Effects of cocoa extract and a multivitamin on cognitive function: A randomized clinical trial

[RedApple]

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 randomized 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 standardized (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 2262 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.

Full paper available here alz-journals.onlinelibrary....

[nightingale-56]

Thanks for posting RedApple , but this does not seem particularly useful to us and we are always told not to take Multivitamins and minerals because of the low amounts of nutrients in them and the fact that some contradict others in the same pill.

[RedApple Administrator in reply to nightingale-56]

That's exactly why I posted it nightingale-56 😊 This seems to suggest otherwise. Nothing is set in stone! 😊

[greygoose in reply to RedApple]

I don't see why it suggests otherwise. Presumably, even with the worst multi-vit something gets through. And, that something would appear to help. Trouble with multi-vits is that you're not getting all the nutrients you think you are, nor - more importantly - all the nutrients you're paying for! And, in this useless piece of 'research', they have no idea which ingredient of the multi-vit is helping. It can't be all of them because, as nightingale-56 says, a lot of the ingredients will be cancelling out a lot of others. So, now, I would think, a lot more research is needed to find out exactly what it was in the multi-vit that actually helped! 🤣🤣🤣

[RedApple Administrator in reply to greygoose]

The researchers acknowledge the limitations of their study, which was actually about cocoa, not MVMs.

'Study limitations included: (1) race and ethnicity of the cohort was not representative of older Americans, which affects generalizability of our results; (2) adherence to study pills and health history (e.g., CVD) were tracked using self-report; (3) inability to assess whether specific components of the COSMOS MVM were responsible for the observed cognitive benefits; '

[greygoose in reply to RedApple]

Well, if they knew that, why on earth did they do it???

OK, I understand the study was about cocoa, so why muddy the waters by adding MVMs? Doesn't make sense to me. And it's certainly not a validation of multi-vits!

[RedApple Administrator in reply to greygoose]

No I agree it's not a complete validation of MVMs. We know nothing about the diets of the participants either, so no idea what their deficiencies might be. But perhaps MVMs do have a place in some circumstances/situations. Even more so if buying and taking them is more economical than buying ingredients for a healthy diet if you cannot afford to.

[greygoose in reply to RedApple]

Well, we'll have to agree to disagree on that one. I cannot see any place for something where you pay for things you're just not getting. Can't see the sense in that.

[RedApple Administrator in reply to greygoose]

I hear you! But we pay for food that comes with no guaranatees that it contains what we need (unless it's processed, and with added vits etc.).

[greygoose in reply to RedApple]

But at least we enjoy eating that! lol Who enjoys taking a pill? Food/eating isn't just about nutrients, it's far more deeply psychological than that.

[RedApple Administrator in reply to greygoose]

Too true. But this conversations is about nutrients, not psychology.

[greygoose in reply to RedApple]

Well, I wasn't going to go into details, I just thought it wasn't a fair comparison. And certainly not an argument in favour of multi-vits!

[Ozziemum]

Shame about the cocoa though 🤷‍♀️

[RedApple Administrator in reply to Ozziemum]

😀 No reason not to drink cocoa as well of course. Maybe cocoa with a MVM dissolved in it would cover both possibilities!

[Ozziemum in reply to RedApple]

Great idea! All in the interests of science 😄

[RedApple Administrator in reply to Ozziemum]

Absolutely!

[nightingale-56 in reply to RedApple]

But, doesn't cocoa have iron in it and would counteract some of the vitamins?

Sorry, probably going off the point again.

[RedApple Administrator in reply to nightingale-56]

You might be right! Vitamin coffee instead perhaps? (H&B sell it) 🤣

[Regenallotment Ambassador in reply to Ozziemum]

was going to say exactly the same 🦋

[SlowDragon Administrator]

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

Most patients with cardiovascular disease will be on a concoction of drugs…..usually a daily PPI as well as aspirin and statins

Vitamin levels drop with age ….and drop further with PPI

Yet heart patients don’t get vitamin levels tested

I would like to see a trial between

Testing and supplementing targeted vitamin deficiencies ….usually vitamin D, vitamin B complex (or at least folate and B12) ……and iron ….but only if needed

Against

A bog standard multivitamin

We see many post menopause members have high iron/ferritin. They do NOT need extra iron from a multivitamin

[RedApple Administrator in reply to SlowDragon]

'We see many post menopause members have high iron/ferritin. They do NOT need extra iron from a multivitamin'

Agreed. So for those people, a multivit isn't a good idea, especially if their thyroid levels aren't optimised. Which is likely the reason they've come to the forum. Generally speaking, wonky thyroid hormone levels affect the way a body deals with incoming nutrients. Imbalances in nutrient levels can (but no guarantees of course) correct themselves naturally with optimal thyroid hormone intake and appropriate dietary intake.