MD, PhD, MAE, FMedSci, FRSB, FRCP, FRCPEd.

Maintenance of cognitive abilities is of critical importance to older adults, yet only a few effective strategies to slow down cognitive decline currently exist. Multivitamin supplementation is used to promote general health; however, it is unclear whether it favorably affects cognition in older age. This study aimed to examine the effect of daily multivitamin/multimineral supplementation on memory in older adults.

The Cocoa Supplement and Multivitamin Outcomes Study Web (COSMOS-Web) ancillary study (NCT04582617) included 3562 older adults. Participants were randomly assigned to a daily multivitamin supplement (Centrum Silver) or placebo and evaluated annually with an Internet-based battery of neuropsychological tests for 3 y. The prespecified primary outcome measure was change in episodic memory, operationally defined as immediate recall performance on the ModRey test, after 1 y of intervention. Secondary outcome measures included changes in episodic memory over 3 y of follow-up and changes in performance on neuropsychological tasks of novel object recognition and executive function over 3 y.

Compared with placebo, participants randomly assigned to multivitamin supplementation had significantly better ModRey immediate recall at 1 y, the primary endpoint (t(5889) = 2.25, P = 0.025), as well as across the 3 y of follow-up on average (t(5889) = 2.54, P = 0.011). Multivitamin supplementation had no significant effects on secondary outcomes. Based on a cross-sectional analysis of the association between age and performance on the ModRey, it was estimated that the effect of the multivitamin intervention improved memory performance above placebo by the equivalent of 3.1 y of age-related memory change.

The authors concluded that daily multivitamin supplementation, compared with placebo, improves memory. Multivitamin supplementation holds promise as a safe and accessible approach to maintaining cognitive health in older age.

These findings are surprising, not least because similar studies have thus far failed to demonstrate such effects. A 2013 trial, for instance, concluded that, in male physicians aged 65 years or older, long-term use of a daily multivitamin did not provide cognitive benefits.

Judging from the abstract alone (unfortunately, I have no access to the full paper), this seems to be a rigorous trial. It was conducted by multiple researchers of high standing. One is therefore inclined to believe the results.

Yet, one might be wise to be cautious.

Provided that a full analysis of the study does not identify major flaws, I would still want to 1) have a plausible explanation as to the mode of action and 2) see an independent replication before I accept the findings.

PS

The study was partly funded by the National Institutes of Health. The vitamins were provided by Pfizer Inc. and Haleon, the makers of the supplement used in the study.

PPS

I have now seen the full paper [thank you Dan] and can confirm that the study was of high quality. Yet, it also has limitations, of course, e.g.:

  • the effect size is modest;
  • the study population is selected and thus the results are not generalizable;
  • the outcome measures were assessed remotely;
  • the success of blinding was not checked [I find it conceivable that some trial participants tried to find out what they were taking, e.g. by tasting the pills].

8 Responses to Multivitamin/multimineral supplement might improve memory

  • QUOTE:
    “The authors concluded that daily multivitamin supplementation, compared with placebo, improves memory. Multivitamin supplementation holds promise as a safe and accessible approach to maintaining cognitive health in older age”….
    I’m shocked Edzard that you gave space to SCAM (your terminology, not mine). The study used a highly processed and unnatural form of ‘nutrition’ provided by ….. a DRUG COMPANY! You couldn’t write the script. Move on, nothing to see here, as they say in the movies.

    • much of SCAM is highly processed and unnatural provided by the pharma industry, as you (should) know.

    • The study used a highly processed and unnatural form of ‘nutrition’ provided by ….. a DRUG COMPANY!

      Who do you think makes “supplements”?

      • @Mojo

        Yes, a few drug companies (big pharma) make vitamin supplements, but not many. A larger number likely supply synthetic ingredients to other non-pharma companies to make vitamins. Most of the higher quality vitamin supplements are not directly manufactured by pharmaceutical companies.

        If you’re unable to meet your nutritional needs through your diet alone, supplements can be a convenient and effective way to do so.

        That said, not all vitamin and mineral supplements are created equal. Some products may contain fillers, additives, and unhealthy ingredients that can do more harm than good when it comes to your health.

        Reputable brands with products that have undergone extensive testing, ideally by a third-party lab, and are sourced from high-quality ingredients. In doing so, the user can ensure that they are getting a supplement that’s pure and potent and that your body can use it efficiently.

        It is my position that vitamin supplements CAN be beneficial, and others do harm.

        • The dose–response relationship, or exposure–response relationship, describes the magnitude of the response of an organism, as a function of exposure (or doses) to a stimulus or stressor (usually a chemical) after a certain exposure time. Dose–response relationships can be described by dose–response curves.

          Motivation for studying dose–response relationships
          Studying dose response, and developing dose–response models, is central to determining “safe”, “hazardous” and (where relevant) beneficial levels and dosages for drugs, pollutants, foods, and other substances to which humans or other organisms are exposed. These conclusions are often the basis for public policy.

          https://en.m.wikipedia.org/wiki/Dose%E2%80%93response_relationship

          See also: Ceiling effect (pharmacology), Wikipedia

        • If you’re unable to meet your nutritional needs through your diet alone, supplements can be a convenient and effective way to do so.

          If you’re not meeting your nutritional needs through diet, the first thing to do is to change your diet.

  • Mojo, I love that, so simple.
    Except for the fact that most people will not go to the extent of taking the time to know if they are meeting the daily requirements for vitamins and minerals via diet. It actually requires some effort to investigate and tabulate it all.

    I agree with your thinking though.

    • Except for the fact that most people will not go to the extent of taking the time to know if they are meeting the daily requirements for vitamins and minerals via diet.

      Supplements aren’t a solution to that, though, because they wouldn’t know which they needed to take, or even that they needed to take them.

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