Vitamin E Slows Functional Decline in Alzheimer’s Disease
Over the past 10 years or so, I have unfortunately witnessed the decline of a family member due to Alzheimer’s Disease. It has been heartbreaking to watch a vivacious and caring soul slowly fade away. In the early days, the increased forgetfulness and lack of motivation was a concern but could be matched by small actions such as devising new routines, placing smoke alarms and extra door locks, and increased attention from family members. As the disease has progressed, however, the burden on caregivers has steadily increased to providing around-the-clock care for the basic activities of daily life. Treatments that can allow Alzheimer’s patients to stay independent for longer, and reduce the burden on caregivers, are beneficial in improving quality of life for all involved in Alzheimer’s disease.
Some nutrition-based risk factors for the disease have been identified in epidemiological research. In general, a healthy diet that includes regular exercise and a high intake of antioxidants can reduce risk, or delay onset, of Alzheimer’s Disease (see Solfrizzi et al. for background into lifestyle factors). Vitamin E is the main fat-soluble antioxidant in the body, including the brain. It scavenges free radicals and helps prevent lipid peroxidation, including in brain cells. In a study published recently by Dysken and associates, the effect of high doses of vitamin E on the progression of Alzheimer’s Disease was investigated.
The study enrolled around 600 patients with mild to moderate Alzheimer’s Disease. These people were mostly male US Veterans with mild to moderate Alzheimer’s Disease and were taking a acetyl-cholesterinase inhibitor (this medication helps preserve cognition in mild Alzheimer’s Disease). Vitamin E as alpha-tocopherol (1000 IU), the drug memantine (10 mg) or placebo were given twice a day in a 2x2 factorial design. The vitamin E dose was therefore 2000 IU per day. The study was double-blinded and randomized in the ratio 1:1:1:1. The primary outcome measure was based on the Alzheimer’s Disease Cooperative Study/Activities of Daily Living (ADCS-ADL) Inventory score, which gives a score of up to 78 to assess how well Alzheimer’s patients can perform normal activities such as performing household tasks, feeding and clothing themselves, and participating in social activities. Someone who is fully functioning would get a score of 78, while advanced Alzheimer’s patients that were completely unable to care for themselves would receive a score of 0. The amount of time spent caring for the patients by primary caregiver was assessed using the Caregiver Activity Survey. Data was collected, where possible, for 4 years, although due to dropouts including death, withdrawal of consent and loss to follow-up, the average time for follow-up was 2.2 years.
The study found that the group supplemented with vitamin E had a clinically meaningful delay in Alzheimer’s Disease progression of 19% compared to placebo. This translates to a 6-month delay in progression. The amount of time required by caregivers to look after the Alzheimer’s patients also decreased in the vitamin E group: this was 2.2 hours less per day in the vitamin E group when compared to placebo. There was also a non-significant decrease in mortality rate in the group supplemented with vitamin E. Memantine, or the combined treatment of memantine and vitamin E, were not significantly different from placebo.
This clinical trial is not the first to show delays in progression of Alzheimer’s Disease when vitamin E is supplemented. For example, Sano et al. found that the same dose of vitamin E in patients with moderate Alzheimer’s Disease delayed time to severe dementia, loss of ability to perform activities of daily living, or death. The editorial notes that different doses of vitamin E in different populations (mild cognitive impairment, or normal cognition) produced null-results, therefore the treatment should currently be focused on mild to moderate assumed Alzheimer’s Disease.
Vitamin E is a low cost treatment: when I checked the current price of vitamin E supplements today on a large online retailer located in the United States, I found yearly treatment costs of the same dose ranging from US$31 to 219, with a median price of US$132. Considering the substantial decrease in caregiver time expected from this treatment, this is likely to be cost-effective.
It is too late for these supplements to be effective for my family member with Alzheimer’s Disease, however they may have helped in the earlier stages of the disease. Anything that could have helped to maintain independence and increase time with family and friends before drifting off into Alzheimer’s fog would have been welcomed. A cure for Alzheimer’s Disease is still being researched. Until a treatment is developed, high dose vitamin E supplements may provide a cost-effective means to delay functional decline and decrease the burden on caregivers.
Dysken MW, Sano M, Asthana S, et al. Effect of Vitamin E and Memantine on Functional Decline in Alzheimer Disease: The TEAM-AD VA Cooperative Randomized Trial. JAMA. 2014;311(1):33-44. doi:10.1001/jama.2013.282834. http://jama.jamanetwork.com/article.aspx?articleid=1810379
Marin DB, Dugue M, Schmeidler J, Santoro J, Neugroschl J, Zaklad G, Brickman A, Schnur E, Hoblyn J, Davis KL. The Caregiver Activity Survey (CAS): longitudinal validation of an instrument that measures time spent caregiving for individuals with Alzheimer's disease. Int J Geriatr Psychiatry. 2000 Aug;15(8):680-6.
Sano M, Ernesto C, Thomas RG, Klauber MR, Schafer K, Grundman M, Woodbury P, Growdon J, Cotman CW, Pfeiffer E, Schneider LS, Thal LJ. A controlled trial of selegiline, alpha-tocopherol, or both as treatment for Alzheimer's disease. The Alzheimer's Disease Cooperative Study. N Engl J Med. 1997 Apr 24;336(17):1216-22. http://www.ncbi.nlm.nih.gov/pubmed/9110909
Solfrizzi V, Capurso C, D'Introno A, Colacicco AM, Santamato A, Ranieri M, Fiore P, Capurso A, Panza F.v. Lifestyle-related factors in predementia and dementia syndromes. Expert Rev Neurother. 2008 Jan;8(1):133-58. http://www.ncbi.nlm.nih.gov/pubmed/18088206
Information on Alzheimer’s Disease from a global public health perspective:
World Health Organisation and Alzheimer’s Disease International. Dementia: A Public Health Priority. 2012. http://www.who.int/mental_health/publications/dementia_report_2012/en/