Results:

Of the 6,377 participants, 6,321 had completed one or more dietary recalls. Sex, history of diabetes, and lipids were not statistically different between the groups. Mediterranean diet adherence weighted frequencies were 35.8% (n = 2,112 of 6,321) for the low adherence group, 45.4% (n = 2,795) for the moderate adherence group, and 18.8% (n = 1,414) for the high adherence group. Compared with participants in the low adherence group, adults in the moderate and high adherence groups were less likely to be born in the United States, less likely to use English as their preferred language, and less likely to have health insurance. The high adherence group had a lower prevalence of hypertension, history of stroke or transient ischemic attack, current or previous smoking status, and a lower mean number of vascular risk factors. In the fully adjusted model, z score–transformed cognitive scores at visit 1 in the high versus low adherence groups were higher for B-SEVLT Sum (β = 0.11; 95% confidence interval [CI], 0.02-0.20), B-SEVLT Recall (β = 0.16; 95% CI, 0.07-0.25), and global cognition (β = 0.10; 95% CI, 0.04-0.16) tests. After a mean follow-up time of 7 years, cognitive change in the high versus low adherence groups was less pronounced for B-SEVLT Sum (β = 0.12; 95% CI, 0.05-0.20) and B SEVLT Recall (β = 0.14; 95% CI, 0.05-0.23), but not for word fluency, DSST score, or global cognition score.