Considerations in selection of diet assessment methods for examining the effect of nutrition on cognition

Older adults are the most rapidly growing age group in the United States, and it is estimated that 22.2% of U.S. adults over 71 years of age have cognitive impairments without dementia and 13.9% have dementia. Cognitive impairment is associated with reduced quality of life, increased risk of hospitalization, inability to live independently, and increased health care costs; therefore, identification of modifiable risk factors for prevention and delay of cognitive decline is of increasing importance. There is a growing body of research and interest in the relationship between diet and cognitive function. Epidemiologic studies suggest that cognitive function may be improved and cognitive decline prevented as a function of a particular nutrient, food group or dietary pattern; however, results from these trials have failed to be replicated in randomized controlled trials. One possible reason for the equivocality of findings in the diet and cognitive function literature may be the methodological issues and limitations in the assessment of dietary patterns and nutritional intake. Self-reported dietary data can be biased by many factors such as age, gender, socioeconomic status, and education; yet, there is limited research on the impact of cognitive function on the integrity of self-reported dietary data. Cognitive function itself may bias diet assessment methods, subsequently obscuring the evaluation of the nutrition-cognition relationship. The present review summarizes methodological validation studies that provide insight into potential errors of diet assessment methods due to cognitive function, identifies research gaps and provides recommendations for improving diet assessment accuracy in studies of individuals with cognitive impairments.