Are there any supplements that help with age-related cognitive decline?

Supplements for Age-Related Cognitive Decline

Most supplements do not help with age-related cognitive decline, with the exception of multivitamins which show promising evidence for memory improvement in older adults. 1

Evidence Against Most Supplements for Cognitive Decline

• The ESPEN guidelines on nutrition in dementia strongly recommend against using several supplements specifically for preventing or correcting cognitive decline:

  • Omega-3 fatty acids (high-quality evidence) 2
  • Vitamin B1 (very low-quality evidence) 2
  • Vitamin B6, B12, and/or folic acid (low-quality evidence) 2
  • Vitamin E (moderate-quality evidence) 2
  • Selenium (very low-quality evidence) 2
  • Copper (very low-quality evidence) 2
  • Vitamin D (very low-quality evidence) 2

• The ESPEN guidelines also recommend against using any other nutritional products for correcting cognitive impairment or preventing further cognitive decline (very low-quality evidence) 2

Vitamin D: Mixed Evidence

• While ESPEN guidelines recommend against vitamin D specifically for cognitive decline, other research suggests a possible relationship:
  • Hypovitaminosis D may increase the risk of cognitive decline and dementia in older adults 2
  • Longitudinal studies show that older individuals with lower vitamin D concentrations had increased risk of global cognitive decline and executive dysfunction 2
  • Some before-after studies report cognitive improvement after vitamin D supplementation, particularly for executive function and processing speed 2
  • However, experts conclude that vitamin D supplementation is not specifically recommended for cognitive decline/dementia but rather for general health benefits in those with deficiency 2

Multivitamins: Promising Recent Evidence

• The most recent high-quality evidence (2023) shows that daily multivitamin supplementation improves memory in older adults:
  • In a randomized clinical trial with 3,562 older adults, multivitamin supplementation significantly improved immediate recall performance after 1 year 1
  • The effect was equivalent to improving memory performance by approximately 3.1 years of age-related memory change 1
  • This contrasts with earlier, smaller studies that found no benefit 3, 4

Omega-3 Fatty Acids: Conflicting Evidence

• Despite ESPEN guidelines recommending against omega-3 supplements for cognitive decline 2, some more recent research suggests potential benefits:
  • A 2019 systematic review found that 10 out of 14 randomized controlled trials showed positive outcomes on at least one domain of cognitive function 5
  • However, the quality and consistency of evidence remains insufficient to make a strong recommendation 4

Practical Approach for Older Adults

• For general cognitive health in older adults:

  • Consider daily multivitamin supplementation as it shows the most promising recent evidence for memory improvement 1
  • Check vitamin D levels and supplement if deficient, though this is for general health rather than specifically for cognition 2
  • Do not rely on omega-3, vitamin E, selenium, copper, or B vitamins solely for cognitive benefits 2

• Focus on dietary patterns rather than individual supplements:

  • Mediterranean diet and DASH (Dietary Approach to Stop Hypertension) dietary patterns have shown neuroprotective effects 6
  • These dietary approaches may provide stronger benefits than individual supplements 6

Common Pitfalls to Avoid

• Assuming that supplements can replace a healthy diet - dietary patterns appear more beneficial than isolated nutrients 6
• Using supplements as the primary intervention for cognitive decline when they should be considered adjunctive at best 2
• Overlooking potential vitamin D deficiency, which should be corrected for general health benefits even if not specifically for cognition 2
• Failing to consider that supplement needs may be greater in those aged 75+ or at higher risk of nutritional deficiency 3