The Impact of Flavanol-Containing Cocoa Extract on Cognitive Function in Older Adults


Cognitive aging is a natural process that affects various aspects of our mental abilities as we grow older. With the global population living longer than ever before, maintaining healthy cognitive function in older individuals has become a crucial area of research.

In recent years, there has been growing interest in the potential benefits of cocoa extract on cognitive aging. This article aims to delve into the impact of cocoa extract on cognitive function and explore its potential as a strategy for promoting healthy cognitive aging.

Understanding Cognitive Aging

Cognitive aging refers to the changes that occur in cognitive abilities, including memory, attention, executive function, and processing speed, as individuals age. These changes can vary greatly among individuals, but some common cognitive decline patterns are observed in older adults. Slower information processing, reduced working memory capacity, and difficulties in learning new information are some of the hallmarks of cognitive aging.

The Role of Cocoa Extract

Cocoa extract, derived from the seeds of the Theobroma cacao tree, has gained attention for its potential cognitive benefits. Cocoa is rich in bioactive compounds such as flavonoids, caffeine, and antioxidants, which have been associated with various health benefits. In particular, flavonoids, a type of plant compound abundant in cocoa, have been extensively studied for their potential effects on cognitive function.

Cocoa Extract and Cognitive Function

Several studies have examined the impact of cocoa extract on cognitive function in both animal models and human subjects. Research suggests that cocoa flavonoids have the ability to improve cognitive performance, enhance attention, boost memory, and promote learning in older individuals. These effects are thought to be mediated by various mechanisms, including increased cerebral blood flow, neuroprotective properties, and enhanced synaptic plasticity.

Neuroprotective Properties

Cocoa extract’s bioactive compounds possess strong antioxidant and anti-inflammatory properties, which can help protect the brain from oxidative stress and inflammation, both of which are associated with cognitive decline. By reducing oxidative damage and inflammation, cocoa extract may help preserve neuronal function and mitigate age-related cognitive decline.

Cerebral Blood Flow and Cognitive Function

Cocoa flavonoids have been shown to improve cerebral blood flow, primarily by increasing nitric oxide availability and promoting vasodilation. Enhanced blood flow to the brain can improve oxygen and nutrient delivery, which is crucial for optimal cognitive function. By enhancing cerebral blood flow, cocoa extract may support healthy brain aging and maintain cognitive abilities.

Synaptic Plasticity and Learning

Synaptic plasticity is the brain’s ability to form new connections between neurons and modify existing ones. It plays a fundamental role in learning and memory processes. Studies suggest that cocoa flavonoids can enhance synaptic plasticity, promoting the formation of new neural connections and supporting cognitive function. By facilitating neuronal communication and plasticity, cocoa extract may help combat age-related cognitive decline.

The COSMOS Web study aims to investigate whether a dietary intervention with flavanol-containing cocoa extract can have a positive effect on cognitive function in individuals aged 60 and above.

This study is a subset of the larger COSMOS study (NCT02422745) and will include 4,000 participants. Preliminary findings from the investigators’ previous work have shown that consuming cocoa flavanols over 12 weeks led to improvements in immediate recall on the ModRey verbal memory task in healthy older adults.


In the COSMOS Web study, researchers will assess the impact of a dietary intervention involving flavanol-containing cocoa extract on various cognitive measures associated with aging. These measures will be evaluated using a novel online-administered test battery specifically designed for this study.

The primary outcome measure will be the change in immediate recall performance on the ModRey test after one year of cocoa extract consumption. Secondary endpoints will include changes in ModRey performance at 2- and 3-year follow-ups, as well as changes in performance tests related to novel object recognition, executive function/working memory, and spatial memory at 1-, 2-, and 3-year follow-ups.

The study will also explore whether baseline measures of cognition and nutritional status can predict the differential effects of cocoa extract supplementation. Additionally, the researchers will investigate the potential interaction between multivitamin intake and flavanol intake from cocoa extract on cognitive outcomes.

A subset of participants will undergo in-person evaluations, allowing for the examination of the impact of cocoa extract intake, as well as the main and interacting effects of multivitamins, on cognitive changes, brain structure, and function using magnetic resonance imaging over a 2-year period.

Recruitment for COSMOS Web involves leveraging the existing COSMOS study, which has already randomized 21,442 older adult participants into cocoa extract and placebo interventions. Approximately 4,000 older adult volunteers will be recruited to participate in COSMOS Web and complete the online cognitive assessments at multiple time points over the follow-up period.

Furthermore, around 200 COSMOS Web participants residing in the Boston area will attend clinic-based study visits at the Clinical and Translational Science Center at Brigham and Women’s Hospital, where they will undergo a neuropsychological test battery for comparison with their online performance.


The implementation of an accredited method for cocoa flavanol analysis by AOAC International has provided a standardized approach to assess cocoa flavanol content. This new method, using reference material RM8403 from the U.S. National Institute of Standards and Technology, has led to changes in how the total cocoa flavanol content is reported.

In the COSMOS intervention, the application of AOAC 2020.05/RM8403 indicates that the intervention tested contains 500 mg/day of cocoa flavanols, including 80 mg of (-)-epicatechin. These standardized measures will be utilized in reporting the cocoa flavanol content moving forward.


The COSMOS Web study presents a unique opportunity to examine the effects of a dietary intervention with flavanol-containing cocoa extract on cognitive function in older adults. By utilizing a novel online cognitive testing battery, researchers can assess cognitive changes over time and explore potential interactions with multivitamin intake.

The study’s findings may provide valuable insights into the impact of cocoa extract on cognitive aging and contribute to the development of strategies for promoting healthy cognitive function in older individuals.

Strategies for Promoting Healthy Cognitive Aging: Based on the potential cognitive benefits of cocoa extract, incorporating it into a healthy lifestyle can be a promising strategy for promoting cognitive health in older individuals. Here are some practical recommendations:

  • Moderate Consumption: Incorporate cocoa extract or dark chocolate with a high cocoa content into the diet in moderation. Opt for products with minimal added sugars and high cocoa content for maximum potential benefits.
  • Physical Exercise: Combine cocoa consumption with regular physical exercise. Exercise has shown independent benefits for cognitive function and can complement the effects of cocoa extract.
  • Balanced Diet: Maintain a well-balanced diet rich in fruits, vegetables, whole grains, lean proteins, and healthy fats. A diverse diet provides essential nutrients for brain health.
  • Social Engagement: Stay socially active and engage in activities that stimulate the mind, such as puzzles, reading, learning new skills, and socializing with friends and family. Social engagement has been linked to better cognitive outcomes.
  • Mindfulness and Stress Management: Incorporate stress management techniques such as mindfulness meditation, deep breathing exercises, or engaging in relaxing hobbies. Chronic stress can negatively impact cognitive function, so managing stress is essential.

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