Subjective cognitive decline (SCD), which is self-reported worsening or more frequent confusion or memory loss, affects an estimated 1 in 9 adults in the United States, according to the Centers for Disease Control and Prevention (CDC). The prevalence of SCD is 11.3 percent in men compared to 10.6 percent in women.
Of adults with SCD, 29.3 percent live alone. While 24.7 percent of those aged 45 to 64 live alone, a greater proportion of those aged 65 and older live alone, at 36.2 percent. Alzheimer’s disease and related dementia also have a large societal burden, affecting more than 46 million people worldwide.
Laura D. Baker, PhD, a Professor of gerontology and geriatric medicine at Wake Forest University, and colleagues investigated whether daily intake of cocoa extract, a multivitamin, or a placebo improved cognition.
In a randomized clinical trial named COSMOS-Mind published in the Alzheimer’s & Dementia Journal on September 14, a daily multivitamin was associated with improved cognition in older adults. This is the first large, long-term, pragmatic trial to support these findings.
The authors recruited 2,262 participants with a mean age of 73 years old, of which 60 percent were women and 89 percent were non-Hispanic White. Patients who participated had to be at least 65 years old and not taking cocoa, vitamin, or mineral supplements.
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Exclusion criteria included no history of heart attack or stroke, no history of cancer in the past two years, not taking insulin for diabetes, no serious illness precluding participation, and the ability to complete a telephone cognitive assessment to screen out those with significant impairment.
Several telephone cognitive tests were administered at baseline and every year for three years to assess “general cognitive status, episodic memory and executive function.” The tests included a 50-point modified Telephone Interview for Cognitive Status, 40-minute Long Delay Word List Recall, Verbal Fluency by Category Test, and Digit Ordering Test.
After testing daily intake of cocoa extract with 500 milligrams per day of flavanols versus placebo and a commercial multivitamin-mineral (MVM) versus placebo, the authors noted a “significant treatment effect of MVM” versus placebo on global cognition with three years of daily MVM use.
Furthermore, participants with a history of self-reported cardiovascular disease (CVD), including transient ischemic attack, congestive heart failure, coronary artery bypass graft, angioplasty, or stent, showed a greater benefit from MVM supplementation, “Suggesting either greater relative improvement or more protection from CVD-related cognitive decline.”
Cocoa extract did not affect cognitive function in this study, but some previous studies have reported significant results. The CoCoA study, which was a double-blind, 8-week randomized controlled trial, found that performance on cognitive tests improved at high or medium doses (993 milligrams or 520 milligrams daily) of cocoa flavanols compared to low doses (45 milligrams daily).
Further research is required in a more diverse patient population and with objective tracking of adherence to study pills and health history as opposed to relying on self-reporting. Additionally, future studies should investigate the mechanisms behind the observed cognitive benefits.
The authors state, “Individual micronutrients and minerals target multiple biologic pathways that support normal body and brain function, and deficiencies in older adults may increase risk for cognitive decline and dementia.”
However, they note that past trials “of single nutrients such as folic acid with or without other B vitamins, omega-3 fatty acids, and vitamin D on cognition have yielded mixed results.”
Alzheimer’s Association Chief Science Officer Maria C. Carrillo, PhD, stated, “While the Alzheimer’s Association is encouraged by these results, we are not ready to recommend widespread use of a multivitamin supplement to reduce risk of cognitive decline in older adults.”
“Independent confirmatory studies are needed in larger, more diverse study populations. It is critical that future treatments and preventions are effective in all populations. For now, and until there is more data, people should talk with their health care providers about the benefits and risks of all dietary supplements, including multivitamins,” she continued.