Association of Habitual Diet Quality and Nutrient Intake with Cognitive Performance in Community-Dwelling Older Adults: A Cross-sectional Study
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Objectives
The rapid aging of the U.S. population has raised concerns about age-related cognitive decline and Alzheimer’s disease. As of 2024, 18% of Americans are ≥65 years—up from 12.4% in 2004—contributing to a projected 7.2 million cases of Alzheimer’s disease among older adults in 2025. Diet is a key modifiable factor for cognitive decline. Therefore, we aimed to characterize diet quality and nutrient intake and to examine the associations between specific dietary components and cognitive performance in older adults in the American Midwest.
Design
The study was designed as a cross-sectional observational study.
Setting
Community-based recruitment in Brookings, South Dakota, and surrounding areas
Participants
A final analytical sample of 72 community-dwelling adults aged 65 years and older
Measurements
Cognitive performance was assessed using subtests from the Consortium to Establish a Registry for Alzheimer’s Disease (CERAD) battery, evaluating episodic memory (Word List Memory/Recall/Recognition), visuospatial skills (Constructional Praxis), and executive function (Verbal Fluency). A composite cognitive score was calculated from memory and visuospatial subtests. Habitual dietary intake was evaluated using structured 24-hour recalls to calculate nutrient intake and the Healthy Eating Index score, supplemented by the Short HEI questionnaire. Demographics, health history, depressive symptoms (Patient Health Questionnaire-9), and sleep quality (Pittsburgh Sleep Quality Index) were also collected.
Results
Participants demonstrated suboptimal diet quality (mean HEI score 54.4 ± 9.4; recommended >80), with only 9.7% meeting fiber recommendations, 11% meeting calcium or vitamin A recommendations, and 1.4% meeting vitamin D requirements. In bivariate comparisons, higher cognitive performance was observed in younger participants (75.5 vs. 79.5 years; p<0.01) and females (78% vs. 50%; p=0.024). Regression models identified significant positive associations between cognitive scores and intakes of dietary fiber (p=0.007), unsaturated fats (mono- and polyunsaturated; p=0.012–0.033), protein (p=0.018), carotenoids (α-carotene, p=0.001; β-carotene, p=0.026; lutein+zeaxanthin, p=0.016), vitamins A (p=0.044) and E (p=0.034), and minerals including magnesium (p=0.006), potassium (p=0.004), copper (p=0.008), zinc (p=0.024), and calcium (p=0.035). Refined grain intake was inversely associated with cognition (p=0.011).
Conclusion
In this population, dietary components like fiber and micronutrients were positively associated with better cognitive function, and the overall nutrient intake shortfalls observed highlight the need for targeted dietary interventions to support healthy brain aging.
