Cognitive Effects of Cocoa Extract Supplementation in Older Adults

0
708

In the United States, adults aged 65 and older constitute the fastest-growing age segment, with a heightened risk for Alzheimer’s disease and related dementias (ADRD) [1]. Cognitive decline during aging is a precursor to ADRD, making interventions targeting early signs crucial [2,3]. Cocoa extract (CE) is a promising candidate, containing flavanols, theobromine, and caffeine, speculated to impact cognitive function positively [4].

Cocoa Flavanols and Cognitive Function

Flavanols, particularly (–)-epicatechin in CE, may influence cognitive function by interacting with intracellular signaling pathways, addressing neuroinflammation and neurodegeneration, and improving cerebral vasodilation and perfusion [5,6]. Epidemiological studies have shown associations between cocoa product consumption and various health benefits, including cognition [4,7,8]. However, evidence from randomized clinical trials (RCTs) on CE supplementation’s cognitive effects in older adults has been inconsistent [[9], [10], [11], [12], [13]].

Review of Previous RCTs

Nine smaller RCTs (n ∼200; treatment duration: ≤6 mo) and two larger RCTs (n > 2000; treatment duration: >12 mo) investigated CE’s effects on cognitive change during mid- or late life [9,10,11,12,13]. While smaller RCTs generally favored CE supplementation, the two larger RCTs, both ancillary to the COcoa Supplement and Multivitamin Outcomes Study (COSMOS) trial, indicated no overall effects on prespecified primary cognitive endpoints [12]. Specifically, COSMOS-Mind and COSMOS-Web reported no significant cognitive benefits, except for improved hippocampal-dependent memory in the latter among participants with lower baseline diet quality or flavanol consumption [12,13].

The COSMOS-Clinic Trial

To provide further clarity, our study investigated the cognitive effects of daily CE supplementation over two years among 573 older adults in the COSMOS-Clinic subcohort, employing in-person neuropsychological assessments [14]. Our primary hypothesis posited that CE supplementation, compared with a placebo, would yield better changes over two years in global cognition, assessed through 11 cognitive tests. Secondarily, we explored effects on episodic memory and executive function/attention. Additionally, we examined potential modifying roles of baseline factors, including diet and flavanol status, on the cognitive effects of CE supplementation compared to the placebo.

Design of the COSMOS-Clinic Trial

The Cocoa Supplement and Multivitamin Outcomes Study (COSMOS) serves as a comprehensive investigation into the effects of cocoa extract (CE) and multivitamin-mineral supplementation on cardiovascular disease and cancer prevention among 21,442 US adults aged 60 years and above. Within this extensive trial, the COSMOS-Clinic sub-cohort, consisting of 573 participants, focused specifically on cognitive outcomes. CE supplementation involved 500 mg flavanols/day, including 80 mg (–)-epicatechin. Daily multivitamin-mineral supplements were also included in the study. Of these participants, 492 completed the 2-year follow-up assessments, forming the basis for the cognitive analysis. Global cognition, assessed through 11 tests, served as the primary outcome, with episodic memory and executive function/attention as secondary outcomes. Repeated measures models were employed for intergroup comparisons.

Results of the COSMOS-Clinic Trial

The mean age of participants at baseline was 69.6 years (standard deviation [SD] = 5.3), with 49.2% being females. The trial found that daily supplementation with CE, in comparison to a placebo, did not yield a significant effect on the 2-year change in global cognition (mean difference (95% confidence interval [CI]): -0.01 (-0.08, 0.05) SD units (SU)). Similarly, CE supplementation had no significant impact on the 2-year change in episodic memory (mean difference (95% CI): -0.01 (-0.13, 0.10) SU) or executive function/attention (mean difference (95% CI): 0.003 (-0.07, 0.08) SU). Subgroup analyses, though uncorrected for multiple testing, indicated potential cognitive benefits of CE supplementation compared to placebo, particularly among individuals with poorer baseline diet quality.

Conclusion and Implications

In this meticulously conducted trial involving 573 older adults undergoing repeated in-person neuropsychological assessments over 2 years, daily CE supplementation did not demonstrate overall cognitive benefits in terms of global or domain-specific cognitive function. While the primary outcomes showed no significant differences, intriguing findings emerged from subgroup analyses, suggesting a potential cognitive advantage of CE among individuals with poorer diet quality. These findings underscore the complexity of the relationship between CE supplementation and cognitive health, emphasizing the need for further research to elucidate the nuanced interactions and potential benefits in specific subgroups.


reference link :https://www.sciencedirect.com/science/article/abs/pii/S0002916523662756

LEAVE A REPLY

Please enter your comment!
Please enter your name here

Questo sito utilizza Akismet per ridurre lo spam. Scopri come vengono elaborati i dati derivati dai commenti.