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Vitamin E outperforms a leading drug in preventing a decline in patients with mild to moderate Alzheimer’s disease
Vitamin E and the drug memantine (Namenda) have been shown to have beneficial effects in moderately severe Alzheimer disease (AD). Until now the evidence for proof of activity was limited in patients with mild to moderate AD. The objective of the study was to determine if vitamin E (alpha tocopherol), or the prescription drug memantine, or both together, could slow progression of mild to moderate AD in patients taking an acetylcholinesterase inhibitor (these include Aricept, Razadyne, and Exelon).
The trial involving 613 patients with mild to moderate AD. It was initiated in August 2007 and concluded in September 2012 at 14 Veterans Affairs medical centers. The patients received either 2000 IU a day of d-alpha tocopherol (n = 152), 20 mg a day of memantine (n = 155), the combination of both (n = 154), or placebo (n = 152).
Results from 561 participants were analyzed (52 were excluded because of a lack of any follow-up data). Over the average follow-up period of 2.27 years, ADCS-ADL Inventory scores (Alzheimer’s Disease Cooperative Study – Activities of Daily Living Scale) declined by 3.15 units less in the alpha tocopherol group compared with the placebo group. In the memantine group, these scores declined 1.98 units less than the placebo group’s decline.
This change in the alpha tocopherol group translates into a delay in clinical progression of 19% per year compared with placebo or a delay of approximately 6.2 months over the follow-up period. Caregiver time increased least in the alpha tocopherol group. All-cause mortality and safety analyses showed a difference only on the serious adverse event of “infections or infestations,” with greater frequencies in the memantine (31 events in 23 participants) and combination groups (44 events in 31 participants) compared with placebo (13 events in 11 participants); there were fewer deaths in the Vitamin E group.
The conclusions and level of relevance by the researchers shows that among patients with mild to moderate AD, 2000 IU/d of alpha tocopherol compared with placebo resulted in slower functional decline. There were no significant differences in the groups receiving memantine alone or memantine plus alpha tocopherol. These findings suggest benefit of alpha tocopherol in mild to moderate AD by slowing functional decline and decreasing caregiver burden. The study is published in JAMA (Journal of the American Medical Association)
JAMA. 2014;311(1):33-44. doi:10.1001/jama.2013.282834.
1 Minneapolis VA Health Care System, Minneapolis, Minnesota
2 James J. Peters VA Medical Research Center, New York, New York
3 William S. Middleton Memorial Veterans Hospital, Madison, Wisconsin
4 Cooperative Studies Program Clinical Research Pharmacy Coordinating Center, Albuquerque, New Mexico
5 Louis Stokes Cleveland VA Medical Center, Cleveland, Ohio
6 Case Western Reserve University School of Medicine, Cleveland, Ohio
7 Washington DC VA Medical Center, Washington, DC
8 University of Pennsylvania School of Medicine, Philadelphia
9 Miami VA Healthcare System, Miami, Florida
10 VA Maryland Healthcare System, Baltimore
11 University of Maryland Medical School, Department of Psychiatry, Baltimore
12 VA North Texas Health Care System, Dallas
13 Ralph H. Johnson VA Medical Center, Charleston, South Carolina
14 Department of Health Studies, Medical University of South Carolina, Charleston
15 Roper St Francis Healthcare, Charleston, South Carolina
16 VA Ann Arbor Healthcare System, Ann Arbor, Michigan
17 VA Caribbean Healthcare System, San Juan, Puerto Rico
18 Bay Pines VA Healthcare System, Bay Pines, Florida
19 VA Boston Healthcare System, Boston, Massachusetts
20 VA Puget Sound Health Care System, Seattle, Washington
21 Department of Psychiatry and Behavioral Sciences, University of Washington, Seattle
22 Iowa City VA Medical Center, Iowa City, Iowa
23 University of Iowa, Iowa City
24 W. G. (Bill) Hefner VA Medical Center, Salisbury, North Carolina
25 Cooperative Studies Program Coordinating Center, VA Connecticut Healthcare System, West Haven
26 Yale University School of Public Health, New Haven, Connecticut