Dietary Patterns and Indicators of Cognitive Function

Healthier diets are generally believed to benefit cognitive health; however, the evidence remains inconsistent, and a systematic examination of multiple healthy dietary patterns within the same context is lacking.

To evaluate the associations of 6 healthy patterns with subjective cognitive decline (SCD) and objective cognitive function.

This was a prospective cohort study based on the Nurses' Health Study (NHS, 1986-2014), NHSII (1991-2017), and the Health Professionals Follow-Up Study (HPFS, 1986-2012). Included were adults with available data on diet and cognitive function. Data analyses were performed from September 2024 to November 2025.

Six dietary pattern scores, including the Alternate Healthy Eating Index 2010 (AHEI-2010), the Dietary Approaches to Stop Hypertension (DASH) diet score, the Healthful Plant-Based Diet Index (hPDI), the Planetary Health Diet Index (PHDI), and the reversed empirical dietary indices for hyperinsulinemia (rEDIH) and inflammatory pattern (rEDIP).

SCD was assessed using 7 questions on perceived cognitive changes. Cognitive function was objectively measured via telephone in the NHS.

A total of 159 347 individuals (mean [SD] age, 44.3 [9.3] years; 131 560 female [82.6%]) were included in this analysis. Among the study participants, higher adherence to all 6 dietary patterns was associated with a lower SCD risk. The DASH diet showed the strongest magnitude (risk ratio [RR] comparing 90th vs 10th percentile of adherence: 0.59; 95% CI, 0.57-0.62), followed by the hPDI (RR, 0.76; 95% CI, 0.65-0.85), rEDIH (RR, 0.76; 95% CI, 0.73-0.80), PHDI (RR, 0.80; 95% CI, 0.75-0.86), AHEI-2010 (RR, 0.84; 95% CI, 0.80-0.89), and rEDIP (RR, 0.89; 95% CI, 0.85-0.93). Higher DASH diet score at ages 45 to 54 years showed the strongest association with SCD. Higher adherence to the DASH diet also showed the strongest association with a higher objectively measured global cognition (mean z score difference comparing 90th vs 10th percentile: 0.05; 95% CI, 0.02-0.09). Key food groups associated with better cognitive function included higher vegetable and fish intake and lower red and processed meats intake.

Results reveal that healthy diets, exemplified by the DASH diet for blood pressure control and diets with lower hyperinsulinemia and inflammation potentials, were associated with a lower SCD risk and better cognitive function. These findings underscore the importance of a healthy diet for maintaining long-term cognitive health.