While a recent study found that cocoa extract had no effect on improving cognitive ability in older people, it did find, however, that a daily dose of multivitamin-mineral supplements improved the memory, executive function, and cognition of those at risk of developing disorders like Alzheimer’s Disease and other forms of dementia.
While experts are still working to understand what factors influence cognitive function and what measures people can take to help prevent cognitive decline, the study, published in Alzheimer’s & Dementia, examined whether or not taking a daily multivitamin or cocoa extract affected cognitive function in older adults.
Although the authors saw no improvements related to taking cocoa, there were positive findings with a daily multivitamin-mineral supplement.
Study author Laura Baker, PhD, professor of gerontology and geriatric medicine at Wake Forest University School of Medicine in Winston-Salem, North Carolina, told MedicalNewsToday: “Daily supplementation with a multivitamin shows potential of improving (or protecting) cognitive abilities in older adults. While more work is needed before a widespread recommendation can be made, the daily supplementation showed a relatively stronger benefit for adults with cardiovascular disease.
“Since only 10% of our sample (~200 people) reported significant cardiovascular events (e.g., stent, congestive heart failure, angioplasty) at the time they entered the study, this finding needs to be replicated in a larger sample that includes more individuals with significant cardiovascular disease.”
Multivitamin and cognitive decline
For the study, the researchers looked at how taking daily cocoa extract or a daily multivitamin-mineral (MVM) supplement affected cognitive function compared with a placebo.
They performed a randomised clinical trial that included more than 2 000 adults aged 65 and older.
Participants had to meet specific eligibility criteria to be in the study. For example, they had to have no history of heart attacks or have a serious illness that would prevent them from participating. They also couldn’t have allergies to cocoa products or caffeine.
The research team set up a baseline for participants’ cognitive function at the beginning of the study.
They also looked at participants’ ability to recall events and memories (episodic memory) and their executive function, which has to do with focus and thinking. They reassessed these components annually for three years.
Results from the study show that cocoa extract did not affect cognition. However, multivitamin use was associated with improved cognition, executive function and episodic memory. Participants with cardiovascular disease saw the greatest benefit.
Cognitive decline in the older adults
Many people experience some level of age-related cognitive decline as they get older – occasionally forgetting details or misplacing something can happen more with age.
But severe cognitive decline may lead to Alzheimer’s disease and dementia, which involves significant changes in a person’s ability to remember or make judgments, and affects their everyday life.
While Alzheimer’s and other forms of dementia are not a usual part of getting older, people over 65 are more at risk of developing these conditions.
Dr Austin Perlmutter, an internal medicine physician, author, a senior director of Science and Clinical Innovation at Big Bold Health, not involved in the study, told MNT:
“Researchers tend to agree that on the whole, ageing is linked to alterations in cognitive function. What is arguably the most commonly discussed change in brain function associated with ageing is a decline in long-term memory, where a general worsening of memory has sometimes been called part of ‘normal ageing’.
“More significant worsening is tethered to dementias like Alzheimer’s disease. There’s also work suggesting a general decline in working memory (a temporary storage system in our brains that lets us work with multiple bits of information) in the elderly as well as relatively more trouble with multitasking.”
Of the study, he said the “positive correlation between the multivitamin consumption and cognition versus placebo is notable, and while the overall data on multivitamins has been less supportive of a clear net benefit in the general population, it does provide some support for the idea that ensuring adequate levels of key micronutrients may be helpful for longer-term brain health in ageing populations, especially those with pre-existing vascular disease”.
Limitations and areas for future research
Overall, the study findings indicate that taking a daily multivitamin is associated with improved cognitive function among older adults. However, there were some limitations.
For instance, the data relied on self-reporting from participants, which can increase the risk of errors in data collection. Representation of certain races or ethnicities did not reflect the older American population. Therefore, the study’s results cannot be generalised, and future studies will need to account for diversity.
In addition, researchers were also unable to link cocoa to the cognitive benefits they observed. They also note that more research is needed to confirm the cognitive benefits of the multivitamin. Other limitations were related to specific data analyses.
Baker noted the following areas for continued research to MNT: “These results point to a new avenue of investigation that will hopefully identify a highly accessible, inexpensive, and safe intervention to provide a layer of protection against cognitive decline for older adults. The results need to be replicated in a larger group that is more representative of the US demographics (e.g., only 11% of our cohort represented communities of colour).
“We need to understand the mechanisms that might account for the observed multivitamin cognitive benefit.”
Study details
Effects of cocoa extract and a multivitamin on cognitive function: A randomized clinical trial
Laura Baker, Joann Manson, Stephen Rapp, Howard Sesso, Sarah Gaussoin, Sally Shumaker, Mark Espeland.
Published in Alzheimer’s & Dementia on 14 September 2022
Abstract
Introduction
Dietary supplements are touted for cognitive protection, but supporting evidence is mixed. COSMOS-Mind tested whether daily administration of cocoa extract (containing 500 mg/day flavanols) versus placebo and a commercial multivitamin-mineral (MVM) versus placebo improved cognition in older women and men.
Methods
COSMOS-Mind, a large randomised two-by-two factorial 3-year trial, assessed cognition by telephone at baseline and annually. The primary outcome was a global cognition composite formed from mean standardizsed (z) scores (relative to baseline) from individual tests, including the Telephone Interview of Cognitive Status, Word List and Story Recall, Oral Trail-Making, Verbal Fluency, Number Span, and Digit Ordering. Using intention-to-treat, the primary endpoint was change in this composite with 3 years of cocoa extract use. The pre-specified secondary endpoint was change in the composite with 3 years of MVM supplementation. Treatment effects were also examined for executive function and memory composite scores, and in pre-specified subgroups at higher risk for cognitive decline.
Results
A total of 2 262 participants were enrolled (mean age = 73y; 60% women; 89% non-Hispanic White), and 92% completed the baseline and at least one annual assessment. Cocoa extract had no effect on global cognition (mean z-score = 0.03, 95% CI: -0.02 to 0.08; P = .28). Daily MVM supplementation, relative to placebo, resulted in a statistically significant benefit on global cognition (mean z = 0.07, 95% CI 0.02 to 0.12; P = .007), and this effect was most pronounced in participants with a history of cardiovascular disease (no history: 0.06, 95% CI 0.01 to 0.11; history: 0.14, 95% CI -0.02 to 0.31; interaction, nominal P = .01). Multivitamin-mineral benefits were also observed for memory and executive function. The cocoa extract by MVM group interaction was not significant for any of the cognitive composites.
Discussion
Cocoa extract did not benefit cognition. However, COSMOS-Mind provides the first evidence from a large, long-term, pragmatic trial to support the potential efficacy of a MVM to improve cognition in older adults. Additional work is needed to confirm these findings in a more diverse cohort and to identify mechanisms to account for MVM effects.
Highlights
• COSMOS-Mind was a large simple pragmatic randomized clinical trial in older adults conducted by mail and telephone.
• The trial used a two-by-two factorial design to assess treatment effects of two different interventions within a single large study.
• We found no cognitive benefit of daily cocoa extract administration (containing 500 mg flavanols) for 3 years.
• Daily multivitamin-mineral (MVM) supplementation for 3 years improved global cognition, episodic memory, and executive function in older adults.
• The MVM benefit appeared to be greater for adults with cardiovascular disease.
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