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 Prospective cohort study of 1410 adults (Ն65 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 questionnaire 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 validated 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 (␤=−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

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Objective To assess the potential of anticholinergic drugs as a cause of non-degenerative mild cognitive impairment in elderly people. Design Longitudinal cohort study. Setting 63 randomly selected general practices in the Montpellier region of southern France. Participants 372 people aged > 60 years without dementia at recruitment. Main outcome measures Anticholinergic burden from drug use, cognitive examination, and neurological assessment. Results 9.2% of subjects continuously used anticholinergic drugs during the year before cognitive assessment. Compared with non-users, they had poorer performance on reaction time, attention, delayed non-verbal memory, narrative recall, visuospatial construction, and language tasks but not on tasks of reasoning, immediate and delayed recall of wordlists, and implicit memory. Eighty per cent of the continuous users were classified as having mild cognitive impairment compared with 35% of non-users, and anticholinergic drug use was a strong predictor of mild cognitive impairment (odds ratio 5.12, P = 0.001). No difference was found between users and non-users in risk of developing dementia at follow-up after eight years. Conclusions Elderly people taking anticholinergic drugs had significant deficits in cognitive functioning and were highly likely to be classified as mildly cognitively impaired, although not at increased risk for dementia. Doctors should assess current use of anticholinergic drugs in elderly people with mild cognitive impairment before considering administration of acetylcholinesterase inhibitors.

Frailty is not specific to a subgroup or region of the world. The construct proposed by Fried and colleagues confirms its predictive validity for adverse-health outcomes, particularly for certain components of disability, thus suggesting that it may be useful in population screening and predicting service needs.