---
title: "Evidence: vascular flavanols, cognition"
description: "Daily multivitamin-mineral supplementation, but not cocoa extract, improved global cognition, memory, and executive function in older adults over three…"
url: "https://magellanlongevity.com/study/s116.md"
canonical: "https://magellanlongevity.com/study/s116.html"
html: "https://magellanlongevity.com/study/s116.html"
type: "study"
study_key: "s116"
journal: "Alzheimers Dement"
year: 2022
pmid: "36102337"
doi: "10.1002/alz.12767"
citations: 1
updated: 2026-09-02
author: "Gabriel Radu, DO"
author_credentials: "Physiatrist (PM&R). NY medical license 275110. NPI 1376861765."
publisher: "Magellan Longevity"
content_format: "markdown"
---

# Evidence: vascular flavanols, cognition

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**HTML version:** https://magellanlongevity.com/study/s116.html · **In the Magellan app:** https://magellanlongevity.com/#/study/s116

## Citation

| Field | Value |
| --- | --- |
| Journal | Alzheimers Dement |
| Year | 2022 |
| PMID | [36102337](https://pubmed.ncbi.nlm.nih.gov/36102337/) |
| DOI | [10.1002/alz.12767](https://doi.org/10.1002/alz.12767) |
| Study key | s116 |

## Takeaway

Daily multivitamin-mineral supplementation, but not cocoa extract, improved global cognition, memory, and executive function in older adults over three years.

## The question

Does daily administration of cocoa extract (500 mg/day flavanols) or a commercial multivitamin-mineral (MVM) improve cognition in older women and men?

## Hypothesis

The study implicitly hypothesized that either cocoa extract or a multivitamin-mineral supplement would improve cognition in older adults.

## Methods

COSMOS-Mind was a 3-year randomized two-by-two factorial trial involving 2262 participants (mean age 73 years; 60% women; 89% non-Hispanic White). Cognition was assessed annually by telephone using a global cognition composite score derived from multiple tests. The primary outcome was the change in this composite with 3 years of cocoa extract use, and a pre-specified secondary outcome was the change with 3 years of MVM supplementation. Treatment effects were also examined for executive function and memory, and in pre-specified subgroups.

## Results

Cocoa extract had no effect on global cognition (mean z-score = 0.03, 95% CI: -0.02 to 0.08; P = .28). Daily MVM supplementation resulted in a statistically significant benefit on global cognition (mean z = 0.07, 95% CI 0.02 to 0.12; P = .007). This MVM effect was more pronounced in participants with a history of cardiovascular disease (no history: 0.06, 95% CI 0.01 to 0.11; history: 0.14, 95% CI -0.02 to 0.31; interaction, nominal P = .01). MVM benefits were also observed for memory and executive function. The interaction between cocoa extract and MVM was not significant.

## Conclusion

Cocoa extract did not benefit cognition in older adults. However, daily multivitamin-mineral supplementation for 3 years improved global cognition, episodic memory, and executive function in older adults, with a potentially greater benefit for those with cardiovascular disease.

## Limitations

Additional work is needed to confirm these findings in a more diverse cohort and to identify mechanisms for the MVM effects. The study population was predominantly non-Hispanic White.

## Verbatim from the abstract

> daily administration of cocoa extract containing 500 mg/day flavanols

## Effect of Supplements on Global Cognition (Mean Z-score Change)

| Measure | Mean Z-score Change |
| --- | --- |
| Cocoa Extract | 0.03 |
| Multivitamin-Mineral | 0.07 |

*Mean z-score change in global cognition after 3 years of supplementation with cocoa extract or multivitamin-mineral.*

## Where this study is used on Magellan

This paper is one of the citations behind the evidence grade on the pages below. Grades are assigned from the published research and are independent of affiliate commissions.

| Compound or device | Evidence grade | Graded pages |
| --- | --- | --- |
| Cocoa Flavanol Extract | Moderate evidence | [Cocoa Flavanol Extract](https://magellanlongevity.com/p/116.md) |

## Reference

1. **Evidence: vascular flavanols, cognition**
   Alzheimers Dement 2022 · [PMID 36102337](https://pubmed.ncbi.nlm.nih.gov/36102337/) · [DOI 10.1002/alz.12767](https://doi.org/10.1002/alz.12767)

   > daily administration of cocoa extract containing 500 mg/day flavanols

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## Related on Magellan Longevity

- [Cocoa Flavanol Extract](https://magellanlongevity.com/p/116.md) — product graded on this and related evidence
- [Dietary flavanols improve cerebral cortical oxygenation and cognition in healthy adults](https://magellanlongevity.com/study/d33235219.md)
- [Cocoa Flavanol Supplementation and Exercise: A Systematic Review](https://magellanlongevity.com/study/d29299877.md)
- [Longevity research map](https://magellanlongevity.com/longevity-research-map.html)
- [Evidence-based longevity supplements](https://magellanlongevity.com/longevity-supplements.md)

## Scope and disclosures

Educational information, not medical advice. Nothing here is intended to diagnose, treat, cure, or prevent any disease. Talk to your physician before starting any supplement or device, especially if you are pregnant, nursing, or taking medication.

Editorial firewall: evidence grades are assigned from the published research and are independent of any affiliate commission. As an Amazon Associate, Magellan Longevity earns from qualifying purchases.

Reviewed for accuracy by a board-certified physician (DO).