Those of us at a certain age , including Rick and me, recall the 1990s craze for vitamin E. At the time studies concluded that vitamin E supplements could stave off dementia, and every neurologist I knew was downing the capsules in the fervent hope that the horror of developing dementia would be avoided. Then came a slew of studies that attempted to utilize the vitamin for cancer and cardiovascular disease prevention. Not only did these studies turn out to be disappointing, some of them actually indicated that vitamin E might increase the risk for certain conditions, notably prostate cancer. Just like every other vitamin, mineral, trace element or supplement craze before it, this one too dropped off the map. Now, as we discuss on PodMed this week, it's bacccckkkkkkk. JAMA reports a study where folks with established dementia were randomized to high dose vitamin E alone, in combination with memantine, memantine alone, or placebo. Guess what? Those who took the vitamin E alone slowed down the progression of their condition by six months.
The study population was culled from 14 Veteran's Administration medical centers, so it was largely male. All 613 participants who enrolled in the study in had mild to moderate Alzheimer's disease and were followed for 6 months to 4 years. At enrollment they were randomized to 2000 IU of alpha-tocopherol per day, 20 mg of memantine daily, the combination, or placebo. The primary outcome measure was the Alzheimer’s Disease Cooperative Study/Activities of Daily Living (ADCS-ADL) Inventory score, but other cognitive, functional and neuropsychiatric measures were also employed, as was an assessment of caregiver involvement.
Besides the delay in progression of symptoms of dementia, the need for increased caregiver involvement was also lowest in the group receiving vitamin E alone. There was no benefit to memantine either alone or in combination, although the memantine receiving groups did have an increased risk of "infections or infestations(!)" No deleterious side effects from vitamin E were noted.
Well, what do we make of this? Constantine Lyketsos, an Alzheimer's disease expert at Johns Hopkins, says he is persuaded by this study and will suggest vitamin E supplements to his patients with mild to moderate AD. The caveat of course is that he will only recommend this intervention in those with mild to moderate disease. This study, and the studies before it, do not establish a benefit for those in earlier stages of dementia, nor do they even intimate a role for vitamin E with regard to prevention. What seems clear from this study as well as emerging data from many others is that there is a course of progression of AD where one intervention may be helpful but isn't at another point, and that seems to be the case with many other disease states as well. So for all of us who believe we're not demented yet, and really don't want to be, vitamin E supplementation isn't the ticket. Sigh.
Other topics this week include driving distractions and car mishaps in NEJM, mammography statistics in JAMA Internal Medicine, and the global effects of smoking, also in NEJM. Until next week, y'all live well.
Vitamin E Redux,4 Comments