The number of people living with dementia worldwide exceeds 55 million, with approximately 10 million new cases diagnosed yearly. 

According to Laura D. Baker, taking cocoa extract versus placebo and taking a commercial multivitamin-mineral supplement daily improved cognition in older adults.

A mild cognitive impairment is characterized by a mental impairment combined with minimal impairments in instrumental activities of daily living and can be the first cognitive manifestation of Alzheimer’s disease. 

Currently, the United States Food and Drug Administration (FDA) has not approved any interventions to prevent cognitive decline in older adults with mild cognitive impairment caused by Alzheimer’s disease, nor has there been sufficient evidence to support the clinical benefit of any pharmacologic treatment. 

However, cocoa extracts have been studied for their potential value in treating mild cognitive impairment.

What’s Better for Your Brain: Vitamins or Cocoa?

Cocoa contains many flavonoids called flavanols, including catechins and epicatechins, theobromine (an alkaloid found in cacao beans), and caffeine. 

The consumption of cocoa flavanols has been shown to slow cognitive decline by improving cerebral vasodilation, blood flow, and angiogenesis.

In addition to rapidly absorbing, epicatechin, the most common flavanol in cocoa, crosses the blood-brain barrier, is detected in the brain, and may accumulate physiological effects at higher concentrations. 

Many studies and small clinical trials support the claims that flavonoids enhance cognition in healthy older adults.

According to a recent review, cocoa flavanols improve memory and executive function the most. Micronutrients and minerals play a crucial role in maintaining normal brain and body functions, and deficiencies may increase cognitive decline and dementia risk in older adults.

A single large randomized controlled trial (RCT) involving only male physicians examined the effects of prolonged daily consumption of a multivitamin-mineral (MVM) alone or with other dietary supplements in older adults

In this study, older adults were treated daily with cocoa extract (CE) and an MVM for three years to test whether they could sustain cognitive function. 

Methodology

At baseline and annually, COSMOS-Mind, a randomized two-by-two factorial 3-year trial, assessed cognition by telephone. The primary outcome was a global cognition composite based on mean standardized scores (relative to baseline) on individual tests. 

These assessments included the Telephone Interview of Cognitive Status, the Word List and Story Recall, the Oral Trail-Making, Verbal Fluency, and Digit Ordering tests. 

A primary endpoint of intention-to-treat was the change in the composite after three years of cocoa extract use. A secondary endpoint of intention-to-treat was the change in the composite after three years of MVM supplementation. 

Studies also examined a prespecified subgroup at a higher risk for cognitive decline for treatment effects on executive function and memory composite scores.

Results of the Study

There were 2262 participants in this study (mean age 73; 60% women; 89% non-Hispanic white), and 92% completed both baseline and annual assessments. 

There was no evidence that cocoa extract enhanced global cognition. Still, daily multivitamin-mineral supplementation significantly improved global cognition compared to placebo, and this benefit was especially pronounced among participants with cardiovascular disease. 

As a result, it is concluded that MVM cognitive benefits may be more excellent in older adults with cardiovascular disease. Global cognitive function was lower at baseline in those with CVD histories than those without, which is consistent with other studies. 

After two years, cognitive function in the MVM-treated CVD history subgroup continued to increase, while cognitive function in the placebo-treated CVD history subgroup declined. 

In CVD-compromised individuals, improvements in micronutrient levels could account for this finding, which could, in turn, benefit brain health. 

According to observational studies, micronutrient levels are typically lower in people with cardiovascular disease (e.g., heart failure) and may be subject to drug interactions in CVD patients. 

For example, vitamin D deficiency is common and can predict disease severity; vitamin K deficiency can cause calcification of coronary arteries and lead to higher CVD-related mortality, which has lead to an increase in vitamin D & K combination supplement. Certain medications can reduce vitamin B12 absorption and bioavailability, and thiamine levels, vitamin C, and selenium are relatively low.

Various cognitive composites showed vitamin-mineral benefits for memory and executive function, although the cocoa extract versus MVM (multivitamin-mineral) interaction was insignificant.  

While cocoa extract did not improve cognition in older adults, COSMOS-Mind offers the first evidence that MVMs can effectively enhance cognitive function in older adults based on a large, long-term, pragmatic trial. 

This finding needs to be confirmed in a larger cohort, and mechanisms to account for MVM effects need to be identified.

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