Multivitamins to Help Memory?

by Joe Breault, MD, ScD, MPH on March 21, 2024

Over the past 30+ years of primary care practice, the most common question from patients was whether they should take vitamin pills. Healthy vegetables, fruits, and an exercise program work better than vitamin pills. But sometimes vitamin or mineral pills are needed. Vegans need B12 supplements. Iron deficiency anemia may need iron treatment in addition to finding the cause. Patients on certain medications that interfere with absorption might need specific supplements. Macular degeneration might progress more slowly on AREDS2 vitamins. Occasionally, patients with low vitamin levels on testing might need supplements (not that testing is routinely recommended).

CDC found that one in ten people 45 years and older experience subjective cognitive decline (SCD). Forty one percent of them had to give up some day-to-day activities. One in three say it interfered with social activities, work, or volunteering. Thirty five percent of them need help with household tasks. A group of experts reviewed existing evidence and developed recommendations for primary care clinicians discussing cognitive decline and risk reduction with their patients. They produced 11 consensus-based recommendations. The recommendations included controlling high blood pressure and diabetes, exercise, good sleep, healthy eating, social activity, and cognitive stimulation. It did not include taking any specific pills every day.

Older patients often want a pill to improve memory, asking about Prevagen. It has apoaequor initially found in jellyfish. The FTC and New York State AG have charged the marketers of Prevagen with making false and unsubstantiated claims that the product improves memory, provides cognitive benefits, and is “clinically shown” to work. Among the multiple court cases about Prevagen, a NY jury verdict filed on 3/11/2024 found eight Prevagen claims were not supported with competent and scientific evidence. Two of the eight claims were also found to be materially misleading: “Prevagen reduces memory problems associated with aging” and “Prevagen is clinically shown to reduce memory problems associated with aging.”

I do not recommend Prevagen to my patients. There is concern whether Prevagen is as safe as the manufacturer claims. Wired reports it may not be:

Thousands of Americans have reported experiencing “adverse events” while taking Prevagen, including seizures, strokes, heart arrhythmias, chest pain, and dizziness. While the existence of adverse event reports alone don’t prove a product is the cause, the nature and pattern of complaints about Prevagen worried FDA officials, according to agency records. One internal report from 2015 stated that the “numerous adverse events reported” indicated “a serious safety hazard.”

Overall, for the average person, including older adults, it is better to have lots of vegetables and fruits in the daily diet and a regular exercise program than a multivitamin or supplement pill. Nor did I take a multivitamin myself. That changed when I reviewed the COSMOS trial results. As reported by sciencedirect.com in a Jan 18, 2024 press release: