Long-Term Multivitamin-Mineral Supplementation Improves Cognition in Older Adults

by | Nov 21, 2022 | 2022, Brain Health, Cognitive Health, Minerals, Vitamins

Written by Taylor Woosley, Staff Writer. 3 years of daily MVM use led to relative improvements both for memory (P=.04) and for executive function (P=.02) in adults ≥65 years and older. 

mineralsDementia is a clinical syndrome characterized by progressive decline in two or more cognitive domains, including memory, language, executive and visuospatial function, personality, and behavior, which causes loss of abilities to perform basic activities of daily living1. Alzheimer’s disease (AD) is the most common cause of dementia and affects around 50 million people worldwide2. It is a heterogeneous and multifactorial disorder that typically presents with cognitive impairment with a progressive decline in memory, disorientation, and personality changes3. AD is characterized by β-amyloid (Aβ)-containing extracellular plaques and tau-containing intracellular neurofibrillary tangles4.

Many nutrients play an important role in brain functioning including cellular energy product, myelin generation, cell maintenance and repair, and neurotransmitter synthesis5. Vitamins and minerals are essential for cognitive health and must be acquired through diet or supplements, such as a multivitamin, to avoid micronutrient deficiencies6. Growing evidence indicates that habitual consumption of chocolate results in improved cognitive performance and measurable attenuation of neurocognitive decline7. Cocoa is one of the best-known sources of dietary polyphenols, mainly monomeric flavanols such as epicatechin and catechin, which have been researched as neuroprotective agents because of their ability to generate nitric oxide which induces vasodilation and improves cerebrovascular perfusion8.

Baker et al. conducted a large-randomized study to evaluate whether daily supplementation of cocoa extract versus placebo or a commercial multivitamin-mineral (MVM) compared to placebo improved cognition in older subjects. Data included was from the COSMOS-Mind study, a large pragmatic, placebo-controlled 2 x 2 factorial clinical trial testing the effects of daily administration with cocoa extract (CE) and/or a MVM on cardiovascular and cancer outcomes. The CE contained 500 mg of cocoa flavanols, including 80 mg (-)-epicatechins, ~50 mg/day of theobromine and ~15 mg/day of caffeine. Subject parent trial eligibility criteria included having no history of myocardial infarction or stroke, no history of cancer within the last 2 years, and not taking cocoa or vitamin/mineral supplements. Further eligibility criteria included a successful completion of ≥2-month placebo run-in with ≥75% study pill adherence, being ≥65 years of age, and being able to complete the telephone cognitive assessment.

35,669 subjects began a placebo run-in, with 21,442 (60%) being randomized into the COSMOS trial. During the placebo run-in, eligible participant were invited to also participate in COSMOS-Mind, with a total of 2262 subjects being enrolled. Subjects were administered a standardized telephone cognitive battery at baseline and annually for 3 years to assess general cognitive status, episodic memory, and executive function. Tests included the 50-point modified Telephone Interview for Cognitive Status (TICSm with a 10-minute short delay word list recall), an additional 40-minute Long Delay Word List Recall, immediate and delated Story Recall (SRI & II), Oral Trail-Making Test Part B (OTMT-B, log transformed), Verbal Fluency by category (VF-C) and letter (VF-L), Number Span (NS), and Digit Ordering Test (DOT). Primary outcome included a global cognition composite formed from mean standardized (z) scores of pre-specified individual test metrics, with higher scores reflecting better performance. Secondary outcomes included an episodic memory composite and an executive function composite. All participants were grouped as originally randomly assigned and scores from all cognitive assessments (baseline and Years 1, 2 and 3) were included in analyses.

Of the enrolled participants, 2082 (92%) completed the cognitive assessment at Year 1, 1906 (84%) at Year 2, 1790 (79%) at Year 3, and 1732 (77%) in all 3 years of follow-up. Significant findings of the study are as follows:

  • The mean change (CE minus CE-placebo) z-score for global cognition was 0.03 (95% CI: -0.02 to 0.08; P = .28).
  • A significant treatment effect of MVM versus MVM-placebo on global cognition was observed, with a mean change (MVM minus MVM-placebo) z-score of 0.07 (95% CI: 0.02 to 0.12; P = .007).
  • MVM supplementation led to relative improvements both for memory (mean change z-score=0.06, 95% CI: 0.002 to 0.13; P=.04) and for executive function (mean change z-score=0.06, 95% CI: 0.01 to 0.11; P=.02).

Results of the study show that daily CE supplementation did not significantly improve cognitive function. However, daily MVM supplementation for 3 years did improve scores for episodic memory, global cognition, and executive function. Study limitations include the affect of generalizability of the study results due to the race and ethnicity of the cohort not being representative of older Americans, the use of a self-report for study adherence and health history, and the inability to assess whether specific components of the COSMOS MVM were responsible for the observed cognitive benefits.

Source: Baker, Laura D., Joann E. Manson, Stephen R. Rapp, Howard D. Sesso, Sarah A. Gaussoin, Sally A. Shumaker, and Mark A. Espeland. “Effects of cocoa extract and a multivitamin on cognitive function: A randomized clinical trial.” Alzheimer’s & Dementia (2022).

© 2022 The Authors. Alzheimer’s & Dementia published by Wiley Periodicals LLC on behalf of Alzheimer’s Association.

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Posted November 21, 2022.

Taylor Woosley studied biology at Purdue University before becoming a 2016 graduate of Columbia College Chicago with a major in Writing. She currently resides in Glen Ellyn, IL.

References:

  1. Weller J, Budson A. Current understanding of Alzheimer’s disease diagnosis and treatment. F1000Res. 2018;7doi:10.12688/f1000research.14506.1
  2. Naseri NN, Wang H, Guo J, Sharma M, Luo W. The complexity of tau in Alzheimer’s disease. Neurosci Lett. Jul 13 2019;705:183-194. doi:10.1016/j.neulet.2019.04.022
  3. Rusek M, Pluta R, Ułamek-Kozioł M, Czuczwar SJ. Ketogenic Diet in Alzheimer’s Disease. Int J Mol Sci. Aug 9 2019;20(16)doi:10.3390/ijms20163892
  4. Knopman DS, Amieva H, Petersen RC, et al. Alzheimer disease. Nature reviews Disease primers. May 13 2021;7(1):33. doi:10.1038/s41572-021-00269-y
  5. Denniss RJ, Barker LA, Day CJ. Improvement in Cognition Following Double-Blind Randomized Micronutrient Interventions in the General Population. Frontiers in behavioral neuroscience. 2019;13:115. doi:10.3389/fnbeh.2019.00115
  6. Vanoh D, Shahar S, Yahya HM, et al. Dietary Supplement Intake and Its Association with Cognitive Function, Physical Fitness, Depressive Symptoms, Nutritional Status and Biochemical Indices in a 3-Year Follow-Up Among Community Dwelling Older Adults: A Longitudinal Study. Clin Interv Aging. 2021;16:161-175. doi:10.2147/cia.S266587
  7. Camandola S, Plick N, Mattson MP. Impact of Coffee and Cacao Purine Metabolites on Neuroplasticity and Neurodegenerative Disease. Neurochem Res. Jan 2019;44(1):214-227. doi:10.1007/s11064-018-2492-0
  8. Carballeda Sangiao N, Chamorro S, de Pascual-Teresa S, Goya L. Aqueous Extract of Cocoa Phenolic Compounds Protects Differentiated Neuroblastoma SH-SY5Y Cells from Oxidative Stress. Biomolecules. Aug 25 2021;11(9)doi:10.3390/biom11091266