New research from the faculty of Icahn School of Medicine at Mount Sinai says that Vitamin E, also known as alpha tocepherol, a fat-soluble nutrient and antioxidant, may slow the decline of ability to carry out daily activities like shopping, preparing meals, planning, and traveling, in patients with mild-to-moderate Alzheimer’s disease. Unfortunately, there was no similar benefit for memory and cognitive function with the vitamin.
The impact of Alzheimer’s Disease on daily living for those suffering from it are many. Alzheimer’s is estimated to affect up to 5.1 million Americans. These daily living difficulties are some of the heaviest burdens of the disease for caregivers, who total about 5.4 million family members and friends.
6.2 months Benefit over Placebo
“Since the cholinesterase inhibitors [galantamine, donepezil, rivastigmine], we have had very little to offer patients with mild-to-moderate dementia,” said Mary Sano, PhD, trial co-investigator. “This trial showed that vitamin E delays progression of functional decline by 19% per year, which translates into 6.2 months benefit over placebo.”
The findings are important since vitamin E is easily purchased at local drugstores and also inexpensive. The clinical trial investigators believe it can be recommended as a treatment strategy, based on the double-blind randomized controlled trial.
Dr. Sano previously led a study on vitamin E in patients with moderately severe Alzheimer’s disease. She found that the vitamin slowed disease progression in this group of patients as well.
Kenneth Davis, MD, President of the Mount Sinai Health System, praised the study.
“This study is the first to show an added benefit for vitamin E in mild-to-moderate disease,” he said. “Now that we have a strong clinical trial showing that vitamin E slows functional decline and reduces the burdens on caregivers, vitamin E should be offered to patients with mild-to-moderate Alzheimer’s disease.”
Why Vitamin E for Cognitive Decline?
Our brains normally consume oxygen at a high rate and contain plentiful polyunsaturated fatty acids in the neural cell membranes. Researchers theorize that if cumulative free-radical damage to neurons over time contributes to cognitive decline and neurodegenerative diseases, such as Alzheimer’s disease, then ingestion of sufficient or supplemental antioxidants, such as vitamin E, might provide some protection.
This antioxidant hypothesis was supported by the results of a 1997 clinical trial by Dr. Sano.
341 patients with Alzheimer’s disease of moderate severity were randomly assigned to receive a placebo, vitamin E (2,000 IU/day dl-alpha-tocopherol), a monoamine oxidase inhibitor (selegiline), or vitamin E and selegiline.
Over 2 years, treatment with vitamin E and selegiline, separately or together, significantly delayed functional deterioration and the need for institutionalization compared to placebo. However, participants taking vitamin E experienced significantly more falls.
In a 2002 study, vitamin E consumption from foods or supplements was associated with less cognitive decline over 3 years in a prospective cohort study of elderly, free-living individuals aged 65–102 years.
On the other hand, a 2006 clinical trial in primarily healthy older women who were randomly assigned to receive 600 IU d-alpha-tocopherol every other day or a placebo for ≤4 years found that the supplements provided no apparent cognitive benefits.
In 2005, another trial in which 769 men and women with mild cognitive impairment were randomly assigned to receive 2,000 IU/day vitamin E, a cholinesterase inhibitor (donepezil), or placebo found no significant differences in the progression rate of Alzheimer’s disease between the vitamin E and placebo groups.
Maurice W. Dysken, Mary Sano, Sanjay Asthana, Julia E. Vertrees, Muralidhar Pallaki, Maria Llorente, Susan Love, Gerard D. Schellenberg, J. Riley McCarten, Julie Malphurs, Susana Prieto, Peijun Chen, David J. Loreck, George Trapp, Rajbir S. Bakshi, Jacobo E. Mintzer, Judith L. Heidebrink, Ana Vidal-Cardona, Lillian M. Arroyo, Angel R. Cruz, Sally Zachariah, Neil W. Kowall, Mohit P. Chopra, Suzanne Craft, Stephen Thielke, Carolyn L. Turvey, Catherine Woodman, Kimberly A. Monnell, Kimberly Gordon, Julie Tomaska, Yoav Segal, Peter N. Peduzzi, Peter D. Guarino. Effect of Vitamin E and Memantine on Functional Decline in Alzheimer Disease JAMA, 2014; 311 (1): 33 DOI:10.1001/jama.2013.282834
Sano M, Ernesto C, Thomas RG, Klauber MR, Schafer K, Grundman M, et al. A controlled trial of selegiline, alpha-tocopherol, or both as treatment for Alzehimer’s disease. N Engl J Med 1997;336:1216-22.
Morris MC, Evand DA, Bienias JL, Tangney CC, Wilson RS. Vitamin E and cognitive decline in older persons. Arch Neurol 2002;59:1125-32.
Kang JH, Cook N, Manson J, Buring J, Grodstein F. A randomized trial of vitamin E supplementation and cognitive function in women. Arch Intern Med 2006;166:2462-8
Petersen RC, Thomas RG, Grundman M, Bennett D, Doody R, Ferris S, et al. Vitamin E and donepezil for the treatment of mild cognitive impairment. N Engl J Med 2005;352:2379-88
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