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Daily use of multivitamin-mineral for 3 years led to improvements in executive function, global cognition, and episodic memory in older adults. This benefit appeared to be greater for adults having cardiovascular disease.
In a randomized clinical trial, although the findings did not support a positive effect of cocoa extract in older adults, cognition remarkably benefited from daily use of safe, readily accessible, and low-cost multivitamin-mineral (MVM) for 3 years. Laura D. Baker et al. aimed to compare the effects of a commercial MVM vs. placebo and daily administration of cocoa extract (containing 500 mg/day flavanols) vs. placebo on cognition in older women and men.
In COSMOS-Mind (a large randomized two-by-two factorial 3-year study), cognition was evaluated over the phone both at the start and on an annual basis. The major endpoint was a composite measure of global cognition based on mean standardized (z) scores (compared to baseline) from individual tests, such as Digit Ordering, Number Span, Verbal Fluency, Oral Trail-Making, Word List and Story Recall, and Telephone Interview of Cognitive Status. Alteration in this composite after three years of cocoa extract consumption using intention-to-treat analysis was the major outcome.
Alteration in the composite after 3 years of MVM supplementation was the predetermined secondary outcome. Additionally, the impact of the treatment was investigated in pre-specified subgroups with an elevated risk of cognitive impairment, and for executive function and memory composite scores. Overall, 2262 volunteers (mean age = 73 years; 60% females; 89% of whom were non-Hispanic White); 92% completed the baseline and a minimum of one yearly evaluation. Global cognition was unaffected by cocoa extract (mean z-score = 0.03).
The findings of the pre-planned subgroup assessment depicted that participants with a baseline history of cardiovascular disease (CVD) may show a more pronounced MVM benefit, indicating either higher relative improvement or more effective protection from CVD-associated cognitive impairment. Global cognition improved significantly with daily MVM supplementation compared to placebo (mean z = 0.07), and this effect was most significant in those with a history of cardiovascular disorders (no history: 0.06; history: 0.14).
The effects of MVM on executive function and memory were reported. For any of the cognitive composites, the cocoa extract by MVM group interaction was not profound. Brain function was not improved by the cocoa extract. But, COSMOS-Mind offered the first proof from a significant, extensive, pragmatic experiment to back up the plausible effectiveness of MVM to enhance cognition in elderly people. These results need to be confirmed in a larger, more diverse cohort, and further research is required for the identification of mechanisms behind MVM effects.
The Journal of the Alzheimer's Association
Effects of cocoa extract and a multivitamin on cognitive function: A randomized clinical trial
Laura D. Baker et al.
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