Multivitamins Slow Cognitive Aging in Older Adults

JoAnn E. Manson, MD, DrPH


December 10, 2021

This transcript has been edited for clarity.

Hello. This is Dr JoAnn Manson, professor of medicine at Harvard Medical School and Brigham and Women's Hospital. I'd like to talk with you about some preliminary but exciting findings that multivitamins may improve cognitive function.

Presented at a Clinical Trials on Alzheimer's Disease (C-TAD) meeting in November, these results are from an ancillary study, COSMOS-Mind, funded by the National Institute on Aging and led by colleagues at Wake Forest School of Medicine. The study was a large-scale randomized trial, COcoa Supplement Multivitamins Outcome Study (COSMOS), with more than 21,000 participants nationwide, testing cocoa extract and multivitamins in the prevention of cardiovascular disease and cancer. The results from the main trial are expected to be published in early 2022.

The parent trial is funded by a public-private partnership. The primary funding came from Mars Edge. The study pills were donated by Mars, and the Centrum Silver Multivitamins were donated by Pfizer and GSK Consumer Healthcare. I'd like to acknowledge that I'm a principal investigator of the main COSMOS trial and a co-investigator of COSMOS-Mind.

I'm going to focus on the multivitamins and cognitive function findings from COSMOS-Mind. The cocoa extract and cognition findings are still in progress, including detailed analyses of the potential modifying effect of baseline diet, and those results are expected to be published in early 2022.

The underlying hypothesis for multivitamins being a benefit for cognition stems from evidence that essential nutrient deficiencies in B12, folate, vitamin D, and other micronutrients have been linked to accelerated cognitive decline and dementia in observational studies. But there have been few randomized trials of these micronutrients and they have mostly tested individual micronutrients and not a comprehensive multivitamin supplement. The one previous large-scale trial of a multivitamin supplement began cognitive testing 2-3 years into the intervention, so it wasn't a full test of the hypothesis.

COSMOS-Mind includes 2262 men and women nationwide, all older than age 65 with a mean age of 73. They underwent repeated cognitive assessments beginning before randomization, a baseline assessment, and assessments at years 1, 2, and 3. The cognitive assessment was a well-validated, telephone-administered cognitive battery that included a composite global score, as well as assessment of episodic memory, executive function, and other domains.

They found that over the 3 years of treatment, participants who were randomized to multivitamins did significantly better than those randomized to a placebo. And the investigators estimated that multivitamins were slowing cognitive aging by 60% over the 3 years, reducing cognitive aging by 1.8 years. The subgroup with a history of cardiovascular disease at baseline seemed to have a particularly strong benefit from the multivitamins.

This is the first large-scale randomized trial suggesting efficacy of multivitamins in slowing cognitive aging. This would be a simple, safe and accessible intervention. However, it's important to keep in mind that these findings need to be replicated. If the findings are confirmed, multivitamin supplementation may become an important means of protecting brain health in older adults. Stay tuned for findings from COSMOS-Mind, as well as other findings from COSMOS expected in early 2022.

Thank you so much for your attention. This is JoAnn Manson.

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