Multivitamins and Cognition: New Data From COSMOS
Introduction:
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Study Overview:
New data from the Cocoa Supplement and Multivitamin Outcomes Study (COSMOS) suggests a daily multivitamin may protect the aging brain. The study, however, has raised concerns about its methodology and the interpretation of findings.
COSMOS Trial Background:
A 2 x 2 factorial trial: coca extract (flavanols) and/or a daily commercial multivitamin-mineral (MVM) supplement for cardiovascular and cancer prevention in adults aged 60 or older. COSMOS-Mind substudy: No cognitive benefit from cocoa extract, but daily MVM supplementation associated with improved global cognition, episodic memory, and executive function.
COSMOS-Clinic Analysis:
573 participants completed in-person cognitive assessments. MVM showed modest benefits in global cognition (mean difference 0.06 SD units [SU]) and episodic memory (mean difference 0.12 SU) over 2 years. Meta-analysis based on three cognitive substudies (5200 participants) showed clear evidence of MVM benefits on global cognition and episodic memory.
Interpretation and Concerns:
MVM benefits demonstrated in memory recall and cognitive aging. Expert concerns about the methodology of the meta-analysis, emphasizing it's not a true meta-analysis as it used existing COSMOS data without additional patients. Questions raised about the clinical significance of scoring slightly better on standardized tests and the potential impact on hard clinical endpoints.
Expert Comments:
Christopher Labos, MD CM, MSc, emphasizes that evidence for multivitamins for brain health is not impressive, cautioning against recommending them purely for this purpose. Claire Sexton, DPhil, Alzheimer’s Association, calls for independent confirmatory studies in larger, more diverse populations before widespread recommendations.
Alzheimer’s Association's Perspective:
Positive findings are promising, but the association is not ready to recommend widespread use of multivitamin supplements to reduce cognitive decline. Envisions a future with multiple treatments addressing the disease in various ways, combined with brain-healthy lifestyle guidelines.
Clinical Trial Mentioned:
The Alzheimer’s Association is leading the US POINTER clinical trial evaluating lifestyle interventions targeting multiple risk factors to protect cognition in older adults at risk for cognitive decline.
Support and Disclosures:
COSMOS-Clinic and cognition studies supported by grants from Mars Edge and the National Institutes of Health. Multivitamin and placebo tablets donated by Pfizer, Inc Consumer Healthcare. COSMOS investigators' disclosures available with the original article. Dr. Labos and Dr. Sexton have no relevant disclosures.
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