Vitamin E Beneficial for Mild-to-Moderate Alzheimer’s Patients

While the clinical relevance is unclear, a recent study shows that high-dose vitamin E somewhat slows functional decline without an associated increase in mortality among patients with mild-to-moderate Alzheimer’s disease.

A team of investigators led by researchers at the University of Minnesota tested the effects of vitamin E and memantine in more than 600 veterans diagnosed with mild-to-moderate Alzheimer’s disease, who had already been treated with stable doses of acetylcholinesterase inhibitor therapy. Participants were randomized to receive 2,000 IU vitamin E, 20 milligrams of memantine, 2,000 IU vitamin E plus 20 milligrams of memantine, or placebo daily. The primary outcome measure was functional decline, measured with the Alzheimer’s Disease Cooperative Study–Activities of Daily Living (ADCS-ADL) Inventory; secondary outcomes were measures of cognition and behavior.

During a mean follow-up of 2.27 years, the vitamin E group demonstrated a statistically significant (19 percent) annual slowing of functional decline, compared to the placebo group. Memantine showed no significant benefit on any of the pre-selected outcome measures. No treatment group had significant benefits on any secondary outcome measures, according to study authors, who noted that the vitamin E group experienced no greater mortality or adverse-event rate than the other groups.

Given the results, primary care practitioners “should consider prescribing vitamin E (1000 IU bid) to patients with mild-to-moderate Alzheimer’s disease,” says Maurice Dysken, MD, a retired professor of psychiatry at the University of Minnesota and lead study author.

“The study showed benefit in giving oral vitamin E at a dosage of 1000 IU bid to patients with mild-to-moderate Alzheimer’s disease, by slowing functional decline and decreasing caregiver burden,” says Dysken, noting that subjects who were taking warfarin were excluded from the study. “Mortality was lowest in the vitamin E group, and there were no significant adverse events associated with vitamin E compared to placebo.”

He stresses, however, that the study included only patients with mild-to-moderate forms of the disease, and not mild-to-severe Alzheimer’s.

“Caution should be advised in prescribing this dosage of vitamin E to patients on warfarin,” adds Dysken. “We don’t have safety data on the potential interaction from our study. Close monitoring of the INR would be warranted if 2000 IU/d of vitamin E were given to these patients.”

—Mark McGraw

Reference

Dysken M, Sano M, et al. Effect of vitamin E and memantine on functional decline in Alzheimer disease: The TEAM-AD VA Cooperative Randomized Trial. JAMA. 2014.