. (retired)
    Submitted December 21, 2022
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