In a study of 2262 individuals, investigators also found that cocoa extract had no effect on cognition.
Cocoa extract does not benefit cognition, however, multivitamin minerals (MVM) have the potential to improve cognition in older adults, according to results of the COSMOS-Mind (NCT03035201) study published in Alzheimer’s and Dementia.
COSMOS-Mind is a large, randomized, 2-by-2, factorial, 3-year trial that assessed whether daily administration of cocoa extract of 500 mg per day compared to the placebo and commercial MVM. Individuals were enrolled in COSMOS-Mind from August 2, 2016, to August 17, 2017.
Out of 2262 individuals, investigators found that cocoa extract had no effect on cognition. However, they found that daily MVM resulted in a statistically significant benefit on global cognition when compared to the placebo. Investigators said the effect was highest in individuals with a history of cardiovascular disease (CVD).
The subgroup with CVD history included more men, tended to be older, had higher body mass index, more hypertension, used statins more, were more depressed, and had less physical activity.
However, investigators found that when this subgroup was removed from the analysis, the main MVM findings remained unchanged, showing that daily MVM continued to have a statistically significant benefit on global cognition.
Additionally, in the pre-specified subgroups, investigators said that cocoa extract effects suggested that response could vary with baseline body mass index. The MVM benefits were also observed for memory as well as executive function.
Investigators assessed cognition by phone at baseline as well as annually. Approximately 92% of individuals completed baseline and at least 1 annual assessment.
Investigators found that out of those who missed at least 1 assessment, individuals were more likely to be from an underrepresented racial or ethnic group, reported less physical activity and more chocolate intake, more smoking, tended to have lower education, and a higher prevalence of type 2 diabetes.
The primary outcome was global cognition composite from the mean standardized scores, relative to baseline, from individual tests, which included a telephone interview of cognitive status, word list and story recall, oral trail-making, verbal fluency, number span, and digit order. The primary endpoint was changed with 3 years of cocoa extract use, using intention-to-treat.
The pre-specified secondary endpoint was also changed with 3 years of MVM supplementation. The treatment effects were also analyzed for executive function and memory composite scores and in subgroups that investigators determined were at higher risk of cognitive decline.
Though this study was one of the first large and long-term trials to support MVM supplementation on cognition, investigators said that additional work is needed to confirm these findings.
They added that other research should be used in a more diverse cohort and to identify mechanisms to account for the effects of MVM.
Furthermore, investigators said that the study limitations included race and ethnicity of the cohort and that adherence to the study pills and health history were self-reported, so the results might not be representative.
Baker, LD, Manson, JE, Rapp, SR, et al. Effects of cocoa extract and a multivitamin on cognitive function: a randomized clinical trial. Alzheimer's Dement. 2022. doi:https://doi.org/10.1002/alz.12767