Vitamin E associated with slower functional decline in Alzheimer disease [TEAM-AD Trial]

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1. Vitamin E supplementation was associated with decrease in the rate of loss in activities of daily living in Alzheimer’s disease patients. 

2. Less caregiver time was needed for patients taking Vitamin E supplementation. 

Evidence Rating Level: 1 (Excellent)       

Study Rundown: This study, the TEAM-AD trial, was conducted to test the effect of long-term Vitamin E supplementation in patients with mild to moderate Alzheimer disease (AD). Vitamin E, alpha tocopherol, has been shown to be effective for mild and severe AD; the literature on memantine, a drug used for AD, is ambiguous. The participants were then divided into four groups: Vitamin E alone, memantine alone, Vitamin E, and memantine, or placebo.

The patients receiving only Vitamin E supplements in the form of alpha tocopherol demonstrated a 19% reduction, or 6 month delay, in AD progression at the conclusion of the trial. No other test group, including the alpha tocopherol plus memantine group, showed any significant differencesfrom the placebo group. This study corroborates findings of previous studies that Vitamin E supplementation is effective in delaying the functional impairment of AD. The mean follow-up time of about two years also extends the evidence beyond the six month study period of previous trials. Nonetheless, the negative effect of co-administration of memantine and Vitamin E needs to be examined. The relative inexpensiveness of Vitamin E supplements has positive implications for both the treatment of AD as well as the financial costs associated with caring for AD patients.

Click to read the study, published today in JAMA

Click to read an accompanying editorial in JAMA

Relevant Reading: Vitamin E and donepezil for the treatment of mild cognitive impairment

In-Depth [randomized controlled trial]: The study randomized 613 AD patients into four groups given alpha tocopherol, memantine, alpha tocopherol + memantine, or a placebo, and monitored their functional status over the course of 48 months. Inclusion criteria included diagnosis of mild to moderate AD with scores on the MMSE between 12 and 26. Alpha tocopherol was administered as two daily 1000units alpha tocopherol doses. Memantine was administered as two daily 10mg doses with a reduced 5mg dosage given to patients with decreased creatinine clearance. AD status was assessed using the ADCS-ADL Inventory, MMSE, NPI, Alzheimer Disease Assessment Scale-Cognitive Subscale, and the Caregiver Activity Scale.  At the mean 2.27 year follow-up, the alpha-tocopherol group had a decrease of 3.15 points (CI_95% 0.92 – 5.39, p=0.03) less in the ADCS-ADL Inventory score than the placebo group. Additionally the caregiver time required for the alpha tocopherol group was 1.79 hours (CI_95% 3.35 – 0.23, p=.12) less than that for the placebo group. The other groups did not show significant differences in outcome measures than the placebo group.

By Ravi Shah and Rif Rahman

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