In Reply Dr Smith and colleagues take issue with a statement in our Viewpoint,1 suggesting that in select patient groups, cognitive decline may be prevented or slowed with supplements. The authors cite data from the VITACOG trial, which found that participants with mild cognitive impairment and higher Hcy levels who received supplemental B vitamins showed slower brain atrophy in regions affected by Alzheimer disease compared with patients who received a placebo. Secondary analyses suggested links between neuroimaging findings and clinical and cognitive outcomes.2 While we encourage the rigorous approach of the VITACOG study, there are study design limitations to consider when interpreting these data as supporting supplement use to prevent or slow cognitive decline.
Hellmuth J, Rabinovici GD, Miller BL. Dietary Supplements for Brain Health—Reply. JAMA. 2019;321(24):2467–2468. doi:10.1001/jama.2019.4967
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