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Vitamin E, anti-inflammatories show benefit in Alzheimer’s disease

Reuters Health • The Doctor's Channel Daily Newscast

NEW YORK (Reuters Health) – An analysis of “real-world” clinical data suggests that treatment with vitamin E and anti-inflammatory drugs may provide long-term benefits in slowing decline in patients with Alzheimer’s disease (AD) who are taking a cholinesterase inhibitor.

“Our results are consistent for a potential benefit of vitamin E on slowing functional decline and a smaller possible benefit of anti-inflammatory medications on slowing cognitive decline in patients suffering from Alzheimer’s disease,” Dr. Alireza Atri told Reuters Health.

Dr. Atri, a cognitive neurologist at Massachusetts General Hospital (MGH), VA Bedford Medical Center, and Harvard Medical School, Boston, led the National Institutes of Health-sponsored research. The findings, presented Thursday at the annual meeting of the American Geriatrics Society in Chicago, stem from 1500 patient-years of data on 540 patients treated at the MGH Memory Disorders Unit.

All of the patients were receiving standard-of-care treatment with a cholinesterase inhibitor — either donepezil (Aricept), rivistigmine (Exelon), or galantamine (Razadyne).

As part of their clinical care, 208 patients also took vitamin E but no anti-inflammatory, 49 took an anti-inflammatory but no vitamin E, 177 took both vitamin E and an anti-inflammatory, and 106 took neither. While the daily dose of vitamin E ranged from 200 to 2000 units, the majority of patients received high doses that ranged from 800 units daily to 1000 units twice daily.

Each patient’s performance on cognitive tests and their ability to carry out daily functions were assessed every 6 months. After a mean follow up of 3.1 years, “there was a modest slowing of decline in function in those patients taking vitamin E,” study investigator Michael R. Flaherty, who presented the data at the meeting, noted in a telephone interview with Reuters Health.

Flaherty, a second-year student at the University of New England College of Osteopathic Medicine in Biddeford, Maine, added that in terms of effect-sizes, the treatment benefit of vitamin E was “small to medium” but increased with time.

Taking an anti-inflammatory medication was associated with “very consistent but generally only small effects on slowing long-term decline in cognitive functioning,” Dr. Atri told Reuters Health.

However, in patients who took both vitamin E and anti-inflammatory medications, in addition to a cholinesterase inhibitor, there appeared to be an addictive effect in terms of slowing overall decline.

Given that past studies have produced equivocal results regarding the potential benefits and risks of high-dose vitamin E and long-term use of anti-inflammatory drugs in AD, the investigators conclude that “further studies are needed to assess the long-term risk-benefit calculus in AD for treatment with vitamin E and anti-inflammatories.”