Several scales have been developed to assess individual and population adherence to the Mediterranean diet. The oldest of these is the Mediterranean Diet Scale (MDScale), developed in 1995 and revised since.^[14] The MDScale includes nine components, including beneficial components (i.e., vegetables, legumes, fruits and nuts, cereal, and fish), detrimental components (i.e., meat, poultry, and high-fat dairy products), ethanol intake, and the ratio of monounsaturated to saturated fatty acids. A score of 0 is assigned to someone whose consumption of beneficial components is below the median and a score of 1 is assigned when consumption is at or above the median. For detrimental components, this is reversed: scores of 0 and 1 are assigned when consumption is at or above the median and below the median, respectively. For ethanol, a value of 1 is assigned to men and women who consume 10–50 grams and 5–25 grams per day, respectively. The total score ranges from 0 (minimal adherence) to 9 (maximal adherence).^[14]

Other scales used internationally include the Mediterranean Food Pattern (MFP), the Mediterranean Diet Score (MD Score), the Short Mediterranean Diet Questionnaire (SMDQ), and the MedDiet Score.^[15] While each score differs in its particularities, all of them assess the intake of similar dietary components, and there appears to be a strong correlation among all the scales for measuring adherence to the Mediterranean diet.^[15]

The Mediterranean-Dietary Approaches to Stop Hypertension Intervention for Neurodegenerative Delay — also known as the MIND diet — is a hybrid of the Dietary Approaches to Stop Hypertension diet (DASH) and Mediterranean diets that is specifically designed to prevent or slow the progression of cognitive decline and promote brain health. The MIND diet incorporates components of both diets, but also includes foods rich in certain vitamins, carotenoids, and flavonoids that are putatively associated with a lower risk for Alzheimer’s disease, dementia, and cognitive decline.

Specifically, the MIND diet comprises beneficial foods, including green leafy vegetables, other vegetables (e.g., green/red peppers, squash, carrots, broccoli, celery, potatoes, tomatoes, peas, beets, corn), berries, nuts, olive oil, whole grains, fish, beans, and poultry; and excludes detrimental foods, including butter/margarine, cheese, red meat and other processed meats, fried fast foods, and pastries and sweets. As with the DASH and Mediterranean diets, a small intake of wine (1 glass/day) is permitted and seen as healthful.^[16]

In cohort studies, higher adherence to the MIND diet has been associated with a lower incidence of Alzheimer’s disease,^[17][18] slower rates of cognitive decline,^[16][19][20] and better global cognitive function.^[21][22]

To date, only one long-term (3-year) randomized controlled study on the MIND diet has been conducted.^[23] Results indicated that in older adults without cognitive impairment but with a family history of dementia, the MIND diet was no better than a standard calorie-restricted control diet for improving cognitive function. Similarly, there were no differences in MRI measures of white-matter hyperintensities, hippocampal volume, or total grey- and white-matter volumes between the MIND diet and control groups, suggesting that the MIND diet may not change brain structure or function over this period of time.

The Mediterranean diet does not explicitly recommend alcohol. However, moderate alcohol intake — in particular, red wine consumed with meals — is a recognized part of the dietary pattern.^[24] Moderate intake is defined as up to 2 drinks per day for men and 1 drink per day for women, and is included as a component in most Mediterranean-diet-scoring indexes.

One study found that people who followed a “moderate Mediterranean drinking plan” including the consumption of red wine with meals had a lower mortality risk compared to people who abstained from alcohol and had low adherence to the Mediterranean diet.^[25] Excluding moderate alcohol intake as a component of the Mediterranean diet reduces the overall association of the diet with mortality risk, with alcohol’s contribution being greater than a low red meat consumption or a high vegetable intake.^[26]

These “health-protective” effects of alcohol (red wine) have been attributed to its polyphenol content (e.g., resveratrol), but this is mostly mechanistic speculation; most people don’t accept that alcohol exerts a health benefit per se. Alcohol — especially in large quantities — is toxic to the brain and can increase the risk of accidental deaths and certain types of cancer;^[27] it’s one of the main risk factors for the global burden of disease.^[28] Thus, while a few glasses of red wine can complement the healthy foods that comprise the Mediterranean diet, an individual’s risk factors, tolerance to alcohol, and personal/religious beliefs should all be taken into consideration. The Mediterranean diet can be incredibly health-promoting in the absence of alcohol.