The DOI matches its Crossref record; 41 of the 41 references it cites were found in a registry or an index; 6 of the 99 sources its claims cite were checked for support.
Benefits in Cognitive Function, Blood Pressure, and Insulin Resistance Through Cocoa Flavanol Consumption in Elderly Subjects With Mild Cognitive Impairment: The Cocoa, Cognition, and Aging (CoCoA) Study
Abstract
Flavanol consumption is favorably associated with cognitive function. We tested the hypothesis that dietary flavanols might improve cognitive function in subjects with mild cognitive impairment. We conducted a double-blind, parallel arm study in 90 elderly individuals with mild cognitive impairment randomized to consume once daily for 8 weeks a drink containing ≈990 mg (high flavanols), ≈520 mg (intermediate flavanols), or ≈45 mg (low flavanols) of cocoa flavanols per day. Cognitive function was assessed by Mini Mental State Examination, Trail Making Test A and B, and verbal fluency test. At the end of the follow-up period, Mini Mental State Examination was similar in the 3 treatment groups ( P =0.13). The time required to complete Trail Making Test A and Trail Making Test B was significantly ( P <0.05) lower in subjects assigned to high flavanols (38.10±10.94 and 104.10±28.73 seconds, respectively) and intermediate flavanols (40.20±11.35 and 115.97±28.35 seconds, respectively) in comparison with those assigned to low flavanols (52.60±17.97 and 139.23±43.02 seconds, respectively). Similarly, verbal fluency test score was significantly ( P <0.05) better in subjects assigned to high flavanols in comparison with those assigned to low flavanols (27.50±6.75 versus 22.30±8.09 words per 60 seconds). Insulin resistance, blood pressure, and lipid peroxidation also decreased among subjects in the high-flavanol and intermediate-flavanol groups. Changes of insulin resistance explained ≈40% of composite z score variability through the study period (partial r 2 =0.4013; P <0.0001). To the best of our knowledge, this is the first dietary intervention study demonstrating that the regular consumption of cocoa flavanols might be effective in improving cognitive function in elderly subjects with mild cognitive impairment. This effect appears mediated in part by an improvement in insulin sensitivity.
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Claims the paper makes
77 Not checked yet · 23 Own interpretation · 10 Own result · 9 Own method · 3 No basis given · 2 Partly supported · 1 Supported · accuracy not yet measured
The cited sources support only part of this claim — read each source’s verdict below.
In the paper
“In this regard, the level of flavanols used in this current study is comparable to the level of cocoa flavanols fed in previous studies where improvements in brain blood flow, 19 vascular function, and blood pressure were observed.25”
§ Benefits in Cognitive Function, Blood Pressure, and Insulin Resistance Through Cocoa Flavanol Consumption in Elderly Subjects With Mild Cognitive Impairment The Cocoa, Cognition, and Aging (CoCoA) Study > Discussion
What the sources say
- Not checked yetcites [19]
- Partly supportedcites [25] sourceExperimental — accuracy not yet measured
The Discussion reports improved flow-mediated dilatation and tabulates blood-pressure reductions at some epicatechin doses, supporting the vascular-function and blood-pressure findings attributed to this review. It does not establish that the citing study used a comparable flavanol dose. Brain blood flow has a separate citation in the citing sentence and is not attributed to this source. (LLM, conf=0.84)
plain- Asserted: passes — The authors put it forward as true.
- Checkable: passes — It can be checked against evidence.
- Load-bearing: unclear — It is unclear whether the paper’s conclusions depend on it.
- Based: passes — The paper gives a reason why it holds.
In the paper
“The time required to complete TMT A significantly changed throughout the study period (PϽ0.0001), with significant reductions observed in subjects assigned to HF (Ϫ14.3Ϯ4.2 seconds; PϽ0.0001) and IF (Ϫ8.8Ϯ3.4 seconds; PϽ0.0001) interventions but not in those assigned to the LF intervention (ϩ1.1Ϯ13.0seconds; Pϭ0.65; Table 1).”
§ Benefits in Cognitive Function, Blood Pressure, and Insulin Resistance Through Cocoa Flavanol Consumption in Elderly Subjects With Mild Cognitive Impairment The Cocoa, Cognition, and Aging (CoCoA) Study > Cognitive Function Measures
What the sources say
- Not checked yetcites Table 1
plaindirect- Asserted: passes — The authors put it forward as true.
- Checkable: passes — It can be checked against evidence.
- Load-bearing: passes — The paper’s conclusions depend on it.
- Based: passes — The paper gives a reason why it holds.
In the paper
“The time required to complete TMT A significantly changed throughout the study period (PϽ0.0001), with significant reductions observed in subjects assigned to HF (Ϫ14.3Ϯ4.2 seconds; PϽ0.0001) and IF (Ϫ8.8Ϯ3.4 seconds; PϽ0.0001) interventions but not in those assigned to the LF intervention (ϩ1.1Ϯ13.0seconds; Pϭ0.65; Table 1).”
§ Benefits in Cognitive Function, Blood Pressure, and Insulin Resistance Through Cocoa Flavanol Consumption in Elderly Subjects With Mild Cognitive Impairment The Cocoa, Cognition, and Aging (CoCoA) Study > Cognitive Function Measures
What the sources say
- Not checked yetcites Table 1
plain- Asserted: passes — The authors put it forward as true.
- Checkable: passes — It can be checked against evidence.
- Load-bearing: passes — The paper’s conclusions depend on it.
- Based: passes — The paper gives a reason why it holds.
In the paper
“The time required to complete TMT A significantly changed throughout the study period (PϽ0.0001), with significant reductions observed in subjects assigned to HF (Ϫ14.3Ϯ4.2 seconds; PϽ0.0001) and IF (Ϫ8.8Ϯ3.4 seconds; PϽ0.0001) interventions but not in those assigned to the LF intervention (ϩ1.1Ϯ13.0seconds; Pϭ0.65; Table 1).”
§ Benefits in Cognitive Function, Blood Pressure, and Insulin Resistance Through Cocoa Flavanol Consumption in Elderly Subjects With Mild Cognitive Impairment The Cocoa, Cognition, and Aging (CoCoA) Study > Cognitive Function Measures
What the sources say
- Not checked yetcites Table 1
plaindirect- Asserted: passes — The authors put it forward as true.
- Checkable: passes — It can be checked against evidence.
- Load-bearing: passes — The paper’s conclusions depend on it.
- Based: passes — The paper gives a reason why it holds.
In the paper
“Mini Mental State Examination score did not significantly change in relation to the 3 different treatments during the study period (Pϭ0.13;Table 1).”
§ Benefits in Cognitive Function, Blood Pressure, and Insulin Resistance Through Cocoa Flavanol Consumption in Elderly Subjects With Mild Cognitive Impairment The Cocoa, Cognition, and Aging (CoCoA) Study > Cognitive Function Measures
What the sources say
- Not checked yetcites Table 1
plain- Asserted: passes — The authors put it forward as true.
- Checkable: passes — It can be checked against evidence.
- Load-bearing: unclear — It is unclear whether the paper’s conclusions depend on it.
- Based: passes — The paper gives a reason why it holds.
In the paper
“Plasma glucose levels significantly changed during the study period (PϽ0.0001), with significant reductions observed in subjects assigned to HF (Ϫ0.6Ϯ0.3 mmol/L; PϽ0.0001) and IF (Ϫ0.5Ϯ0.1 mmol/L; PϽ0.0001) but not in those assigned to LF (Ϫ0.1Ϯ0.5 mmol/L; Pϭ0.19; Table 2).”
§ Benefits in Cognitive Function, Blood Pressure, and Insulin Resistance Through Cocoa Flavanol Consumption in Elderly Subjects With Mild Cognitive Impairment The Cocoa, Cognition, and Aging (CoCoA) Study > Metabolic Parameters
What the sources say
- Not checked yetcites Table 2
plain- Asserted: passes — The authors put it forward as true.
- Checkable: passes — It can be checked against evidence.
- Load-bearing: passes — The paper’s conclusions depend on it.
- Based: passes — The paper gives a reason why it holds.
None of the sources cited for this claim have been checked yet.
In the paper
“According to the above results, the composite cognitive z score significantly changed during the study period (PϽ0.0001), with HF (ϩ0.693Ϯ0.223;PϽ0.0001) and IF (ϩ0.404Ϯ0.141;PϽ0.0001) groups demonstrating significant improvement; no change was observed in the LF group (Ϫ0.072Ϯ0.383;Pϭ0.31; Table 1 and Figure S2).”
§ Benefits in Cognitive Function, Blood Pressure, and Insulin Resistance Through Cocoa Flavanol Consumption in Elderly Subjects With Mild Cognitive Impairment The Cocoa, Cognition, and Aging (CoCoA) Study > Cognitive Function Measures
What the sources say
- Not checked yetcites Table 1
- Not checked yetcites Figure S2
plain- Asserted: passes — The authors put it forward as true.
- Checkable: passes — It can be checked against evidence.
- Load-bearing: passes — The paper’s conclusions depend on it.
- Based: passes — The paper gives a reason why it holds.
None of the sources cited for this claim have been checked yet.
In the paper
“Composite cognitive z score at the end of follow-up was significantly (PϽ0.05)better in subjects assigned to HF in comparison with those assigned to LF (Table 1 and Figure S2).”
§ Benefits in Cognitive Function, Blood Pressure, and Insulin Resistance Through Cocoa Flavanol Consumption in Elderly Subjects With Mild Cognitive Impairment The Cocoa, Cognition, and Aging (CoCoA) Study > Cognitive Function Measures
What the sources say
- Not checked yetcites Table 1
- Not checked yetcites Figure S2
plaincorrelational- Asserted: passes — The authors put it forward as true.
- Checkable: passes — It can be checked against evidence.
- Load-bearing: passes — The paper’s conclusions depend on it.
- Based: passes — The paper gives a reason why it holds.
In the paper
“Thus, systolic and diastolic blood pressure levels at the end of follow-up were significantly (PϽ0.05)lower in subjects assigned to HF and IF in comparison with those assigned to LF (Table 2).”
§ Benefits in Cognitive Function, Blood Pressure, and Insulin Resistance Through Cocoa Flavanol Consumption in Elderly Subjects With Mild Cognitive Impairment The Cocoa, Cognition, and Aging (CoCoA) Study > Blood Pressure
What the sources say
- Not checked yetcites Table 2
plain- Asserted: passes — The authors put it forward as true.
- Checkable: passes — It can be checked against evidence.
- Load-bearing: passes — The paper’s conclusions depend on it.
- Based: passes — The paper gives a reason why it holds.
In the paper
“Thus, systolic and diastolic blood pressure levels at the end of follow-up were significantly (PϽ0.05)lower in subjects assigned to HF and IF in comparison with those assigned to LF (Table 2).”
§ Benefits in Cognitive Function, Blood Pressure, and Insulin Resistance Through Cocoa Flavanol Consumption in Elderly Subjects With Mild Cognitive Impairment The Cocoa, Cognition, and Aging (CoCoA) Study > Blood Pressure
What the sources say
- Not checked yetcites Table 2
plain- Asserted: passes — The authors put it forward as true.
- Checkable: passes — It can be checked against evidence.
- Load-bearing: passes — The paper’s conclusions depend on it.
- Based: passes — The paper gives a reason why it holds.
- It may state two separate claims as one. 24
- Probably not a substantial claim. 20
- The quote only partly states this claim. 2
Every source the paper cites for this claim was checked and supports it.
In the paper
“In this regard, dietary flavanol consumption has been shown to reduce blood pressure and improve insulin sensitivity, 17,18 as well as to induce vasodilation of the peripheral 17,18 and cerebral vascular system, 19 increasing brain blood flow and perfusion.19,20”
§ Benefits in Cognitive Function, Blood Pressure, and Insulin Resistance Through Cocoa Flavanol Consumption in Elderly Subjects With Mild Cognitive Impairment The Cocoa, Cognition, and Aging (CoCoA) Study > Abstract
What the sources say
- Supportedcites [17] source
The Abstract (p. 1671) reports that 15 days of flavanol-rich dark chocolate, but not flavanol-free white chocolate, increased insulin sensitivity and reduced blood pressure in hypertensive adults with impaired glucose tolerance. This supports the attributed claim; the study's finding is specific to that population and intervention. (LLM, conf=0.93)
- Supportedcites [18] source
The Discussion (p. 5) reports that consumption of flavanol-rich dark chocolate decreased blood pressure and reduced insulin resistance. The conclusion (p. 6) likewise describes beneficial effects on blood pressure and insulin sensitivity in people with essential hypertension. (LLM, conf=0.93)
plaindirect- Asserted: passes — The authors put it forward as true.
- Checkable: passes — It can be checked against evidence.
- Load-bearing: passes — The paper’s conclusions depend on it.
- Based: passes — The paper gives a reason why it holds.
It may state two separate claims as one.
- Supported
The cited sources support only part of this claim — read each source’s verdict below.
In the paper
“The current demonstration of significant reductions in both systolic and diastolic blood pressure levels after regular cocoa flavanol consumption is consistent with previous findings obtained both in normotensives and in hypertensive subjects, as well as medicated individuals.17,18,29,30”
§ Benefits in Cognitive Function, Blood Pressure, and Insulin Resistance Through Cocoa Flavanol Consumption in Elderly Subjects With Mild Cognitive Impairment The Cocoa, Cognition, and Aging (CoCoA) Study > Discussion
What the sources say
- Partly supportedcites [17] sourceExperimental — accuracy not yet measured
The Introduction and Discussion report blood-pressure reductions with dark chocolate in healthy and hypertensive subjects, consistent with the cited comparison. The paper does not report corresponding findings in medicated individuals; its Patient selection section says medication use was an exclusion criterion. (LLM, conf=0.88)
- Partly supportedcites [18] sourceExperimental — accuracy not yet measured
The Results (pp. 3–5) report reductions in systolic and diastolic blood pressure after dark chocolate consumption in hypertensive patients and normotensive controls. The hypertensive patients were never treated (Results, p. 3), so this paper does not support the portion about medicated individuals. (LLM, conf=0.88)
- Not checked yetcites [29] source
- Partly supportedcites [30] sourceExperimental — accuracy not yet measured
The Results and Discussion report that cocoa flavanols lowered systolic blood pressure in medicated patients with coronary artery disease, and the Discussion says this aligns with previous studies. The paper does not establish blood-pressure reductions in both normotensive and hypertensive groups; its reference to previous findings does not specify those populations. The citing authors’ own finding about systolic and diastolic pressure is not attributed to this source. (LLM, conf=0.84)
plain- Asserted: passes — The authors put it forward as true.
- Checkable: passes — It can be checked against evidence.
- Load-bearing: fails — The paper’s conclusions may not depend on it.
- Based: passes — The paper gives a reason why it holds.
Probably not a substantial claim. The paper’s conclusions may not depend on it.
- Partly supported
A result the paper reports from its own data — it cites no other source for it, so there is none to check. The quote shows it is in the paper.
In the paper
“In this regard, we found a significant improvement of insulin resistance after cocoa flavanol consumption.”
§ Benefits in Cognitive Function, Blood Pressure, and Insulin Resistance Through Cocoa Flavanol Consumption in Elderly Subjects With Mild Cognitive Impairment The Cocoa, Cognition, and Aging (CoCoA) Study > Discussion
plaindirect- Asserted: passes — The authors put it forward as true.
- Checkable: passes — It can be checked against evidence.
- Load-bearing: passes — The paper’s conclusions depend on it.
- Based: passes — The paper gives a reason why it holds.
The quote only partly states this claim.
In the paper
“With regard to total cholesterol, low-density lipoprotein cholesterol, high-density lipoprotein cholesterol, and triglycerides concentrations, no significant differences were found among the 3 treatment groups at the end of follow-up (Table 2).”
§ Benefits in Cognitive Function, Blood Pressure, and Insulin Resistance Through Cocoa Flavanol Consumption in Elderly Subjects With Mild Cognitive Impairment The Cocoa, Cognition, and Aging (CoCoA) Study > Metabolic Parameters
What the sources say
- Not checked yetcites Table 2
plain- Asserted: passes — The authors put it forward as true.
- Checkable: passes — It can be checked against evidence.
- Load-bearing: unclear — It is unclear whether the paper’s conclusions depend on it.
- Based: passes — The paper gives a reason why it holds.
It may state two separate claims as one.
A result the paper reports from its own data — it cites no other source for it, so there is none to check. The quote shows it is in the paper.
In the paper
“We found significant improvements in performance on a battery of neuropsychological tests mainly exploring executive function but also aspects of working memory, short-term memory, long-term episodic memory, processing speed, and global cognition, after 8 weeks of regular cocoa flavanol consumption.”
- Also stated in: § Additional information · boosted
“For the first time, regular cocoa flavanol consumption has been shown to positively affect cognitive function in older adults with early memory decline.”
§ Benefits in Cognitive Function, Blood Pressure, and Insulin Resistance Through Cocoa Flavanol Consumption in Elderly Subjects With Mild Cognitive Impairment The Cocoa, Cognition, and Aging (CoCoA) Study > Discussion
boosteddirect- Asserted: passes — The authors put it forward as true.
- Checkable: passes — It can be checked against evidence.
- Load-bearing: passes — The paper’s conclusions depend on it.
- Based: passes — The paper gives a reason why it holds.
It may state two separate claims as one.
- Also stated in: § Additional information · boosted
A result the paper reports from its own data — it cites no other source for it, so there is none to check. The quote shows it is in the paper.
In the paper
“In particular, the benefits were remarkably evident for processing speed, executive function, and working memory, as indicated by the improvement in TMT A and TMT B scores.”
§ Benefits in Cognitive Function, Blood Pressure, and Insulin Resistance Through Cocoa Flavanol Consumption in Elderly Subjects With Mild Cognitive Impairment The Cocoa, Cognition, and Aging (CoCoA) Study > Discussion
boosteddirect- Asserted: passes — The authors put it forward as true.
- Checkable: passes — It can be checked against evidence.
- Load-bearing: passes — The paper’s conclusions depend on it.
- Based: passes — The paper gives a reason why it holds.
It may state two separate claims as one.
The paper states this without a source or data behind it here, so there is nothing to check it against. The quote shows it is in the paper.
In the paper
“Finally, subjects enrolled in our study were generally in good health and without known cardiovascular disease.”
§ Benefits in Cognitive Function, Blood Pressure, and Insulin Resistance Through Cocoa Flavanol Consumption in Elderly Subjects With Mild Cognitive Impairment The Cocoa, Cognition, and Aging (CoCoA) Study > Limitations
plain- Asserted: passes — The authors put it forward as true.
- Checkable: passes — It can be checked against evidence.
- Load-bearing: unclear — It is unclear whether the paper’s conclusions depend on it.
- Based: passes — The paper gives a reason why it holds.
It may state two separate claims as one.
A result the paper reports from its own data — it cites no other source for it, so there is none to check. The quote shows it is in the paper.
In the paper
“The current demonstration of significant reductions in both systolic and diastolic blood pressure levels after regular cocoa flavanol consumption is consistent with previous findings obtained both in normotensives and in hypertensive subjects, as well as medicated individuals.17,18,29,30”
§ Benefits in Cognitive Function, Blood Pressure, and Insulin Resistance Through Cocoa Flavanol Consumption in Elderly Subjects With Mild Cognitive Impairment The Cocoa, Cognition, and Aging (CoCoA) Study > Discussion
boosteddirect- Asserted: passes — The authors put it forward as true.
- Checkable: passes — It can be checked against evidence.
- Load-bearing: passes — The paper’s conclusions depend on it.
- Based: passes — The paper gives a reason why it holds.
It may state two separate claims as one.
In the paper
“Baseline performance on the cognitive function tests was similar for the 3 treatment groups, indicating an adequate randomization procedure (Table 1).”
§ Benefits in Cognitive Function, Blood Pressure, and Insulin Resistance Through Cocoa Flavanol Consumption in Elderly Subjects With Mild Cognitive Impairment The Cocoa, Cognition, and Aging (CoCoA) Study > Cognitive Function Measures
What the sources say
- Not checked yetcites Table 1
hedged- Asserted: passes — The authors put it forward as true.
- Checkable: passes — It can be checked against evidence.
- Load-bearing: passes — The paper’s conclusions depend on it.
- Based: passes — The paper gives a reason why it holds.
It may state two separate claims as one.
What the paper did — it cites no source for this, so there is none to check. The quote shows it is in the paper.
In the paper
“We conducted a double-blind, parallel arm study in 90 elderly individuals with mild cognitive impairment randomized to consume once daily for 8 weeks a drink containing Ϸ990 mg (high flavanols), Ϸ520 mg ( intermediate flavanols), or Ϸ45 mg (low flavanols) of cocoa flavanols per day.”
§ Benefits in Cognitive Function, Blood Pressure, and Insulin Resistance Through Cocoa Flavanol Consumption in Elderly Subjects With Mild Cognitive Impairment The Cocoa, Cognition, and Aging (CoCoA) Study > Abstract
plainn = 90- Asserted: passes — The authors put it forward as true.
- Checkable: passes — It can be checked against evidence.
- Load-bearing: passes — The paper’s conclusions depend on it.
- Based: passes — The paper gives a reason why it holds.
Probably not a substantial claim. It may state two separate claims as one.
What the paper did — it cites no source for this, so there is none to check. The quote shows it is in the paper.
In the paper
“The overall compliance was 99.6% at week 4 and 99.4% at week 8, without difference among the LF, IF, and HF interventions.”
§ Benefits in Cognitive Function, Blood Pressure, and Insulin Resistance Through Cocoa Flavanol Consumption in Elderly Subjects With Mild Cognitive Impairment The Cocoa, Cognition, and Aging (CoCoA) Study > Adherence to the Study Protocol
plain- Asserted: passes — The authors put it forward as true.
- Checkable: passes — It can be checked against evidence.
- Load-bearing: unclear — It is unclear whether the paper’s conclusions depend on it.
- Based: passes — The paper gives a reason why it holds.
It may state two separate claims as one.
What the paper did — it cites no source for this, so there is none to check. The quote shows it is in the paper.
In the paper
“Thus, the study was based on an estimated sample size of 90 subjects, with a ratio of 1:1:1 for the 3 treatment groups, which has been calculated to be adequate to achieve 90% power to detect a moderate effect size (Cohen dϭ0.40) with 2 degrees of freedom and an ␣ of 0.05 on the global cognitive z score between HF and LF.”
§ Benefits in Cognitive Function, Blood Pressure, and Insulin Resistance Through Cocoa Flavanol Consumption in Elderly Subjects With Mild Cognitive Impairment The Cocoa, Cognition, and Aging (CoCoA) Study > Statistical Analysis
hedgedn = 90- Asserted: passes — The authors put it forward as true.
- Checkable: passes — It can be checked against evidence.
- Load-bearing: passes — The paper’s conclusions depend on it.
- Based: passes — The paper gives a reason why it holds.
Probably not a substantial claim.
In the paper
“Dietary total flavanol intake was also similar in the 3 study groups at enrollment and slightly decreased during the run-in period to a similar degree in all of the groups, a consequence of the dietary prescriptions (Table S3).”
§ Benefits in Cognitive Function, Blood Pressure, and Insulin Resistance Through Cocoa Flavanol Consumption in Elderly Subjects With Mild Cognitive Impairment The Cocoa, Cognition, and Aging (CoCoA) Study > Study Population
What the sources say
- Not checked yetcites Table S3
plain- Asserted: passes — The authors put it forward as true.
- Checkable: passes — It can be checked against evidence.
- Load-bearing: fails — The paper’s conclusions may not depend on it.
- Based: passes — The paper gives a reason why it holds.
Probably not a substantial claim. The paper’s conclusions may not depend on it. It may state two separate claims as one.
In the paper
“The dairy-based cocoa drinks used in this study were specially designed so that they were indistinguishable in taste and appearance, calorically balanced, and contained similar macronutrient, mineral, theobromine, and caffeine content, varying significantly only in the content of cocoa flavanols (Table S1, available in the online-only Data Supplement).”
§ Benefits in Cognitive Function, Blood Pressure, and Insulin Resistance Through Cocoa Flavanol Consumption in Elderly Subjects With Mild Cognitive Impairment The Cocoa, Cognition, and Aging (CoCoA) Study > Study Design and Outcomes
What the sources say
- Not checked yetcites Table S1
plain- Asserted: passes — The authors put it forward as true.
- Checkable: passes — It can be checked against evidence.
- Load-bearing: passes — The paper’s conclusions depend on it.
- Based: passes — The paper gives a reason why it holds.
It may state two separate claims as one.
What the paper did — it cites no source for this, so there is none to check. The quote shows it is in the paper.
In the paper
“The statistical analysis was conducted according to the intention-totreat principle.”
§ Benefits in Cognitive Function, Blood Pressure, and Insulin Resistance Through Cocoa Flavanol Consumption in Elderly Subjects With Mild Cognitive Impairment The Cocoa, Cognition, and Aging (CoCoA) Study > Statistical Analysis
plain- Asserted: passes — The authors put it forward as true.
- Checkable: passes — It can be checked against evidence.
- Load-bearing: fails — The paper’s conclusions may not depend on it.
- Based: passes — The paper gives a reason why it holds.
Probably not a substantial claim. The paper’s conclusions may not depend on it.
What the paper did — it cites no source for this, so there is none to check. The quote shows it is in the paper.
In the paper
“As a predefined procedure, an integrated measure of overall cognitive function, composite cognitive z score, was also constructed for each participant by converting the logtransformed raw scores from the individual tests to standardized scores (z score) that were based on the means and pooled SDs of the whole population at baseline.”
§ Benefits in Cognitive Function, Blood Pressure, and Insulin Resistance Through Cocoa Flavanol Consumption in Elderly Subjects With Mild Cognitive Impairment The Cocoa, Cognition, and Aging (CoCoA) Study > Cognitive Function Assessment
plain- Asserted: passes — The authors put it forward as true.
- Checkable: passes — It can be checked against evidence.
- Load-bearing: passes — The paper’s conclusions depend on it.
- Based: passes — The paper gives a reason why it holds.
Probably not a substantial claim.
What the paper did — it cites no source for this, so there is none to check. The quote shows it is in the paper.
In the paper
“Furthermore, caloric intake was controlled throughout the study, because no significant differences in body weight (HF, 70.67Ϯ8.39kg; IF, 68.59Ϯ8.19kg; LF, 71.17Ϯ8.65 kg; Pϭ0.486) or body mass index (HF, 27.20Ϯ2.7 kg/m 2 ; IF, 26.27Ϯ2.50kg/m 2 ; LF, 26.90Ϯ2.75kg/m 2 ; Pϭ0.427) among the 3 study groups were observed at the end of follow-up.”
§ Benefits in Cognitive Function, Blood Pressure, and Insulin Resistance Through Cocoa Flavanol Consumption in Elderly Subjects With Mild Cognitive Impairment The Cocoa, Cognition, and Aging (CoCoA) Study > Adherence to the Study Protocol
plain- Asserted: passes — The authors put it forward as true.
- Checkable: passes — It can be checked against evidence.
- Load-bearing: fails — The paper’s conclusions may not depend on it.
- Based: passes — The paper gives a reason why it holds.
Probably not a substantial claim. The paper’s conclusions may not depend on it.
In the paper
“The 3 study groups were comparable with regard to sex, age, anthropometric characteristics, cardiovascular risk factor prevalence, and pharmacological treatments (Table S2).”
§ Benefits in Cognitive Function, Blood Pressure, and Insulin Resistance Through Cocoa Flavanol Consumption in Elderly Subjects With Mild Cognitive Impairment The Cocoa, Cognition, and Aging (CoCoA) Study > Study Population
What the sources say
- Not checked yetcites Table S2
plain- Asserted: passes — The authors put it forward as true.
- Checkable: passes — It can be checked against evidence.
- Load-bearing: passes — The paper’s conclusions depend on it.
- Based: passes — The paper gives a reason why it holds.
It may state two separate claims as one.
What the paper did — it cites no source for this, so there is none to check. The quote shows it is in the paper.
In the paper
“After a 1-week run-in period, participants were randomly assigned to consume once daily a dairy-based cocoa drink containing cocoa flavanols either at a high (HF; Ϸ990 mg of flavanols per serving), intermediate (IF; Ϸ520 mg of flavanols per serving), or low level (LF; Ϸ45 mg of flavanols per serving) for 8 weeks.”
§ Benefits in Cognitive Function, Blood Pressure, and Insulin Resistance Through Cocoa Flavanol Consumption in Elderly Subjects With Mild Cognitive Impairment The Cocoa, Cognition, and Aging (CoCoA) Study > Study Design and Outcomes
plain- Asserted: passes — The authors put it forward as true.
- Checkable: passes — It can be checked against evidence.
- Load-bearing: passes — The paper’s conclusions depend on it.
- Based: passes — The paper gives a reason why it holds.
Probably not a substantial claim.
What the paper did — it cites no source for this, so there is none to check. The quote shows it is in the paper.
In the paper
“Cognitive testing was performed at baseline and after 8 weeks (Ϯ2 days) using a combination of 4 well-validated standardized tests: the Mini Mental State Examination, Trail Making Test (TMT) A, TMT B, and a verbal fluency test.”
§ Benefits in Cognitive Function, Blood Pressure, and Insulin Resistance Through Cocoa Flavanol Consumption in Elderly Subjects With Mild Cognitive Impairment The Cocoa, Cognition, and Aging (CoCoA) Study > Cognitive Function Assessment
plain- Asserted: passes — The authors put it forward as true.
- Checkable: passes — It can be checked against evidence.
- Load-bearing: passes — The paper’s conclusions depend on it.
- Based: passes — The paper gives a reason why it holds.
Probably not a substantial claim.
None of the sources cited for this claim have been checked yet.
In the paper
“In this regard, dietary flavanol consumption has been shown to reduce blood pressure and improve insulin sensitivity, 17,18 as well as to induce vasodilation of the peripheral 17,18 and cerebral vascular system, 19 increasing brain blood flow and perfusion.19,20”
§ Benefits in Cognitive Function, Blood Pressure, and Insulin Resistance Through Cocoa Flavanol Consumption in Elderly Subjects With Mild Cognitive Impairment The Cocoa, Cognition, and Aging (CoCoA) Study > Abstract
What the sources say
boosteddirect- Asserted: passes — The authors put it forward as true.
- Checkable: passes — It can be checked against evidence.
- Load-bearing: passes — The paper’s conclusions depend on it.
- Based: passes — The paper gives a reason why it holds.
It may state two separate claims as one.
A conclusion the paper draws from its own results — it cites no other source for it, so there is none to check. The quote shows it is in the paper.
In the paper
“We found that cognitive performance was improved with regular cocoa flavanol consumption without evidence of any relevant adverse effects.”
§ Benefits in Cognitive Function, Blood Pressure, and Insulin Resistance Through Cocoa Flavanol Consumption in Elderly Subjects With Mild Cognitive Impairment The Cocoa, Cognition, and Aging (CoCoA) Study > Discussion
plaindirect- Asserted: passes — The authors put it forward as true.
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It may state two separate claims as one. The quote only partly states this claim.
A conclusion the paper draws from its own results — it cites no other source for it, so there is none to check. The quote shows it is in the paper.
In the paper
“Interestingly, the improvement of cognitive performance was associated with a reduction in insulin resistance, suggesting a possible influential role of glucose metabolism in modulating cognitive function in these subjects.”
§ Benefits in Cognitive Function, Blood Pressure, and Insulin Resistance Through Cocoa Flavanol Consumption in Elderly Subjects With Mild Cognitive Impairment The Cocoa, Cognition, and Aging (CoCoA) Study > Discussion
hedgedcorrelational- Asserted: passes — The authors put it forward as true.
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It may state two separate claims as one.
None of the sources cited for this claim have been checked yet.
In the paper
“In particular, high blood pressure has been linked with the pathophysiology of MCI other than with Alzheimer disease and vascular dementia.10,11”
§ Benefits in Cognitive Function, Blood Pressure, and Insulin Resistance Through Cocoa Flavanol Consumption in Elderly Subjects With Mild Cognitive Impairment The Cocoa, Cognition, and Aging (CoCoA) Study > Abstract
plaincorrelational- Asserted: passes — The authors put it forward as true.
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It may state two separate claims as one.
In the paper
“Interestingly, flavonoids have been reported recently to exert additional benefits to established hypoglycemic therapy in postmenopausal type 2 diabetic patients.26”
§ Benefits in Cognitive Function, Blood Pressure, and Insulin Resistance Through Cocoa Flavanol Consumption in Elderly Subjects With Mild Cognitive Impairment The Cocoa, Cognition, and Aging (CoCoA) Study > Discussion
What the sources say
- Not checked yetcites [26] source
plaindirect- Asserted: passes — The authors put it forward as true.
- Checkable: passes — It can be checked against evidence.
- Load-bearing: fails — The paper’s conclusions may not depend on it.
- Based: passes — The paper gives a reason why it holds.
Probably not a substantial claim. The paper’s conclusions may not depend on it.
None of the sources cited for this claim have been checked yet.
In the paper
“Alterations in the insulin signaling pathway have also been suggested as potential contributors to cognitive dysfunction because of the pivotal role of this hormone in modulating brain structure and function.[12][13][14]”
§ Benefits in Cognitive Function, Blood Pressure, and Insulin Resistance Through Cocoa Flavanol Consumption in Elderly Subjects With Mild Cognitive Impairment The Cocoa, Cognition, and Aging (CoCoA) Study > Abstract
What the sources say
hedgedconditional- Asserted: passes — The authors put it forward as true.
- Checkable: passes — It can be checked against evidence.
- Load-bearing: fails — The paper’s conclusions may not depend on it.
- Based: passes — The paper gives a reason why it holds.
Probably not a substantial claim. The paper’s conclusions may not depend on it.
A conclusion the paper draws from its own results — it cites no other source for it, so there is none to check. The quote shows it is in the paper.
In the paper
“In addition to these cognitive improvements, the regular dietary inclusion of cocoa flavanols was associated with significant reductions in blood pressure, as well as in improvements in some metabolic markers.”
§ Benefits in Cognitive Function, Blood Pressure, and Insulin Resistance Through Cocoa Flavanol Consumption in Elderly Subjects With Mild Cognitive Impairment The Cocoa, Cognition, and Aging (CoCoA) Study > Discussion
plaincorrelational- Asserted: passes — The authors put it forward as true.
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It may state two separate claims as one.
In the paper
“Supportive of this concept, it has been demonstrated recently that the insulin sensitizer rosiglitazone could protect against cognitive decline in diabetic subjects with MCI.27”
§ Benefits in Cognitive Function, Blood Pressure, and Insulin Resistance Through Cocoa Flavanol Consumption in Elderly Subjects With Mild Cognitive Impairment The Cocoa, Cognition, and Aging (CoCoA) Study > Discussion
What the sources say
- Not checked yetcites [27] source
hedgedconditional- Asserted: passes — The authors put it forward as true.
- Checkable: passes — It can be checked against evidence.
- Load-bearing: fails — The paper’s conclusions may not depend on it.
- Based: passes — The paper gives a reason why it holds.
Probably not a substantial claim. The paper’s conclusions may not depend on it.
A conclusion the paper draws from its own results — it cites no other source for it, so there is none to check. The quote shows it is in the paper.
In the paper
“Although additional confirmatory studies are warranted, the findings reported herein suggest that the regular dietary inclusion of flavanols could be one element of a dietary approach to the maintaining and improving not only cardiovascular health but also specifically brain health.”
§ Benefits in Cognitive Function, Blood Pressure, and Insulin Resistance Through Cocoa Flavanol Consumption in Elderly Subjects With Mild Cognitive Impairment The Cocoa, Cognition, and Aging (CoCoA) Study > Perspectives
hedgedconditional- Asserted: passes — The authors put it forward as true.
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It may state two separate claims as one.
A conclusion the paper draws from its own results — it cites no other source for it, so there is none to check. The quote shows it is in the paper.
In the paper
“Third, from pathophysiological perspective, it is yet unclear whether the observed benefits in neurocognition are a direct consequence of cocoa flavanol themselves or a secondary effect related to general improvements in cardiovascular function or health.”
§ Benefits in Cognitive Function, Blood Pressure, and Insulin Resistance Through Cocoa Flavanol Consumption in Elderly Subjects With Mild Cognitive Impairment The Cocoa, Cognition, and Aging (CoCoA) Study > Limitations
hedged- Asserted: passes — The authors put it forward as true.
- Checkable: passes — It can be checked against evidence.
- Load-bearing: fails — The paper’s conclusions may not depend on it.
- Based: passes — The paper gives a reason why it holds.
Probably not a substantial claim. The paper’s conclusions may not depend on it.
None of the sources cited for this claim have been checked yet.
In the paper
“First, because standard MCI criteria do not define optimal tests to establish cognitive performance in subjects with MCI, 22 cognitive testing was performed using a battery of well-validated, standardized, and widely used neuropsychological tests exploring only some aspects of the complex cognitive dysfunction in subjects with MCI.1,2”
§ Benefits in Cognitive Function, Blood Pressure, and Insulin Resistance Through Cocoa Flavanol Consumption in Elderly Subjects With Mild Cognitive Impairment The Cocoa, Cognition, and Aging (CoCoA) Study > Limitations
plain- Asserted: passes — The authors put it forward as true.
- Checkable: passes — It can be checked against evidence.
- Load-bearing: fails — The paper’s conclusions may not depend on it.
- Based: passes — The paper gives a reason why it holds.
Probably not a substantial claim. The paper’s conclusions may not depend on it. It may state two separate claims as one.
A conclusion the paper draws from its own results — it cites no other source for it, so there is none to check. The quote shows it is in the paper.
In the paper
“Other than the possible direct effects of flavanols on cognitive function, general improvements in cardiovascular function and specific metabolic parameters could have, alone or in combination, played a role in improving cognitive performance in this study population.”
§ Benefits in Cognitive Function, Blood Pressure, and Insulin Resistance Through Cocoa Flavanol Consumption in Elderly Subjects With Mild Cognitive Impairment The Cocoa, Cognition, and Aging (CoCoA) Study > Discussion
hedgedconditional- Asserted: passes — The authors put it forward as true.
- Checkable: passes — It can be checked against evidence.
- Load-bearing: unclear — It is unclear whether the paper’s conclusions depend on it.
- Based: passes — The paper gives a reason why it holds.
It may state two separate claims as one.
In the paper
“F2-isoprostanes are generated from arachidonic acid through a process of nonenzymatic free radical-catalyzed lipid peroxidation, thus representing an established marker of oxidative stress.33”
§ Benefits in Cognitive Function, Blood Pressure, and Insulin Resistance Through Cocoa Flavanol Consumption in Elderly Subjects With Mild Cognitive Impairment The Cocoa, Cognition, and Aging (CoCoA) Study > Discussion
What the sources say
- Not checked yetcites [33] source
boosteddirect- Asserted: passes — The authors put it forward as true.
- Checkable: passes — It can be checked against evidence.
- Load-bearing: fails — The paper’s conclusions may not depend on it.
- Based: passes — The paper gives a reason why it holds.
Probably not a substantial claim. The paper’s conclusions may not depend on it. It may state two separate claims as one.
In the paper
“Indeed, a direct antioxidant effect of polyphenols in vivo has been questioned recently, because concentrations in blood are low compared with other antioxidants, and extensive metabolism after ingestion lowers their antioxidant activity.34”
§ Benefits in Cognitive Function, Blood Pressure, and Insulin Resistance Through Cocoa Flavanol Consumption in Elderly Subjects With Mild Cognitive Impairment The Cocoa, Cognition, and Aging (CoCoA) Study > Discussion
What the sources say
- Not checked yetcites [34] source
plain- Asserted: passes — The authors put it forward as true.
- Checkable: passes — It can be checked against evidence.
- Load-bearing: fails — The paper’s conclusions may not depend on it.
- Based: passes — The paper gives a reason why it holds.
Probably not a substantial claim. The paper’s conclusions may not depend on it.
In the paper
“However, we cannot exclude that these reductions in blood pressure, in addition to improving cardiovascular health, may contribute to supporting improvements in cognitive performance and even help in the prevention of blood pressure-related cognitive declines across a longer time course.31”
§ Benefits in Cognitive Function, Blood Pressure, and Insulin Resistance Through Cocoa Flavanol Consumption in Elderly Subjects With Mild Cognitive Impairment The Cocoa, Cognition, and Aging (CoCoA) Study > Discussion
What the sources say
- Not checked yetcites [31] source
hedgedconditional- Asserted: passes — The authors put it forward as true.
- Checkable: passes — It can be checked against evidence.
- Load-bearing: fails — The paper’s conclusions may not depend on it.
- Based: passes — The paper gives a reason why it holds.
Probably not a substantial claim. The paper’s conclusions may not depend on it.
None of the sources cited for this claim have been checked yet.
In the paper
“In this regard, although we did not specifically evaluate the effect of cocoa flavanols on endothelial function, a number of studies, some also from our group, clearly demonstrated the ability of flavonoids to improve NO bioavailability in vasculature, 17,18,25 which, in turn, plays a pivotal role in modulating cerebrovascular tone.28”
§ Benefits in Cognitive Function, Blood Pressure, and Insulin Resistance Through Cocoa Flavanol Consumption in Elderly Subjects With Mild Cognitive Impairment The Cocoa, Cognition, and Aging (CoCoA) Study > Discussion
What the sources say
boosteddirect- Asserted: passes — The authors put it forward as true.
- Checkable: passes — It can be checked against evidence.
- Load-bearing: passes — The paper’s conclusions depend on it.
- Based: passes — The paper gives a reason why it holds.
It may state two separate claims as one.
In the paper
“On the other hand, the exclusion of habitual consumers of dietary supplements with antioxidant properties likely did not affect the representativeness of our study population, because the consumption of these supplements among our elderly population is quite low, generally Ͻ10%, similar to that observed in other cohorts from our country.35”
§ Benefits in Cognitive Function, Blood Pressure, and Insulin Resistance Through Cocoa Flavanol Consumption in Elderly Subjects With Mild Cognitive Impairment The Cocoa, Cognition, and Aging (CoCoA) Study > Limitations
What the sources say
- Not checked yetcites [35] source
hedged- Asserted: passes — The authors put it forward as true.
- Checkable: passes — It can be checked against evidence.
- Load-bearing: unclear — It is unclear whether the paper’s conclusions depend on it.
- Based: passes — The paper gives a reason why it holds.
It may state two separate claims as one.
A conclusion the paper draws from its own results — it cites no other source for it, so there is none to check. The quote shows it is in the paper.
In the paper
“Second, because our study consisted of a 2-month intervention, the extent of the cognitive benefits and their duration, as well as their impact on a clinical course of MCI, remain to be established.”
§ Benefits in Cognitive Function, Blood Pressure, and Insulin Resistance Through Cocoa Flavanol Consumption in Elderly Subjects With Mild Cognitive Impairment The Cocoa, Cognition, and Aging (CoCoA) Study > Limitations
plain- Asserted: passes — The authors put it forward as true.
- Checkable: passes — It can be checked against evidence.
- Load-bearing: passes — The paper’s conclusions depend on it.
- Based: passes — The paper gives a reason why it holds.
Probably not a substantial claim. It may state two separate claims as one.
What the paper did — it cites no source for this, so there is none to check. The quote shows it is in the paper.
In the paper
“In this regard, although we did not specifically evaluate the effect of cocoa flavanols on endothelial function, a number of studies, some also from our group, clearly demonstrated the ability of flavonoids to improve NO bioavailability in vasculature, 17,18,25 which, in turn, plays a pivotal role in modulating cerebrovascular tone.28”
§ Benefits in Cognitive Function, Blood Pressure, and Insulin Resistance Through Cocoa Flavanol Consumption in Elderly Subjects With Mild Cognitive Impairment The Cocoa, Cognition, and Aging (CoCoA) Study > Discussion
plain- Asserted: passes — The authors put it forward as true.
- Checkable: passes — It can be checked against evidence.
- Load-bearing: fails — The paper’s conclusions may not depend on it.
- Based: passes — The paper gives a reason why it holds.
Probably not a substantial claim. The paper’s conclusions may not depend on it.
In the paper
“First, because standard MCI criteria do not define optimal tests to establish cognitive performance in subjects with MCI, 22 cognitive testing was performed using a battery of well-validated, standardized, and widely used neuropsychological tests exploring only some aspects of the complex cognitive dysfunction in subjects with MCI.1,2”
§ Benefits in Cognitive Function, Blood Pressure, and Insulin Resistance Through Cocoa Flavanol Consumption in Elderly Subjects With Mild Cognitive Impairment The Cocoa, Cognition, and Aging (CoCoA) Study > Limitations
What the sources say
- Not checked yetcites [22] source
plain- Asserted: passes — The authors put it forward as true.
- Checkable: passes — It can be checked against evidence.
- Load-bearing: fails — The paper’s conclusions may not depend on it.
- Based: passes — The paper gives a reason why it holds.
Probably not a substantial claim. The paper’s conclusions may not depend on it.
The paper relies on this without support.
No dietary intervention study had yet specifically investigated neurocognitive performance in response to dietary flavanols in subjects with MCI.
“To the best of our knowledge, no dietary intervention study has yet specifically investigated the topic of neurocognitive performance in response to dietary flavanols in subjects with MCI.”
Claims other papers make about this one
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In the citing paper
“Dietary interventions have indicated improved vascular function linked to the consumption of polyphenols from different sources, including cocoa and dealcoholized red wine (60, 168, 225, 417, 834).”
From Sources of Vascular Nitric Oxide and Reactive Oxygen Species and Their Regulation (2019) · cites this paper as [225]
Citations
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Metadata
- Authors
- Desideri, G., Kwik-Uribe, C., Grassi, D., Necozione, S., Ghiadoni, L., Mastroiacovo, D., Raffaele, A., Ferri, L., Bocale, R., Lechiara, M. C., Marini, C., & Ferri, C.
- Affiliations
- University of Pisa (IT)
- ORCID
- Venue
- Hypertension
- Published
- 2012-09
- Volume
- 60
- Issue
- 3
- Pages
- 794-801
- ISSN
- 0194-911X (ISSN-L)
- 1524-4563
- OpenAlex
- W2157857601
- Semantic Scholar
- b5ec6c4ca070b47009785a99a925182aa2a856b6
- Cited by
- 311
- References
- 41
- Citations by year
- 2026: 17 · 2025: 14 · 2024: 21 · 2023: 25 · 2022: 30 · 2021: 18 · 2020: 23 · 2019: 24 · 2018: 30 · 2017: 21 · 2016: 23 · 2015: 25 · 2014: 14 · 2013: 22 · 2012: 4
- FWCI
- 14.54
- Type
- journal article
- Language
- en
- Open access
- closed
- Locations
- Hypertension (publishedVersion)
- PubMed (publishedVersion)
- CINECA IRIS Institutial research information system (University of Pisa) (submittedVersion)
- IRIS Research product catalog (Sapienza University of Rome) (submittedVersion)
- Archivio Istituzionale della Ricerca - Università degli Studi dell Aquila (submittedVersion)
- Topics
- Health Sciences › Medicine › Biochemistry (medical) › Phytochemicals and Antioxidant Activities
- Health Sciences › Medicine › Psychiatry and Mental health › Dementia and Cognitive Impairment Research
- Health Sciences › Medicine › Complementary and alternative medicine › Medicinal Plants and Neuroprotection
- Keywords
- cocoa flavanols, mild cognitive impairment, cognitive function, older adults, insulin resistance, blood pressure, lipid peroxidation, dietary intervention, Trail Making Test, verbal fluency, Mini-Mental State Examination
- MeSH terms
- Aged, Aged, 80 and over, Aging, Blood Pressure, Cacao, Cognition, Cognition Disorders, Dose-Response Relationship, Drug, Double-Blind Method, Eating, Female, Follow-Up Studies, Humans, Insulin Resistance, Intelligence Tests, Male, Middle Aged, Lipid Peroxidation, Treatment Outcome, Flavanones
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