RCT finds multivitamins but not cocoa extract improves global cognition

Daily multivitamins and minerals, but no cocoa extract, resulted in improvements in global cognition in older adults, according to a recent RCT

Taking a multivitamin and mineral supplement instead of a cocoa extract daily for up to three years leads to improvements in global cognition, episodic memory, and executive functioning in older adults, according to results of a randomized, controlled study by a US team researchers.

There are currently more than 55 million people living with dementia worldwide, and almost 10 million new cases are added each year. Mild cognitive impairment describes a condition in which individuals have cognitive impairment but with minimal impairment in instrumental activities of daily living, and may be the first cognitive expression of Alzheimer’s disease. However, there are currently no approved treatments for mild cognitive impairment, but studies have explored the potential value of using cocoa extracts. For example, there is some data to suggest that flavonoids (found in cocoa extract) have the potential to prevent the progression of neurodegenerative pathologies and boost cognitive performance. In addition, other evidence has shown a positive effect of cocoa polyphenols on memory and executive function. But no studies have been positive, and other work in healthy older adults suggested that eight weeks of dark chocolate flavanols had no effect on cognition. The effect of multivitamins on cognition is even less clear, as many studies have examined the effects of individual vitamins. Still, a randomized, double-blind, placebo-controlled study found that long-term use of a daily multivitamin showed no cognitive benefits in male physicians aged 65 and older.

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However, whether the combination of multivitamins and minerals together with a cocoa extract could have a positive effect on cognition remains unclear and was the subject of the current study. Using a 2 x 2 factorial design, US researchers conducted the COSMOS-MIND study, which was an add-on study to the large-scale COSMOS study designed to evaluate whether a cocoa extract and a multivitamin-mineral pill reduced the risk of major cardiovascular events and totally invasive cancer. COSMOS-Mind used a telephone interview to assess cognitive function and impairment to determine whether cocoa flavanols or a vitamin supplement could improve cognitive function in adults aged 65 years and older over a 3-year annual follow-up period. Participants were randomized into four groups: a cocoa extract (CE) placebo/multivitamin mineral (MVM) placebo; CE-MVM placebo; CE placebo MVM; CE MVM. The tests included a baseline telephone interview on cognitive status (which ruled out pre-existing cognitive impairment), word list and story recall (assessment of episodic memory), verbal tracking, verbal fluency, number span, and digit order (all of which served as executive controls). functional network). The primary outcome was a global cognitive composite formed from each test and reported as a z-score, such that higher scores reflect better performance.

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Multivitamins and global cognition

A total of 2262 participants with a mean age of 72.97 years (40.4% male) were enrolled and randomly assigned to the four groups.

For patients in the CE group, the mean change in z-score (compared to placebo) was 0.03 (95% CI -0.02-0.08, p=0.28). However, when researchers examined the effect of multivitamin use, the mean change in z-score was 0.07 (95% CI 0.02-0.12, p=0.007). Further analysis revealed that this effect was greater in subjects with a history of cardiovascular disease (no history: 0.06; with history: 0.14).

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CE also had no effect on episodic memory or executive function compositions. In contrast, the multivitamin-mineral supplement improved episodic memory (mean change z-score = 0.06, p=0.04) and for executive function (mean change z-score = 0.06, p=0.02).

The authors concluded that taking a CE daily for 3 years did not positively affect global cognition, while their study provided the first evidence that an inexpensive multivitamin-mineral supplement had the potential to improve cognitive function in older adults to enhance.

Baker LD et al. Effects of Cacao Extract and a Multivitamin on Cognitive Function: A Randomized Clinical Trial Alzheimer’s Dementia 2022

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