Cocoa extract supplement benefits cognition in older adults with lower diet quality

12 Dec 2023 --- Researchers from Mass General Brigham found a potential protective effect of cocoa on the cognition of older adults with lower diet quality in a new randomized trial known as the COcoa Supplement and Multivitamin Outcomes Study (COSMOS).

The study’s findings suggest that taking cocoa extract supplements containing 500 mg of cocoa flavanols daily had cognitive benefits for older adults with lower habitual diet quality. Oddly enough, mental benefits were not found among participants with healthy dietary patterns.

The findings of this trial are consistent with the results from an earlier study that used a web-based cognitive assessment of a separately recruited set of COSMOS participants. COSMOS is an investigator-initiated large-scale, long-term clinical trial.

Neuropsychological assessments
The study, conducted by researchers at Mass General Brigham, US, included 573 older adults who underwent detailed, in-person cognitive testing and was published online in The American Journal of Clinical Nutrition.

There were 573 participants in the clinic subcohort who completed all cognitive tests at baseline — of these, 492 completed the two-year follow-up assessments. The primary outcome was global cognition. Secondary outcomes were episodic memory and executive function. 

Participants received detailed cognitive testing in person. Neuropsychological assessments over two years showed that daily cocoa extract supplementation — compared to a placebo, had no overall benefits for global or domain-specific cognitive function.The flavanols in cocoa extract are believed to affect cognitive health positively. 

The secondary analyses showed that participants with poor diet quality had cognitive benefits from taking the cocoa extract supplement. 

Daily supplementation
According to the research, adults aged 65 years and older are at high risk for developing Alzheimer’s disease and related dementias (ADRD) and constitute the fastest-growing age segment in the US. Subtle decrements in cognitive function during aging strongly predict worsened cognitive decline and an increased risk of ADRD years later. 

Interventions that target the earliest signs of age-related cognitive decline may preserve cognitive function. Cocoa extract represents a promising example of nutrient supplementation to benefit late-life cognition.

The cocoa extract contains flavanols and small amounts of theobromine and caffeine. The study indicates that flavanols affect cognitive function by interacting with intracellular signaling pathways, mediating neuroinflammation and neurodegeneration and improving cerebral vasodilation and perfusion. 

The COSMOS study incorporates two-by-two factorial randomized clinical trials of cocoa extract — 500 mg flavanols a day and 80 mg epicatechin or a daily multivitamin-mineral supplement for cardiovascular disease and cancer prevention among 21,442 US adults aged over 60 years.

More than 21,000 older women and men were enrolled across the US to participate in the randomized, double-blinded, placebo-controlled study to test whether taking daily cocoa extract supplements or a standard multivitamin reduces the risk of developing heart disease, stroke, cancer and other health outcomes. 

Meanwhile, the FDA will not object to a qualified health claim on reducing the risk of cardiovascular disease from conventional foods. The claim will only apply to cocoa flavanols in high-flavanol powder containing at least 4% of naturally conserved cocoa flavanols or food with high-flavanol cocoa powder.

In addition, researchers from Kerman University of Medical Sciences in Iran found a link between the Nordic or Baltic Sea diet and protective effects on neurological function.

By Inga de Jong