***TASK*** the task is to summarize an input biomedical literature in six sentences 
    ***INPUT*** the input is a biomedical literature 
    ***OUTPUT*** the output is the summary of an input biomedical literature in six sentences 
    ***DOCUMENTATION*** 
    ***EXAMPLES*** 
    Input: BACKGROUND The Lyon Diet Heart Study is a r and omized secondary prevention trial aim ed at testing whether a Mediterranean-type diet may reduce the rate of recurrence  after a first myocardial infa rct ion . An intermediate analysis showed a striking protective effect after 27 months of follow-up . This report presents results of an extended follow-up ( with a mean of 46 months per patient ) and deals with the relationships of dietary patterns and traditional risk factors with recurrence . METHODS AND RESULTS Three composite outcomes ( COs ) combining either cardiac death and nonfatal myocardial infa rct ion ( CO 1 ) , or the preceding plus major secondary end points ( unstable angina , stroke , heart failure , pulmonary or peripheral embolism ) ( CO 2 ) , or the preceding plus minor events requiring hospital admission ( CO 3 ) were studied . In the  Mediterranean diet group , CO 1 was reduced ( 14 events versus 44 in the prudent Western-type diet group , P=0.0001 ) , as were CO 2 ( 27 events versus 90 , P=0.0001 ) and CO 3 ( 95 events versus 180 , P=0 . 0002 ) . Adjusted risk ratios ranged from 0.28 to 0.53 . Among the traditional risk factors , total cholesterol ( 1 mmol/L being associated with an increased risk of 18 % to 28 % ) , systolic blood pressure ( 1 mm Hg being associated with an increased risk of 1 % to 2 % ) , leukocyte count ( adjusted risk ratios ranging from 1.64 to 2.86 with count > 9x10(9)/L ) , female sex ( adjusted risk ratios , 0.27 to 0 . 46 ) , and aspirin use ( adjusted risk ratios , 0.59 to 0.82 ) were each significantly and independently associated with recurrence . CONCLUSIONS The protective effect of the Mediterranean dietary pattern was maintained up to 4 years after the first infa rct ion , confirming previous intermediate analyses . Major traditional risk factors , such as high blood cholesterol and blood pressure , were shown to be independent and joint predictors of recurrence , indicating that the Mediterranean dietary pattern did not alter , at least qualitatively , the usual relationships between major risk factors and recurrence . Thus , a comprehensive strategy to decrease cardiovascular morbidity and mortality should include primarily a cardioprotective diet . It should be associated with other ( pharmacological ? ) means aim ed at reducing modifiable risk factors . Further trials combining the 2 approaches are warranted CONTEXT Higher adherence to a Mediterranean-type diet is linked to lower risk for mortality and chronic diseases , but its association with cognitive decline is unclear . OBJECTIVE To investigate the association of a Mediterranean diet with change in cognitive performance and risk for dementia in elderly French persons . DESIGN , SETTING , AND PARTICIPANTS Prospect i ve cohort study of 1410 adults ( > or = 65 years ) from Bordeaux , France , included in the Three-City cohort in 2001 - 2002 and reexamined at least once over 5 years .  Adherence to a Mediterranean diet ( scored as 0 to 9 ) was computed from a food frequency question naire and 24-hour recall . MAIN OUTCOME MEASURES Cognitive performance was assessed on 4 neuropsychological tests : the Mini-Mental State Examination ( MMSE ) , Isaacs Set Test ( IST ) , Benton Visual Retention Test ( BVRT ) , and Free and Cued Selective Reminding Test ( FCSRT ) . Incident cases of dementia ( n = 99 ) were vali date d by an independent expert committee of neurologists . RESULTS Adjusting for age , sex , education , marital status , energy intake , physical activity , depressive symptomatology , taking 5 medications/d or more , apolipoprotein E genotype , cardiovascular risk factors , and stroke , higher Mediterranean diet score was associated with fewer MMSE errors ( beta = -0.006 ; 95 % confidence interval [ CI ] , -0.01 to -0.0003 ; P = .04 for 1 point of the Mediterranean diet score ) . Performance on the IST , BVRT , or FCSRT over time was not significantly associated with Mediterranean diet adherence . Greater adherence as a categorical variable ( score 6 - 9 ) was not significantly associated with fewer MMSE errors and better FCSRT scores in the entire cohort , but among individuals who remained free from dementia over 5 years , the association for the highest compared with the lowest group was significant ( adjusted for all factors , for MMSE : beta = -0.03 ; 95 % CI , -0.05 to -0.001 ; P = .04 ; for FCSRT : beta = 0.21 ; 95 % CI , 0.008 to 0.41 ; P = .04 ) . Mediterranean diet adherence was not associated with the risk for incident dementia ( fully adjusted model : hazard ratio , 1.12 ; 95 % CI , 0.60 to 2.10 ; P = .72 ) , although power to detect a difference was limited . CONCLUSIONS Higher adherence to a Mediterranean diet was associated with slower MMSE cognitive decline but not consistently with other cognitive tests . Higher adherence was not associated with risk for incident dementia Although elevated plasma cholesterol levels represent a well-established and significant risk for developing atherosclerosis , there is a wide spectrum of cholesterol levels in patients with coronary artery disease ( CAD ) . Most secondary prevention studies have generated convincing evidence that cholesterol reduction in patients with high cholesterol levels is associated with improved clinical outcome by reducing risk of further cardiovascular events . However , other risk factors may play a prominent role in the pathogenesis of coronary disease in the majority of patients with near-normal cholesterol values . The Cholesterol and Recurrent Events ( CARE ) study was design ed to address whether the pharmacologic reduction of cholesterol levels with the 3-hydroxy-3-methylglutaryl coenzyme A ( HMG-CoA ) reductase inhibitor , pravastatin , would reduce the sum of fatal coronary artery disease ( CAD ) and nonfatal myocardial infa rct ion ( MI ) in patients who have survived an MI yet have a total cholesterol value < 240 mg/dl ( < 6.2 mmol/liter ) . The other inclusion criteria for this study were age 21 - 75 years , low density lipoprotein ( LDL ) cholesterol levels of 115 - 174 mg/dl ( 3.0 - 4.5 mmol/liter ) , and fasting serum triglyceride levels < 350 mg/dl ( < 4.0 mmol/liter ) . A total of 4,159 eligible consenting patients without other study exclusions were then r and omly assigned to receive either pravastatin 40 mg daily or matching placebo in addition to their individualized conventional therapy . The trial was design ed to have a median follow-up of 5 years . Study endpoints will be evaluated with respect to predefined subgroups according to baseline lipid values , age , gender , prior cardiovascular risk factors , and history . ( ABSTRACT TRUNCATED AT 250 WORDS CONTEXT Both higher adherence to a Mediterranean-type diet and more physical activity have been independently associated with lower Alzheimer disease ( AD ) risk but their combined association has not been investigated . OBJECTIVE To investigate the combined association of diet and physical activity with AD risk . DESIGN , SETTING , AND PATIENTS Prospect i ve cohort study of 2 cohorts comprising 1880 community-dwelling elders without dementia living in New York , New York , with both diet and physical activity information available . St and ardized neurological and neuropsychological measures were administered approximately every 1.5 years from 1992 through 2006 . Adherence to a Mediterranean-type diet ( scale of 0 - 9 ; trichotomized into low , middle , or high ; and dichotomized into low or high ) and physical activity ( sum of weekly participation in various physical activities , weighted by the type of physical activity [ light , moderate , vigorous ] ; trichotomized into no physical activity , some , or much ; and dichotomized into low or high ) , separately and combined , were the main predictors in Cox models . Models were adjusted for cohort , age , sex , ethnicity , education , apolipoprotein E genotype , caloric intake , body mass index , smoking status , depression , leisure activities , a comorbidity index , and baseline Clinical Dementia Rating score . MAIN OUTCOME MEASURE Time to incident AD . RESULTS A total of 282 incident AD cases occurred during a mean ( SD ) of 5.4 ( 3.3 ) years of follow-up . When considered simultaneously , both  Mediterranean-type diet adherence  ( compared with low diet score , hazard ratio [ HR ] for middle diet score was 0.98 [ 95 % confidence interval { CI } , 0.72 - 1.33 ] ; the HR for high diet score was 0.60 [ 95 % CI , 0.42 - 0.87 ] ; P = .008 for trend ) and physical activity ( compared with no physical activity , the HR for some physical activity was 0.75 [ 95 % CI , 0.54 - 1.04 ] ; the HR for much physical activity was 0.67 [ 95 % CI , 0.47 - 0.95 ] ; P = .03 for trend ) were associated with lower AD risk . Compared with individuals neither adhering to the diet nor participating in physical activity ( low diet score and no physical activity ; absolute AD risk of 19 % ) , those both adhering to the diet and participating in physical activity ( high diet score and high physical activity ) had a lower risk of AD ( absolute risk , 12 % ; HR , 0.65 [ 95 % CI , 0.44 - 0.96 ] ; P = .03 for trend ) . CONCLUSION In this study , both higher Mediterranean-type diet adherence and higher physical activity were independently associated with reduced risk for AD OBJECTIVE To determine whether the Mediterranean diet and other dietary variables are predictors of transition from healthy cognitive aging to mild cognitive impairment and cognitive decline . DESIGN Longitudinal . PARTICIPANTS We assessed 1528 individuals , aged 60 - 64 years , who were participating in a prospect i ve epidemiological study of mental health and aging . We tested participants at two time points , 4 years apart , for mild cognitive impairment using either the International Consensus Criteria , impairment on the Clinical Dementia Rating scale ( Clinical Dementia Rating : 0.5 ) , or any of a suite of criteria sets ( any mild cognitive disorder ) . We used logistic regression to assess the dietary predictors of conversion to clinical diagnoses and multiple regression to identify the predictors of cognitive decline ( change in global cognition ) in healthy participants . RESULTS Of the 1528 participants with no cognitive impairment in the first wave of assessment and complete data , 10 participants were diagnosed with mild cognitive impairment , 19 with Clinical Dementia Rating 0.5 , and 37 participants presented with any mild cognitive disorder at follow-up . Adherence to Mediterranean diet was not found to be protective against cognitive decline but excessive caloric intake , and high intake of monounsaturated fats was predictive of mild cognitive impairment . CONCLUSIONS In this large longitudinal investigation of generally healthy individuals Mediterranean diet was not found to be protective of cognitive decline In this large-scale prospect i ve epidemiological study , we examined associations of long-term adherence to the Mediterranean diet ( MeDi ) and subsequent cognitive function and decline .  We included 16,058 women from the Nurses ' Health Study , aged ≥70 y , who underwent cognitive testing by telephone 4 times during 6 y , beginning in 1995 - 2001 , and provided repeated information on diet between 1984 and the first cognitive exam . Primary outcomes were the Telephone Interview for Cognitive Status ( TICS ) and composite scores of verbal memory and global cognition .  MeDi adherence was based on intakes of : vegetables , fruits , legumes , whole grains , nuts , fish , red and processed meats , moderate alcohol , and the ratio of monounsaturated : saturated fat . Long-term MeDi exposure was estimated by averaging all repeated measures of diet ( > 13 y , on average ) . In primary analyses of cognitive change , the MeDi was not associated with decline in global cognition or verbal memory . In a secondary approach examining cognitive status in older age , determined by averaging all 4 repeated measures of cognition , each higher quintile of long-term MeDi score was linearly associated with better multivariable-adjusted mean cognitive scores [ differences in mean Z-scores between extreme quintiles of MeDi = 0.06 ( 95 % CI : 0.01 , 0.11 ) ; = 0.05 ( 95 % CI : 0.01 , 0.08 ) ; and = 0.06 ( 95 % CI : 0.03 , 0.10 ) st and ard units ; P-trends = 0.004 , 0.002 , and < 0.001 for TICS , global cognition , and verbal memory , respectively ] . These associations were similar to those 
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Data from Greece , Serbia , and Italy clearly showed lower coronary heart disease rates among mediterranean population s ( as well as among the Japanese ) , compared with those from northern europe or the United States .
Longitudinal studies of cognitive function generally showed that greater adherence to a mediterranean diet was associated with better function .
Studies of the mediterranean diet and alzheimer ’s disease also demonstrated a benefit .
It may be fair to say that the perception that mediterranean diet patterns are beneficial for cognitive function in the elderly rests principally with the WHICaP findings