As of this date, no interventions to prevent cognitive decline in asymptomatic older adults have been approve by the FDA. The statistics on dementias, including Alzheimer’s disease are sobering:
- 1 IN 3 SENIORS DIES WITH ALZHEIMER’S OR ANOTHER DEMENTIA. IT KILLS MORE THAN BREAST CANCER AND PROSTATE CANCER COMBINED
- Between 2000 and 2018, deaths from heart disease have decreased 7.8% while deaths from Alzheimer’s disease have increased 146%
- Women comprise two-thirds of the 5.5 million cases of Alzheimer’s disease in the United States
I would say there is an urgent need to identify a more comprehensive understanding of the cause of Alzheimer’s disease and safe and effective strategies to preserve cognitive function as women and men age, to reduce the risk and incidence of Alzheimer’s disease, and then fast track new research and broadened research to address underlying mechanisms that are not currently being addressed with the drugs that are being offered and that don’t currently offer a solution.
Trials of single nutrients such as folic acid, omega 3 fatty acids, glutathione, Curcumin, Lemon balm, Bacopa, Vitamin D and others have yielded in some cases good preliminary results and in other cases, mixed results. The current study attempts to research the effect of daily treatment with cocoa extract and/or a multiple vitamin-mineral for 3 years and its potential protective cognitive function in older adults.
The COSMOS-Mind study, a large randomized 3 year trial, assessed cognition function annually. The primary outcome was a global cognition composite score from individual tests. A total of 2262 participants were enrolled (mean age of 73; 60% women; 89% non-Hispanic White). The trial tested whether daily administration of a cocoa extract (containing 500 mg/day of flavonols) versus placebo and multi vitamin – mineral (MVM) supplement versus placebo improved cognition in older women and men.
Cocoa extract had no effect on global cognition compared to baseline but the daily MVM supplement relative to placebo resulted in a statistically significant benefit on global cognition compared to baseline and it was most pronounced in individuals with a history of cardiovascular disease. The MVM benefits were also observed for memory and executive function.
Commentary: I’m always looking for good news on cocoa, given my daily post lunch consumption of dark chocolate (and eating it as we speak). Cocoa contains high quantities of catechins and epicatechins which are members of the flavonol family. Cocoa in its unprocessed form also contains theobromine and caffeine. Consumption of cocoa flavonols have been shown to slow cognitive decline by improving cerebral vasodilation, flood flow, perfusion and angiogenesis. These mechanisms would indicate benefit in vascular dementia. Most of the support for the potential for cognition enhancement effects of flavonoids in healthy adults comes from epidemiological studies and a few clinical trials. Memory and executive function seem to benefit the most but again, in healthy adults, and also with usual amounts of 500-750 mg/day of cocoa flavonols, more than the 500 mg/day used in the current study. As I said in the beginning, individual nutrients have been studied with mixed results, but only one > 12 month study of a MVM alone or with other supplements was done in older adults, and including male physicians in this one randomized controlled trial.
So, where does that leave us? Use of the MVM daily, for 3 years, improved global cognition, episodic memory and executive function in adult women and men who did not suffer from a diagnosis of dementia. The cocoa extract of 500 mg/day did not. Perhaps the dose was too low. Take home: perhaps I’ll go have a second piece!!!
Reference: Baker L, Manson J, Rapp S, et al. Effects of a cocoa extract and multivitamin on cognitive function: A randomized clinical trial. Alzheimer’s and Dementia, J of the Alzheimer’s Association. September 14, 2022
