Alzheimer Disease AD: is a progressive neuro degenerative disorder involving cognitive and behavioral impairment due to the damage and destruction of brain’s nerve cells or neurons which leads to memory losses, changes in thinking, language skills and behaviors.
Vitamin E: is a fat soluble vitamin that acts as an antioxidant and a free radical scavenger. Vitamin E requires bile for absorption and 25% of it gets absorbed orally. The storage sites for this vitamin are adipose tissues, muscles and liver.
Alpha Tocopherol: is a type of Vitamin E, which human body is able to absorb and cumulate.
Treatments with Vitamin E and antioxidants: have been done in patients with moderately severe Alzheimer disease and in patients with mild cognitive impairment MCI, but has never been initiated in patients with mild – moderate AD, already taking acetylcholinestrase inhibitor as a therapeutic regimen.
New researches: have successfully shown that Vitamin E when taken for at least 2.3 years is helpful in slowing down the functional decline in patients suffering from mild – moderate Alzheimer’s disease, without raising the mortality rates in the groups which underwent this therapy.
Study: the study conducted by researchers… Maurice Dysken Md and colleagues of VA Health Care System, Minneapolis was published in the Journal of the American Medical Association January 2014.
Objectives of the study: to find out whether Vitamin E ( alpha tocopherol), memantine or both play a role in slowing down the development of mild – moderate AD in patients who are already on acetylcholinestrase inhibitor treatment.
Trial: was randomized double blinded placebo controlled. 613 patients who were previously diagnosed with mild to moderate AD were included in the study.
- 2000 IU/d of alpha tocopherol in 152 patients.
- 20 mg/d of memantine in 155 patients.
- combination of both in 154 patients.
- 2 placebos in 152 patients.
The follow up period was for 2.3 years.
Parameters measured: researchers observed the following aspects in the patients, using Alzheimer’s disease co-operative study/activities;
- cognitive functioning
- memory and language
- ability to perform activities of daily life (ADL)
- psychological problems
- behavioral problems
- caregiver burden.
ADRs: the series of adverse drug events related to infestation and infection were seen to be heightened in memantine group (31 events in 23 patients) and combination groups (44 events in 31 patients) whereas in the placebo only 13 events occurred in 11 participants.
Results of the study: on comparing alpha tocopherol to a placebo… slower functional reduction and decline was detected by alpha tocopherol. Groups receiving memantine or combination of alpha tocopherol and memantine werenot able to show any defined differences in slowing down the functional decline in AD patients. The study also proved helpful in reducing the caregiver burden by lessening 2 hours of care giver a day.
Although alpha tocopherol alone proved beneficial but its combination with memantine showed lesser or no effects. There is a possibility that when given together, memantine may handicap the activeness of Vitamin E but further studies are needed to confirm the interaction between these two.
In contrast to 2005 meta analysis: the researchers of the above study also mentioned that they did not find any remarkable increase in the mortality rates with Vitamin E in contrast to the meta analysis of 2005 which showed that high amounts of Vitamin E, approximately >4000 IU/d can elevate the risks of all cause mortality.
Whereas in the new study… the annual mortality rate was found to 7.3% in alpha tocopherol group and 9.4% in the placebo controlled group.
The researchers also stated that the meta analysis for Vitamin E incorporated only one AD study & even in that the all cause mortality rate was found to be lesser in the alpha tocopherol groups when compared to groups who were on other forms of treatments for the disease.
Another study in Chicago: suggested that supplementation with high quantities of Vitamin E does not give negative outcomes in AD patients. The study continued up to 15 years and incorporated 847 patients of AD, showed that those who took 1000-2000 IU/d of vitamin E were 26% less likely to die than those who did not take the vitamin supplementation. The study was reported by Valory Pavlik, PhD, Baylor College of Medicine.
Guidelines: previous guidelines do recommend the use of Vitamin E in patients with moderately severe dementia but are not present for Alzheimer’s. The co author of the study (published in JAMA) Mary sano, PhD of Icahn school of Medicine, NY believes that the outcomes shown by this vitamin are strong and durable enough to make an official recommendation for patients with mild – moderate AD to start using Vitamin E supplements.
My thoughts on the topic:
- Vitamin supplementations are not to replace the natural dietary source of them but studying the individual vitamins can prove helpful in finding out their hidden positive roles in various health related problems.
- Healthy individuals should not start taking high doses of Vitamin E supplementation to ward off Alzheimer’s as it is not yet fully known whether these vitamins are helpful in preventing the disease as well or not.
- These studies are defining the positive roles of Vitamin E in AD and more studies should be conducted in a more advanced clinical settings to find out its use in AD and to ascertain its safety profile as well.
- Patients should only take high doses of the supplements for such a long time after consulting their physicians or pharmacists.
- Adherence to the therapeutic regimen is very crucial to get its full benefits and patients should be counselled on it as some patients may believe that they are already getting the vitamins from their diets, so why should they add up the number of pills to take.
- US Pharmacist January 2014.
- JAMA 2014.