MIND diet moderates the associations between cerebrovascular and neurodegenerative disease burden and cognition.

INTRODUCTION: The Mediterranean-Dietary Approaches to Stop Hypertension Intervention for Neurodegenerative Delay (MIND) diet is associated with reduced dementia risk, but its role in moderating pathology-cognition relationships in high-risk populations remains unclear. This study examined associations of the MIND diet and Healthy Eating Index (HEI) with cognition and tested whether diet quality modifies the impact of brain pathology on cognitive performance. METHODS: Sixty-six older adults (aged 60-82 years; mean education of 12 years, 65% Black, 73% female) completed MRI and the VioScreen food frequency questionnaire (FFQ). Multivariable linear regression models examined associations between diet scores (MIND, HEI-2020) and cognitive outcomes (cognition composite, memory, executive function), adjusting for age, sex, and education level. Interaction analyses cross-sectionally tested whether diet moderated relationships between structural brain pathology-white matter hyperintensity (WMH), hippocampal, and cortical volumes-and cognition, followed by post-hoc simple slopes analyses. RESULTS: Higher MIND diet scores were independently associated with better memory performance (p < 0.05). These were significant interactions between WMH volume and MIND diet score across cognitive outcomes (all p-interactions < 0.05). Greater WMH volume was associated with worse cognitive performance at low (all p < 0.01), but not mean or high MIND diet scores (all p > 0.05). Similarly, cortical volume-cognition associations were present in those with low MIND diet scores and attenuated in those with mean or high scores. In contrast, the HEI-2020 score did not modify the effects of brain pathology on cognition, and neither diet quality measure modified hippocampal volume-cognition relationships. CONCLUSION: The MIND diet may buffer the cognitive consequences of cerebrovascular pathology and cortical atrophy in older adults at elevated dementia risk and promote cognitive resilience over general healthy eating guidelines.