Vitamin and mineral supplementation for maintaining cognitive function in cognitively healthy people in mid and late life
Background Vitamins and minerals play multiple functions within the central nervous system which may help to maintain brain health and optimal cognitive functioning. Supplementation of the diet with various vitamins and minerals has been suggested as a means of maintaining cognitive function, or eve...
Gespeichert in:
| Veröffentlicht in: | Cochrane database of systematic reviews 2018-12, Vol.2019 (1), p.CD011906 |
|---|---|
| Hauptverfasser: | , , , , , , , , , , , |
| Format: | Artikel |
| Sprache: | eng |
| Schlagworte: | |
| Online-Zugang: | Volltext |
| Tags: |
Tag hinzufügen
Keine Tags, Fügen Sie den ersten Tag hinzu!
|
| container_end_page | |
|---|---|
| container_issue | 1 |
| container_start_page | CD011906 |
| container_title | Cochrane database of systematic reviews |
| container_volume | 2019 |
| creator | Rutjes, Anne WS Denton, David A Di Nisio, Marcello Chong, Lee‐Yee Abraham, Rajesh P Al‐Assaf, Aalya S Anderson, John L Malik, Muzaffar A Vernooij, Robin WM Martínez, Gabriel Tabet, Naji McCleery, Jenny Tabet, Naji |
| description | Background
Vitamins and minerals play multiple functions within the central nervous system which may help to maintain brain health and optimal cognitive functioning. Supplementation of the diet with various vitamins and minerals has been suggested as a means of maintaining cognitive function, or even of preventing dementia, in later life.
Objectives
To evaluate the effects of vitamin and mineral supplementation on cognitive function in cognitively healthy people aged 40 years or more.
Search methods
We searched ALOIS, the Cochrane Dementia and Cognitive Improvement Group’s (CDCIG) specialised register, as well as MEDLINE, Embase, PsycINFO, CINAHL, ClinicalTrials.gov and the WHO Portal/ICTRP from inception to 26th January 2018.
Selection criteria
We included randomised controlled trials that evaluated the cognitive effects on people aged 40 years or more of any vitamin or mineral supplements taken by mouth for at least three months.
Data collection and analysis
Study selection, data extraction, and quality assessments were done in duplicate. Vitamins were considered broadly in the categories of B vitamins, antioxidant vitamins, and combinations of both. Minerals were considered separately, where possible. If interventions and outcomes were considered sufficiently similar, then data were pooled. In order to separate short‐term cognitive effects from possible longer‐term effects on the trajectory of cognitive decline, data were pooled for various treatment durations from 3 months to 12 months and up to 10 years or more.
Main results
In total, we included 28 studies with more than 83,000 participants. There were some general limitations of the evidence. Most participants were enrolled in studies which were not designed primarily to assess cognition. These studies often had no baseline cognitive assessment and used only brief cognitive assessments at follow‐up. Very few studies assessed the incidence of dementia. Most study reports did not mention adverse events or made only very general statements about them. Only 10 studies had a mean follow‐up > 5 years. Only two studies had participants whose mean age was < 60 years at baseline. The risk of bias in the included studies was generally low, other than a risk of attrition bias for longer‐term outcomes. We considered the certainty of the evidence behind almost all results to be moderate or low.
We included 14 studies with 27,882 participants which compared folic acid, vitamin B12, vitamin B6, or a combination of |
| doi_str_mv | 10.1002/14651858.CD011906.pub2 |
| format | Article |
| fullrecord | <record><control><sourceid>proquest_pubme</sourceid><recordid>TN_cdi_pubmedcentral_primary_oai_pubmedcentral_nih_gov_6353240</recordid><sourceformat>XML</sourceformat><sourcesystem>PC</sourcesystem><sourcerecordid>2157679916</sourcerecordid><originalsourceid>FETCH-LOGICAL-c4732-a7b7a54d47f82ca06edc23c9a98345ad927c1cb7fc525d05c58cb0d52c120fbd3</originalsourceid><addsrcrecordid>eNqFUctOxCAUJUbj-xcmLN3MCLRAuzHR8ZmYuFG3hFI6g6FQS6vp30udR9SNqwv3nHsOlwPABKMZRoic45RRnNFsNr9GGOeIzZq-IDvgcASmI7L743wAjkJ4QyhhOeH74CBBlDKa80MwvJpO1sZB6UoYq26lhaFvGqtr7TrZGe9g5VtYSxOvxhm3gMovnOnMh4ZV79Q3JSpsu3aASy1ttxxgo31UGtHalN8eVnYaWlPpE7BXSRv06boeg5fbm-f5_fTx6e5hfvk4VSlPyFTygkualimvMqIkYrpUJFG5zLMkpbKMCymsCl4pSmiJqKKZKlBJicIEVUWZHIOLlW78oDoOx63ijqJpTS3bQXhpxG_EmaVY-A_BEpqQFEWBs7VA6997HTpRm6C0tdJp3wdBMOWM5zlmkcpWVNX6EFpdbW0wEmNuYpOb2OQ2mpM4OPn5yO3YJqhIuFoRPo3Vg1BeLdvo_4_uH5cv0Les1Q</addsrcrecordid><sourcetype>Open Access Repository</sourcetype><iscdi>true</iscdi><recordtype>article</recordtype><pqid>2157679916</pqid></control><display><type>article</type><title>Vitamin and mineral supplementation for maintaining cognitive function in cognitively healthy people in mid and late life</title><source>MEDLINE</source><source>Alma/SFX Local Collection</source><source>EZB Electronic Journals Library</source><source>Cochrane Library</source><creator>Rutjes, Anne WS ; Denton, David A ; Di Nisio, Marcello ; Chong, Lee‐Yee ; Abraham, Rajesh P ; Al‐Assaf, Aalya S ; Anderson, John L ; Malik, Muzaffar A ; Vernooij, Robin WM ; Martínez, Gabriel ; Tabet, Naji ; McCleery, Jenny ; Tabet, Naji</creator><creatorcontrib>Rutjes, Anne WS ; Denton, David A ; Di Nisio, Marcello ; Chong, Lee‐Yee ; Abraham, Rajesh P ; Al‐Assaf, Aalya S ; Anderson, John L ; Malik, Muzaffar A ; Vernooij, Robin WM ; Martínez, Gabriel ; Tabet, Naji ; McCleery, Jenny ; Tabet, Naji</creatorcontrib><description>Background
Vitamins and minerals play multiple functions within the central nervous system which may help to maintain brain health and optimal cognitive functioning. Supplementation of the diet with various vitamins and minerals has been suggested as a means of maintaining cognitive function, or even of preventing dementia, in later life.
Objectives
To evaluate the effects of vitamin and mineral supplementation on cognitive function in cognitively healthy people aged 40 years or more.
Search methods
We searched ALOIS, the Cochrane Dementia and Cognitive Improvement Group’s (CDCIG) specialised register, as well as MEDLINE, Embase, PsycINFO, CINAHL, ClinicalTrials.gov and the WHO Portal/ICTRP from inception to 26th January 2018.
Selection criteria
We included randomised controlled trials that evaluated the cognitive effects on people aged 40 years or more of any vitamin or mineral supplements taken by mouth for at least three months.
Data collection and analysis
Study selection, data extraction, and quality assessments were done in duplicate. Vitamins were considered broadly in the categories of B vitamins, antioxidant vitamins, and combinations of both. Minerals were considered separately, where possible. If interventions and outcomes were considered sufficiently similar, then data were pooled. In order to separate short‐term cognitive effects from possible longer‐term effects on the trajectory of cognitive decline, data were pooled for various treatment durations from 3 months to 12 months and up to 10 years or more.
Main results
In total, we included 28 studies with more than 83,000 participants. There were some general limitations of the evidence. Most participants were enrolled in studies which were not designed primarily to assess cognition. These studies often had no baseline cognitive assessment and used only brief cognitive assessments at follow‐up. Very few studies assessed the incidence of dementia. Most study reports did not mention adverse events or made only very general statements about them. Only 10 studies had a mean follow‐up > 5 years. Only two studies had participants whose mean age was < 60 years at baseline. The risk of bias in the included studies was generally low, other than a risk of attrition bias for longer‐term outcomes. We considered the certainty of the evidence behind almost all results to be moderate or low.
We included 14 studies with 27,882 participants which compared folic acid, vitamin B12, vitamin B6, or a combination of these to placebo. The majority of participants were aged over 60 years and had a history of cardio‐ or cerebrovascular disease. We found that giving B vitamin supplements to cognitively healthy adults, mainly in their 60s and 70s, probably has little or no effect on global cognitive function at any time point up to 5 years (SMD values from ‐0.03 to 0.06) and may also have no effect at 5‐10 years (SMD ‐0.01). There were very sparse data on adverse effects or on incidence of cognitive impairment or dementia.
We included 8 studies with 47,840 participants in which the active intervention was one or more of the antioxidant vitamins: ß‐carotene, vitamin C or vitamin E. Results were mixed. For overall cognitive function, there was low‐certainty evidence of benefit associated with ß‐carotene after a mean of 18 years of treatment (MD 0.18 TICS points, 95% CI 0.01 to 0.35) and of vitamin C after 5 years to 10 years (MD 0.46 TICS points, 95% CI 0.14 to 0.78), but not at earlier time points. From two studies which reported on dementia incidence, there was low‐certainty evidence of no effect of an antioxidant vitamin combination or of vitamin E, either alone or combined with selenium. One of the included studies had been designed to look for effects on the incidence of prostate cancer; it found a statistically significant increase in prostate cancer diagnoses among men taking vitamin E.
One trial with 4143 participants compared vitamin D3 (400 IU/day) and calcium supplements to placebo. We found low‐ to moderate‐certainty evidence of no effect of vitamin D3 and calcium supplements at any time‐point up to 10 years on overall cognitive function (MD after a mean of 7.8 years ‐0.1 MMSE points, 95% CI ‐0.81 to 0.61) or the incidence of dementia (HR 0.94, 95% CI 0.72 to 1.24). A pilot study with 60 participants used a higher dose of vitamin D3 (4000 IU on alternate days) and found preliminary evidence that this dose probably has no effect on cognitive function over six months.
We included data from one trial of zinc and copper supplementation with 1072 participants. There was moderate‐certainty evidence of little or no effect on overall cognitive function (MD 0.6 MMSE points, 95% CI ‐0.19 to 1.39) or on the incidence of cognitive impairment after 5 years to 10 years. A second smaller trial provided no usable data, but reported no cognitive effects of six months of supplementation with zinc gluconate.
From one study with 3711 participants, there was low‐certainty evidence of no effect of approximately five years of selenium supplementation on the incidence of dementia (HR 0.83, 95% CI 0.61 to 1.13).
Finally, we included three trials of complex supplements (combinations of B vitamins, antioxidant vitamins, and minerals) with 6306 participants. From the one trial which assessed overall cognitive function, there was low‐certainty evidence of little or no effect on the TICS (MD after a mean of 8.5 years 0.12, 95% CI ‐0.14 to 0.38).
Authors' conclusions
We did not find evidence that any vitamin or mineral supplementation strategy for cognitively healthy adults in mid or late life has a meaningful effect on cognitive decline or dementia, although the evidence does not permit definitive conclusions. There were very few data on supplementation starting in midlife (< 60 years); studies designed to assess cognitive outcomes tended to be too short to assess maintenance of cognitive function; longer studies often had other primary outcomes and used cognitive measures which may have lacked sensitivity. The only positive signals of effect came from studies of long‐term supplementation with antioxidant vitamins. These may be the most promising for further research.</description><identifier>ISSN: 1465-1858</identifier><identifier>ISSN: 1469-493X</identifier><identifier>EISSN: 1465-1858</identifier><identifier>EISSN: 1469-493X</identifier><identifier>DOI: 10.1002/14651858.CD011906.pub2</identifier><identifier>PMID: 30556597</identifier><language>eng</language><publisher>Chichester, UK: John Wiley & Sons, Ltd</publisher><subject><![CDATA[Adult ; Aged ; Antioxidants ; Antioxidants - administration & dosage ; Ascorbic Acid ; Ascorbic Acid - administration & dosage ; beta Carotene ; beta Carotene - administration & dosage ; Calcium ; Calcium - administration & dosage ; Cholecalciferol ; Cholecalciferol - administration & dosage ; Cognition ; Cognition - drug effects ; Cognition - physiology ; Cognitive Dysfunction ; Cognitive Dysfunction - prevention & control ; Cognitive enhancement ; Complementary & alternative medicine ; Copper ; Copper - administration & dosage ; Dementia ; Dementia & cognition ; Dementia - prevention & control ; Dietary Supplements ; Folic Acid ; Folic Acid - administration & dosage ; Humans ; Medicine General & Introductory Medical Sciences ; Mental health ; Middle Aged ; Minerals ; Minerals - administration & dosage ; Modifiable Risk Factors ; Neurology ; Randomized Controlled Trials as Topic ; Selenium ; Selenium - administration & dosage ; Vitamin A ; Vitamin A - administration & dosage ; Vitamin B 12 ; Vitamin B 12 - administration & dosage ; Vitamin B 6 ; Vitamin B 6 - administration & dosage ; Vitamin E ; Vitamin E - administration & dosage ; Vitamins ; Vitamins - administration & dosage ; Zinc ; Zinc - administration & dosage]]></subject><ispartof>Cochrane database of systematic reviews, 2018-12, Vol.2019 (1), p.CD011906</ispartof><rights>Copyright © 2019 The Cochrane Collaboration. Published by John Wiley & Sons, Ltd.</rights><lds50>peer_reviewed</lds50><oa>free_for_read</oa><woscitedreferencessubscribed>false</woscitedreferencessubscribed><citedby>FETCH-LOGICAL-c4732-a7b7a54d47f82ca06edc23c9a98345ad927c1cb7fc525d05c58cb0d52c120fbd3</citedby><cites>FETCH-LOGICAL-c4732-a7b7a54d47f82ca06edc23c9a98345ad927c1cb7fc525d05c58cb0d52c120fbd3</cites></display><links><openurl>$$Topenurl_article</openurl><openurlfulltext>$$Topenurlfull_article</openurlfulltext><thumbnail>$$Tsyndetics_thumb_exl</thumbnail><link.rule.ids>230,314,780,784,885,27924,27925</link.rule.ids><backlink>$$Uhttps://www.ncbi.nlm.nih.gov/pubmed/30556597$$D View this record in MEDLINE/PubMed$$Hfree_for_read</backlink></links><search><creatorcontrib>Rutjes, Anne WS</creatorcontrib><creatorcontrib>Denton, David A</creatorcontrib><creatorcontrib>Di Nisio, Marcello</creatorcontrib><creatorcontrib>Chong, Lee‐Yee</creatorcontrib><creatorcontrib>Abraham, Rajesh P</creatorcontrib><creatorcontrib>Al‐Assaf, Aalya S</creatorcontrib><creatorcontrib>Anderson, John L</creatorcontrib><creatorcontrib>Malik, Muzaffar A</creatorcontrib><creatorcontrib>Vernooij, Robin WM</creatorcontrib><creatorcontrib>Martínez, Gabriel</creatorcontrib><creatorcontrib>Tabet, Naji</creatorcontrib><creatorcontrib>McCleery, Jenny</creatorcontrib><creatorcontrib>Tabet, Naji</creatorcontrib><title>Vitamin and mineral supplementation for maintaining cognitive function in cognitively healthy people in mid and late life</title><title>Cochrane database of systematic reviews</title><addtitle>Cochrane Database Syst Rev</addtitle><description>Background
Vitamins and minerals play multiple functions within the central nervous system which may help to maintain brain health and optimal cognitive functioning. Supplementation of the diet with various vitamins and minerals has been suggested as a means of maintaining cognitive function, or even of preventing dementia, in later life.
Objectives
To evaluate the effects of vitamin and mineral supplementation on cognitive function in cognitively healthy people aged 40 years or more.
Search methods
We searched ALOIS, the Cochrane Dementia and Cognitive Improvement Group’s (CDCIG) specialised register, as well as MEDLINE, Embase, PsycINFO, CINAHL, ClinicalTrials.gov and the WHO Portal/ICTRP from inception to 26th January 2018.
Selection criteria
We included randomised controlled trials that evaluated the cognitive effects on people aged 40 years or more of any vitamin or mineral supplements taken by mouth for at least three months.
Data collection and analysis
Study selection, data extraction, and quality assessments were done in duplicate. Vitamins were considered broadly in the categories of B vitamins, antioxidant vitamins, and combinations of both. Minerals were considered separately, where possible. If interventions and outcomes were considered sufficiently similar, then data were pooled. In order to separate short‐term cognitive effects from possible longer‐term effects on the trajectory of cognitive decline, data were pooled for various treatment durations from 3 months to 12 months and up to 10 years or more.
Main results
In total, we included 28 studies with more than 83,000 participants. There were some general limitations of the evidence. Most participants were enrolled in studies which were not designed primarily to assess cognition. These studies often had no baseline cognitive assessment and used only brief cognitive assessments at follow‐up. Very few studies assessed the incidence of dementia. Most study reports did not mention adverse events or made only very general statements about them. Only 10 studies had a mean follow‐up > 5 years. Only two studies had participants whose mean age was < 60 years at baseline. The risk of bias in the included studies was generally low, other than a risk of attrition bias for longer‐term outcomes. We considered the certainty of the evidence behind almost all results to be moderate or low.
We included 14 studies with 27,882 participants which compared folic acid, vitamin B12, vitamin B6, or a combination of these to placebo. The majority of participants were aged over 60 years and had a history of cardio‐ or cerebrovascular disease. We found that giving B vitamin supplements to cognitively healthy adults, mainly in their 60s and 70s, probably has little or no effect on global cognitive function at any time point up to 5 years (SMD values from ‐0.03 to 0.06) and may also have no effect at 5‐10 years (SMD ‐0.01). There were very sparse data on adverse effects or on incidence of cognitive impairment or dementia.
We included 8 studies with 47,840 participants in which the active intervention was one or more of the antioxidant vitamins: ß‐carotene, vitamin C or vitamin E. Results were mixed. For overall cognitive function, there was low‐certainty evidence of benefit associated with ß‐carotene after a mean of 18 years of treatment (MD 0.18 TICS points, 95% CI 0.01 to 0.35) and of vitamin C after 5 years to 10 years (MD 0.46 TICS points, 95% CI 0.14 to 0.78), but not at earlier time points. From two studies which reported on dementia incidence, there was low‐certainty evidence of no effect of an antioxidant vitamin combination or of vitamin E, either alone or combined with selenium. One of the included studies had been designed to look for effects on the incidence of prostate cancer; it found a statistically significant increase in prostate cancer diagnoses among men taking vitamin E.
One trial with 4143 participants compared vitamin D3 (400 IU/day) and calcium supplements to placebo. We found low‐ to moderate‐certainty evidence of no effect of vitamin D3 and calcium supplements at any time‐point up to 10 years on overall cognitive function (MD after a mean of 7.8 years ‐0.1 MMSE points, 95% CI ‐0.81 to 0.61) or the incidence of dementia (HR 0.94, 95% CI 0.72 to 1.24). A pilot study with 60 participants used a higher dose of vitamin D3 (4000 IU on alternate days) and found preliminary evidence that this dose probably has no effect on cognitive function over six months.
We included data from one trial of zinc and copper supplementation with 1072 participants. There was moderate‐certainty evidence of little or no effect on overall cognitive function (MD 0.6 MMSE points, 95% CI ‐0.19 to 1.39) or on the incidence of cognitive impairment after 5 years to 10 years. A second smaller trial provided no usable data, but reported no cognitive effects of six months of supplementation with zinc gluconate.
From one study with 3711 participants, there was low‐certainty evidence of no effect of approximately five years of selenium supplementation on the incidence of dementia (HR 0.83, 95% CI 0.61 to 1.13).
Finally, we included three trials of complex supplements (combinations of B vitamins, antioxidant vitamins, and minerals) with 6306 participants. From the one trial which assessed overall cognitive function, there was low‐certainty evidence of little or no effect on the TICS (MD after a mean of 8.5 years 0.12, 95% CI ‐0.14 to 0.38).
Authors' conclusions
We did not find evidence that any vitamin or mineral supplementation strategy for cognitively healthy adults in mid or late life has a meaningful effect on cognitive decline or dementia, although the evidence does not permit definitive conclusions. There were very few data on supplementation starting in midlife (< 60 years); studies designed to assess cognitive outcomes tended to be too short to assess maintenance of cognitive function; longer studies often had other primary outcomes and used cognitive measures which may have lacked sensitivity. The only positive signals of effect came from studies of long‐term supplementation with antioxidant vitamins. These may be the most promising for further research.</description><subject>Adult</subject><subject>Aged</subject><subject>Antioxidants</subject><subject>Antioxidants - administration & dosage</subject><subject>Ascorbic Acid</subject><subject>Ascorbic Acid - administration & dosage</subject><subject>beta Carotene</subject><subject>beta Carotene - administration & dosage</subject><subject>Calcium</subject><subject>Calcium - administration & dosage</subject><subject>Cholecalciferol</subject><subject>Cholecalciferol - administration & dosage</subject><subject>Cognition</subject><subject>Cognition - drug effects</subject><subject>Cognition - physiology</subject><subject>Cognitive Dysfunction</subject><subject>Cognitive Dysfunction - prevention & control</subject><subject>Cognitive enhancement</subject><subject>Complementary & alternative medicine</subject><subject>Copper</subject><subject>Copper - administration & dosage</subject><subject>Dementia</subject><subject>Dementia & cognition</subject><subject>Dementia - prevention & control</subject><subject>Dietary Supplements</subject><subject>Folic Acid</subject><subject>Folic Acid - administration & dosage</subject><subject>Humans</subject><subject>Medicine General & Introductory Medical Sciences</subject><subject>Mental health</subject><subject>Middle Aged</subject><subject>Minerals</subject><subject>Minerals - administration & dosage</subject><subject>Modifiable Risk Factors</subject><subject>Neurology</subject><subject>Randomized Controlled Trials as Topic</subject><subject>Selenium</subject><subject>Selenium - administration & dosage</subject><subject>Vitamin A</subject><subject>Vitamin A - administration & dosage</subject><subject>Vitamin B 12</subject><subject>Vitamin B 12 - administration & dosage</subject><subject>Vitamin B 6</subject><subject>Vitamin B 6 - administration & dosage</subject><subject>Vitamin E</subject><subject>Vitamin E - administration & dosage</subject><subject>Vitamins</subject><subject>Vitamins - administration & dosage</subject><subject>Zinc</subject><subject>Zinc - administration & dosage</subject><issn>1465-1858</issn><issn>1469-493X</issn><issn>1465-1858</issn><issn>1469-493X</issn><fulltext>true</fulltext><rsrctype>article</rsrctype><creationdate>2018</creationdate><recordtype>article</recordtype><sourceid>RWY</sourceid><sourceid>EIF</sourceid><recordid>eNqFUctOxCAUJUbj-xcmLN3MCLRAuzHR8ZmYuFG3hFI6g6FQS6vp30udR9SNqwv3nHsOlwPABKMZRoic45RRnNFsNr9GGOeIzZq-IDvgcASmI7L743wAjkJ4QyhhOeH74CBBlDKa80MwvJpO1sZB6UoYq26lhaFvGqtr7TrZGe9g5VtYSxOvxhm3gMovnOnMh4ZV79Q3JSpsu3aASy1ttxxgo31UGtHalN8eVnYaWlPpE7BXSRv06boeg5fbm-f5_fTx6e5hfvk4VSlPyFTygkualimvMqIkYrpUJFG5zLMkpbKMCymsCl4pSmiJqKKZKlBJicIEVUWZHIOLlW78oDoOx63ijqJpTS3bQXhpxG_EmaVY-A_BEpqQFEWBs7VA6997HTpRm6C0tdJp3wdBMOWM5zlmkcpWVNX6EFpdbW0wEmNuYpOb2OQ2mpM4OPn5yO3YJqhIuFoRPo3Vg1BeLdvo_4_uH5cv0Les1Q</recordid><startdate>20181217</startdate><enddate>20181217</enddate><creator>Rutjes, Anne WS</creator><creator>Denton, David A</creator><creator>Di Nisio, Marcello</creator><creator>Chong, Lee‐Yee</creator><creator>Abraham, Rajesh P</creator><creator>Al‐Assaf, Aalya S</creator><creator>Anderson, John L</creator><creator>Malik, Muzaffar A</creator><creator>Vernooij, Robin WM</creator><creator>Martínez, Gabriel</creator><creator>Tabet, Naji</creator><creator>McCleery, Jenny</creator><creator>Tabet, Naji</creator><general>John Wiley & Sons, Ltd</general><scope>7PX</scope><scope>RWY</scope><scope>ZYTZH</scope><scope>CGR</scope><scope>CUY</scope><scope>CVF</scope><scope>ECM</scope><scope>EIF</scope><scope>NPM</scope><scope>AAYXX</scope><scope>CITATION</scope><scope>7X8</scope><scope>5PM</scope></search><sort><creationdate>20181217</creationdate><title>Vitamin and mineral supplementation for maintaining cognitive function in cognitively healthy people in mid and late life</title><author>Rutjes, Anne WS ; Denton, David A ; Di Nisio, Marcello ; Chong, Lee‐Yee ; Abraham, Rajesh P ; Al‐Assaf, Aalya S ; Anderson, John L ; Malik, Muzaffar A ; Vernooij, Robin WM ; Martínez, Gabriel ; Tabet, Naji ; McCleery, Jenny ; Tabet, Naji</author></sort><facets><frbrtype>5</frbrtype><frbrgroupid>cdi_FETCH-LOGICAL-c4732-a7b7a54d47f82ca06edc23c9a98345ad927c1cb7fc525d05c58cb0d52c120fbd3</frbrgroupid><rsrctype>articles</rsrctype><prefilter>articles</prefilter><language>eng</language><creationdate>2018</creationdate><topic>Adult</topic><topic>Aged</topic><topic>Antioxidants</topic><topic>Antioxidants - administration & dosage</topic><topic>Ascorbic Acid</topic><topic>Ascorbic Acid - administration & dosage</topic><topic>beta Carotene</topic><topic>beta Carotene - administration & dosage</topic><topic>Calcium</topic><topic>Calcium - administration & dosage</topic><topic>Cholecalciferol</topic><topic>Cholecalciferol - administration & dosage</topic><topic>Cognition</topic><topic>Cognition - drug effects</topic><topic>Cognition - physiology</topic><topic>Cognitive Dysfunction</topic><topic>Cognitive Dysfunction - prevention & control</topic><topic>Cognitive enhancement</topic><topic>Complementary & alternative medicine</topic><topic>Copper</topic><topic>Copper - administration & dosage</topic><topic>Dementia</topic><topic>Dementia & cognition</topic><topic>Dementia - prevention & control</topic><topic>Dietary Supplements</topic><topic>Folic Acid</topic><topic>Folic Acid - administration & dosage</topic><topic>Humans</topic><topic>Medicine General & Introductory Medical Sciences</topic><topic>Mental health</topic><topic>Middle Aged</topic><topic>Minerals</topic><topic>Minerals - administration & dosage</topic><topic>Modifiable Risk Factors</topic><topic>Neurology</topic><topic>Randomized Controlled Trials as Topic</topic><topic>Selenium</topic><topic>Selenium - administration & dosage</topic><topic>Vitamin A</topic><topic>Vitamin A - administration & dosage</topic><topic>Vitamin B 12</topic><topic>Vitamin B 12 - administration & dosage</topic><topic>Vitamin B 6</topic><topic>Vitamin B 6 - administration & dosage</topic><topic>Vitamin E</topic><topic>Vitamin E - administration & dosage</topic><topic>Vitamins</topic><topic>Vitamins - administration & dosage</topic><topic>Zinc</topic><topic>Zinc - administration & dosage</topic><toplevel>peer_reviewed</toplevel><toplevel>online_resources</toplevel><creatorcontrib>Rutjes, Anne WS</creatorcontrib><creatorcontrib>Denton, David A</creatorcontrib><creatorcontrib>Di Nisio, Marcello</creatorcontrib><creatorcontrib>Chong, Lee‐Yee</creatorcontrib><creatorcontrib>Abraham, Rajesh P</creatorcontrib><creatorcontrib>Al‐Assaf, Aalya S</creatorcontrib><creatorcontrib>Anderson, John L</creatorcontrib><creatorcontrib>Malik, Muzaffar A</creatorcontrib><creatorcontrib>Vernooij, Robin WM</creatorcontrib><creatorcontrib>Martínez, Gabriel</creatorcontrib><creatorcontrib>Tabet, Naji</creatorcontrib><creatorcontrib>McCleery, Jenny</creatorcontrib><creatorcontrib>Tabet, Naji</creatorcontrib><collection>Wiley-Blackwell Cochrane Library</collection><collection>Cochrane Library</collection><collection>Cochrane Library (Open Aceess)</collection><collection>Medline</collection><collection>MEDLINE</collection><collection>MEDLINE (Ovid)</collection><collection>MEDLINE</collection><collection>MEDLINE</collection><collection>PubMed</collection><collection>CrossRef</collection><collection>MEDLINE - Academic</collection><collection>PubMed Central (Full Participant titles)</collection><jtitle>Cochrane database of systematic reviews</jtitle></facets><delivery><delcategory>Remote Search Resource</delcategory><fulltext>fulltext</fulltext></delivery><addata><au>Rutjes, Anne WS</au><au>Denton, David A</au><au>Di Nisio, Marcello</au><au>Chong, Lee‐Yee</au><au>Abraham, Rajesh P</au><au>Al‐Assaf, Aalya S</au><au>Anderson, John L</au><au>Malik, Muzaffar A</au><au>Vernooij, Robin WM</au><au>Martínez, Gabriel</au><au>Tabet, Naji</au><au>McCleery, Jenny</au><au>Tabet, Naji</au><format>journal</format><genre>article</genre><ristype>JOUR</ristype><atitle>Vitamin and mineral supplementation for maintaining cognitive function in cognitively healthy people in mid and late life</atitle><jtitle>Cochrane database of systematic reviews</jtitle><addtitle>Cochrane Database Syst Rev</addtitle><date>2018-12-17</date><risdate>2018</risdate><volume>2019</volume><issue>1</issue><spage>CD011906</spage><pages>CD011906-</pages><issn>1465-1858</issn><issn>1469-493X</issn><eissn>1465-1858</eissn><eissn>1469-493X</eissn><abstract>Background
Vitamins and minerals play multiple functions within the central nervous system which may help to maintain brain health and optimal cognitive functioning. Supplementation of the diet with various vitamins and minerals has been suggested as a means of maintaining cognitive function, or even of preventing dementia, in later life.
Objectives
To evaluate the effects of vitamin and mineral supplementation on cognitive function in cognitively healthy people aged 40 years or more.
Search methods
We searched ALOIS, the Cochrane Dementia and Cognitive Improvement Group’s (CDCIG) specialised register, as well as MEDLINE, Embase, PsycINFO, CINAHL, ClinicalTrials.gov and the WHO Portal/ICTRP from inception to 26th January 2018.
Selection criteria
We included randomised controlled trials that evaluated the cognitive effects on people aged 40 years or more of any vitamin or mineral supplements taken by mouth for at least three months.
Data collection and analysis
Study selection, data extraction, and quality assessments were done in duplicate. Vitamins were considered broadly in the categories of B vitamins, antioxidant vitamins, and combinations of both. Minerals were considered separately, where possible. If interventions and outcomes were considered sufficiently similar, then data were pooled. In order to separate short‐term cognitive effects from possible longer‐term effects on the trajectory of cognitive decline, data were pooled for various treatment durations from 3 months to 12 months and up to 10 years or more.
Main results
In total, we included 28 studies with more than 83,000 participants. There were some general limitations of the evidence. Most participants were enrolled in studies which were not designed primarily to assess cognition. These studies often had no baseline cognitive assessment and used only brief cognitive assessments at follow‐up. Very few studies assessed the incidence of dementia. Most study reports did not mention adverse events or made only very general statements about them. Only 10 studies had a mean follow‐up > 5 years. Only two studies had participants whose mean age was < 60 years at baseline. The risk of bias in the included studies was generally low, other than a risk of attrition bias for longer‐term outcomes. We considered the certainty of the evidence behind almost all results to be moderate or low.
We included 14 studies with 27,882 participants which compared folic acid, vitamin B12, vitamin B6, or a combination of these to placebo. The majority of participants were aged over 60 years and had a history of cardio‐ or cerebrovascular disease. We found that giving B vitamin supplements to cognitively healthy adults, mainly in their 60s and 70s, probably has little or no effect on global cognitive function at any time point up to 5 years (SMD values from ‐0.03 to 0.06) and may also have no effect at 5‐10 years (SMD ‐0.01). There were very sparse data on adverse effects or on incidence of cognitive impairment or dementia.
We included 8 studies with 47,840 participants in which the active intervention was one or more of the antioxidant vitamins: ß‐carotene, vitamin C or vitamin E. Results were mixed. For overall cognitive function, there was low‐certainty evidence of benefit associated with ß‐carotene after a mean of 18 years of treatment (MD 0.18 TICS points, 95% CI 0.01 to 0.35) and of vitamin C after 5 years to 10 years (MD 0.46 TICS points, 95% CI 0.14 to 0.78), but not at earlier time points. From two studies which reported on dementia incidence, there was low‐certainty evidence of no effect of an antioxidant vitamin combination or of vitamin E, either alone or combined with selenium. One of the included studies had been designed to look for effects on the incidence of prostate cancer; it found a statistically significant increase in prostate cancer diagnoses among men taking vitamin E.
One trial with 4143 participants compared vitamin D3 (400 IU/day) and calcium supplements to placebo. We found low‐ to moderate‐certainty evidence of no effect of vitamin D3 and calcium supplements at any time‐point up to 10 years on overall cognitive function (MD after a mean of 7.8 years ‐0.1 MMSE points, 95% CI ‐0.81 to 0.61) or the incidence of dementia (HR 0.94, 95% CI 0.72 to 1.24). A pilot study with 60 participants used a higher dose of vitamin D3 (4000 IU on alternate days) and found preliminary evidence that this dose probably has no effect on cognitive function over six months.
We included data from one trial of zinc and copper supplementation with 1072 participants. There was moderate‐certainty evidence of little or no effect on overall cognitive function (MD 0.6 MMSE points, 95% CI ‐0.19 to 1.39) or on the incidence of cognitive impairment after 5 years to 10 years. A second smaller trial provided no usable data, but reported no cognitive effects of six months of supplementation with zinc gluconate.
From one study with 3711 participants, there was low‐certainty evidence of no effect of approximately five years of selenium supplementation on the incidence of dementia (HR 0.83, 95% CI 0.61 to 1.13).
Finally, we included three trials of complex supplements (combinations of B vitamins, antioxidant vitamins, and minerals) with 6306 participants. From the one trial which assessed overall cognitive function, there was low‐certainty evidence of little or no effect on the TICS (MD after a mean of 8.5 years 0.12, 95% CI ‐0.14 to 0.38).
Authors' conclusions
We did not find evidence that any vitamin or mineral supplementation strategy for cognitively healthy adults in mid or late life has a meaningful effect on cognitive decline or dementia, although the evidence does not permit definitive conclusions. There were very few data on supplementation starting in midlife (< 60 years); studies designed to assess cognitive outcomes tended to be too short to assess maintenance of cognitive function; longer studies often had other primary outcomes and used cognitive measures which may have lacked sensitivity. The only positive signals of effect came from studies of long‐term supplementation with antioxidant vitamins. These may be the most promising for further research.</abstract><cop>Chichester, UK</cop><pub>John Wiley & Sons, Ltd</pub><pmid>30556597</pmid><doi>10.1002/14651858.CD011906.pub2</doi><oa>free_for_read</oa></addata></record> |
| fulltext | fulltext |
| identifier | ISSN: 1465-1858 |
| ispartof | Cochrane database of systematic reviews, 2018-12, Vol.2019 (1), p.CD011906 |
| issn | 1465-1858 1469-493X 1465-1858 1469-493X |
| language | eng |
| recordid | cdi_pubmedcentral_primary_oai_pubmedcentral_nih_gov_6353240 |
| source | MEDLINE; Alma/SFX Local Collection; EZB Electronic Journals Library; Cochrane Library |
| subjects | Adult Aged Antioxidants Antioxidants - administration & dosage Ascorbic Acid Ascorbic Acid - administration & dosage beta Carotene beta Carotene - administration & dosage Calcium Calcium - administration & dosage Cholecalciferol Cholecalciferol - administration & dosage Cognition Cognition - drug effects Cognition - physiology Cognitive Dysfunction Cognitive Dysfunction - prevention & control Cognitive enhancement Complementary & alternative medicine Copper Copper - administration & dosage Dementia Dementia & cognition Dementia - prevention & control Dietary Supplements Folic Acid Folic Acid - administration & dosage Humans Medicine General & Introductory Medical Sciences Mental health Middle Aged Minerals Minerals - administration & dosage Modifiable Risk Factors Neurology Randomized Controlled Trials as Topic Selenium Selenium - administration & dosage Vitamin A Vitamin A - administration & dosage Vitamin B 12 Vitamin B 12 - administration & dosage Vitamin B 6 Vitamin B 6 - administration & dosage Vitamin E Vitamin E - administration & dosage Vitamins Vitamins - administration & dosage Zinc Zinc - administration & dosage |
| title | Vitamin and mineral supplementation for maintaining cognitive function in cognitively healthy people in mid and late life |
| url | https://sfx.bib-bvb.de/sfx_tum?ctx_ver=Z39.88-2004&ctx_enc=info:ofi/enc:UTF-8&ctx_tim=2024-12-20T17%3A47%3A48IST&url_ver=Z39.88-2004&url_ctx_fmt=infofi/fmt:kev:mtx:ctx&rfr_id=info:sid/primo.exlibrisgroup.com:primo3-Article-proquest_pubme&rft_val_fmt=info:ofi/fmt:kev:mtx:journal&rft.genre=article&rft.atitle=Vitamin%20and%20mineral%20supplementation%20for%20maintaining%20cognitive%20function%20in%20cognitively%20healthy%20people%20in%20mid%20and%20late%20life&rft.jtitle=Cochrane%20database%20of%20systematic%20reviews&rft.au=Rutjes,%20Anne%20WS&rft.date=2018-12-17&rft.volume=2019&rft.issue=1&rft.spage=CD011906&rft.pages=CD011906-&rft.issn=1465-1858&rft.eissn=1465-1858&rft_id=info:doi/10.1002/14651858.CD011906.pub2&rft_dat=%3Cproquest_pubme%3E2157679916%3C/proquest_pubme%3E%3Curl%3E%3C/url%3E&disable_directlink=true&sfx.directlink=off&sfx.report_link=0&rft_id=info:oai/&rft_pqid=2157679916&rft_id=info:pmid/30556597&rfr_iscdi=true |