Do multivitamin supplements and cocoa extracts improve cognitive abilities in the elderly?

What is dementia?

Dementia is the umbrella term for various clinical pictures of the brain, which are characterized by a decline in mental performance and a progressive loss of memory. The ability to remember and concentrate diminishes and especially the long-term memory and acquired abilities diminish with the course of the disease. For the subdivision of the causes, a distinction is made between primary and secondary dementia:

• In primary dementia, the brain is the main organ affected. The symptoms result from damage to the nerve cells. The most common type of dementia is Alzheimer's dementia. A circulatory disorder of the brain can also be a cause of the decrease in cognitive performance, in which case it is called vascular dementia.
• Secondary dementia develops as a consequence of another existing disease. This can be the case, for example, with addictive disorders, thyroid disorders or after a traumatic brain injury. Likewise, medications and a lack of nutrients and vitamins can cause secondary dementia to develop. This form of dementia can also regress if the cause is corrected, such as the lack of nutrients or treatment of the underlying disease.

Therapy of dementia is difficult

Depending on the stage of dementia, it can be quite complicated to alleviate the symptoms. If there is an underlying disease, it should generally be treated comprehensively. If necessary, the individual specialist departments should work together in a coordinated manner. Behavioral therapy measures can be used, especially in the case of social withdrawal or changes in character. Often the symptoms can be alleviated accordingly. Medication can be useful against depressive moods, following medical advice. In order to maintain the existing cognitive abilities, there are various possibilities that should be used to train and develop them. Suitable for this are memory exercises (e.g. puzzles, guessing proverbs or songs), mindfulness exercises or coordination exercises (gymnastics, dancing). Through physical exercise, neuronal connections can be formed.

Furthermore, countless medications and dietary supplements are used for therapy. Since especially the deficiency of micronutrients represents an increased risk for the development of dementia, they are always a cause for investigation of their effect on the preservation of cognitive functions.

Multivitamin improves cognitive abilities

The journal Alzheimer's & Dementia recently published the results of a study conducted by researchers at Wake Forest University School of Medicine in North Carolina. The COSMOS-Mind (COcoa Supplement and Multivitamin Outcomes Study of the Mind) study examined whether cocoa extract improves cognitive abilities in older adults compared to a commercially available multivitamin mineral (MVM). In its unprocessed form, the cocoa bean is rich in flavanols. Their cognition-enhancing effects have been supported by several epidemiological and small clinical studies in the past. Trials of individual micronutrients, such as folic acid and vitamin D, for their importance in cognition showed mixed results, but meta-analytic reviews concluded that the evidence was insufficient to recommend them.

Study design

The COSMOS-Mind study enrolled 2262 subjects with an average age of 73 years, of whom approximately 60% were female. Approximately 92% underwent baseline and annual follow-up examinations thereafter. Participants suffered from age-standard risk factors such as hypertension, type 2 diabetes and obesity. They were included, however, only if they had no history of myocardial infarction or stroke; other cardiovascular diseases (transient ischemic attack, decompensated heart failure, coronary artery bypass graft, angioplasty, and stent) were allowed. Another selection criterion was not to have undergone cancer in the past two years.

Subjects were assigned to groups in which they received either a multivitamin-mineral supplement (MVM), a cocoa supplement containing 500 mg flavanols, or placebo. The allocation was done in a 2x2 randomized design, meaning that all factors (MVM, cocoa preparation, MVM placebo, and cocoa placebo) were combined. The total of four groups were studied and compared with each other.

In the course of this, the subjects' cognitive abilities were assessed by telephone over 3 years at baseline, once a year, and at the end of the study. Verbal fluency, story recall, and number handling were assessed.

Results of the study

The daily intake of 500 mg flavanols showed no positive correlation with the subjects' cognitive performance. In contrast, the daily intake of MVM proved to be effectively effective on the subjects' cognitive abilities. Global cognition and episodic memory in particular improved greatly, but executive functions (mental functions by which people control their own behavior in light of the environment) also developed positively. Significant benefit was statistically demonstrated compared with placebo despite a low z-score of 0.07 with a 95% confidence interval of 0.02 to 0.12 when multivitamins were taken. In participants with cardiovascular disease, this effect was even more pronounced, with a z-score of 0.14, but with a wider confidence interval of -0.02 to 0.31. This finding is highly significant because these patients are predisposed to faster decline in cognitive performance anyway.

According to researcher Laura D. Baker, daily multivitamin use nevertheless reduced overall cognitive degeneration by 60%, which is roughly equivalent to a slowing of 1.8 years.

Conclusion

Dementia is a slowly progressive disease that is often diagnosed late. Not only the course of the disease and its symptoms, but also the causes of dementia are so diverse that it should be diagnosed individually in each patient and treated in an interdisciplinary manner. Social withdrawal should be avoided at all costs to prevent further problems. However, cognitive abilities can be trained and supported at any age, for example by regularly performing memory exercises to strengthen neuronal connections. A healthy diet and sufficient exercise are also important for maintaining cognitive abilities.

The COSMOS-Mind study was the first large-scale, placebo-controlled, long-term study with positive results suggesting that daily supplementation of a multivitamin mineral may well improve cognitive abilities in seniors. Cocoa extract, on the other hand, showed no improvement in mental cognition even after three years. Further research is needed to confirm the benefits of these results and to make firm recommendations. Nevertheless, this study is of great public health importance in setting standards to protect and improve cognitive function in the elderly.