1. In male physicians aged greater than 65 years old, no mean difference in cognition was observed between multivitamin and placebo groups.
Evidence Rating Level: 1 (Excellent)
Study Rundown: Cognitive decline is a common pathology that arises with aging, and it is associated with significant morbidity and mortality. The evidence for the role of multivitamins in preventing cognitive decline is sparse and inconsistent. This study is one of the first large long-term clinical trials to examine the relationship of daily multivitamins and the potential protective effects on cognitive decline. The study included male physicians aged >65 years old. Participants were randomized into groups that were characterized by active and placebo combinations of beta-carotene, vitamin C, vitamin E and/or multivitamin. Patient follow-up occurred for up to 14 years and included 4 cognitive assessments. Results failed to show a statistically significant difference in cognitive scores or verbal memory between the treatment groups. The major limitation of the trial arises from its study population, which included only male physicians. First, this population is more likely to be well nourished and highly educated. Especially given that education is known to be protective against cognitive decline, the potential benefit may be less in this group compared to the general population. Furthermore, this data cannot be generalized to woman as they may have different nutritional needs. Nevertheless, the strengths of this study include its robust study design, long-term follow up and large population size.
In-Depth [randomized controlled trial]: This study enrolled 5947 male physicians aged 65 years or older. The trial was run as a 2 X 2 X 2 X 2 factorial trial – patients once accepted were randomized into 4 separate active or placebo vitamin groups until there were 16 separate groups with different characteristics. Outcomes were measured by composite scores of common cognitive tests reflecting global cognition, verbal memory, and category fluency. Verbal memory score – a strong predictor of Alzheimer’s disease – also was used as a secondary outcome. It was found that cognitive function did not change significantly throughout the follow-up period between multivitamin and placebo group -0.01 SU [CI95% -0.04 – 0.02] for the global cognitive score. Verbal memory score also showed no difference over the follow-up period -0.005 SU [CI95% -0.04 – 0.03].
By Adam Whittington and Aimee Li, MD
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