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Mediterranean and MIND Dietary Patterns and Cognitive Performance in Multiple Sclerosis: A Cross-Sectional Analysis of the UK Multiple Sclerosis Register

Maggie Yu, Steve Simpson-Yap, Annalaura Lerede Orcid Logo, Richard Nicholas, Shelly Coe Orcid Logo, Thanasis G. Tektonidis Orcid Logo, Eduard Martinez Solsona, Rod Middleton Orcid Logo, Yasmine Probst Orcid Logo, Adam Hampshire, Elasma Milanzi, Guangqin Cui, Rebekah Allison Davenport Orcid Logo, Sandra Neate, Mia Pisano, Harry Kirkland, Jeanette Reece Orcid Logo

Nutrients, Volume: 17, Issue: 21, Start page: 3326

Swansea University Authors: Richard Nicholas, Rod Middleton Orcid Logo

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DOI (Published version): 10.3390/nu17213326

Abstract

Background: Multiple sclerosis (MS) is a chronic auto-immune neuroinflammatory disorder presenting as a range of systemic and neurological symptoms, including cognitive impairment. Emerging evidence suggests that diets targeting brain health—such as the Mediterranean (MED) and Mediterranean-DASH Int...

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Published in: Nutrients
ISSN: 2072-6643
Published: MDPI AG 2025
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URI: https://cronfa.swan.ac.uk/Record/cronfa70817
Abstract: Background: Multiple sclerosis (MS) is a chronic auto-immune neuroinflammatory disorder presenting as a range of systemic and neurological symptoms, including cognitive impairment. Emerging evidence suggests that diets targeting brain health—such as the Mediterranean (MED) and Mediterranean-DASH Intervention for Neurodegenerative Delay (MIND) diets—may improve cognitive function; however, studies examining their role in people living with MS are limited. Methods: We examined cross-sectional associations between diet and cognition data from 967 participants in the United Kingdom Multiple Sclerosis Register (UKMSR). Dietary pattern scores (alternate Mediterranean; aMED, and MIND) were derived from the 130-item EPIC-Norfolk food frequency questionnaire. Cognition was assessed using the MS-specific Cognitron-MS (C-MS) battery (13 tasks) and summarised as overall cognition (global G factor) and four domains (object memory, problem solving, information processing speed [IPS], and words memory). Cognitive outcomes were expressed as Deviation-from-Expected (DfE) scores standardised to demographic and device characteristics using external regression-based norms. Linear models were adjusted for total energy intake, MS phenotype, disease duration since diagnosis, and current disease-modifying therapy (DMT) use. Interactions tested moderation by MS phenotype (relapsing vs. progressive MS) and current DMT use (yes vs. no). Sensitivity analyses included within-domain multiple-comparison control, rank-based inverse-normal transformation, and winsorisation. Results: Greater alignment with aMED and MIND dietary patterns were associated with higher scores in specific cognitive domains but not in overall cognition. Higher aMED scores were associated most consistently with better IPS, while higher MIND scores were additionally associated with better words memory. In categorical models, participants with the middle or highest tertiles of aMED or MIND scores performed up to ~0.4 SD better on tasks of Verbal Analogies, Word Definitions, Simple Reaction Time, Words Memory Immediate, or Words Memory Delays compared with those in the lowest tertile. These findings were robust across sensitivity analyses. Stratified analyses showed differential cognitive performance and diet-cognition associations by MS phenotype and DMT use. Conclusions: Mediterranean and MIND dietary patterns showed modest cross-sectional associations with specific cognition domains, with differential cognitive performance in different subgroups according to MS phenotype and DMT use. Although causal inference is not possible, our findings indicate future MS-related dietary studies (longitudinal and/or randomised controlled trials) examining cognitive function domains across different MS subgroups are warranted.
Keywords: multiple sclerosis; cognitive performance; cross-sectional study; mediterranean diet; MIND diet
College: Faculty of Medicine, Health and Life Sciences
Funders: This research was funded by the MULTIPLE SCLEROSIS AUSTRALIA project grant under grant number MSA #222089. A.L. conducted this work as part of the UK Research and Innovation Centre for Doctoral Training in Artificial Intelligence for Healthcare (http://ai4health.io, grant number EP/S023283/1), and as part of a postdoctoral position funded by the Institute of Psychiatry, Psychology & Neuroscience at King’s College London.
Issue: 21
Start Page: 3326

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