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Up Front | Mar 2014

Medical Updates

Vitamin E May Slow Functional Decline in AD

Vitamin E may benefit patients with mild to moderate Alzheimer disease (AD), slowing the rate of functional decline by about 6 months, according to a study in JAMA.1

Maurice W. Dysken, MD, of the Minneapolis VA Health Care System, and colleagues conducted a double-masked, placebo-controlled, parallel-group, randomized clinical trial of 613 patients with AD (mean age, 79 years) seen in Veterans Affairs medical centers between August 2007 and September 2012. Patients were randomly assigned to one of four treatment groups, each receiving a daily dosage of one of the following: 2,000 international units (IU) vitamin E, 200 mg memantine, both vitamin E and memantine, or placebo.

Over a mean follow-up of 2.27 years, the group consuming vitamin E alone had a 6.2-month delay in functional decline, and caregiver time per patient decreased. The study's results showed no evidence that high-dosage vitamin E had any impact on memory, the authors concluded.

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 patients) and combination groups (44 events in 31 patients) compared with placebo (13 events in 11 patients).

High-dosage consumption of vitamin E has not been shown to prevent AD in previous studies, with some of these suggesting that it may confer other risks. In the Heart Outcomes Prevention Evaluation—The Ongoing Outcomes (HOPE-TOO) study, patients who consumed 400 IU vitamin E per day had an increased risk of heart failure (13%) and hospitalization for heart conditions (21%) versus placebo.2 The Selenium and Vitamin E Cancer Prevention Trial (SELECT) found that healthy men older than 50 years taking 400 IU vitamin E daily had a 17% increased risk of prostate cancer compared with those taking placebo.3 A 2004 meta-analysis of 19 studies showed that high consumption of vitamin E supplements was associated with a higher overall risk of mortality.4

  1. Dysken MW, Sano M, Asthana S, et al. Effect of vitamin E and memantine on functional decline in Alzheimer disease: The TEAM-AD VA Cooperative Randomized Trial. JAMA. 2014;311(1):33-44.
  2. Lonn E, Brosch J, Yusuf S, et al. Effects of long-term vitamin E supplementation on cardiovascular events and cancer: a randomized controlled trial. JAMA. 2005;293(11):1338-1347.
  3. Klein EA, Thompson Jr IM, Tangen CM, et al. Vitamin E and the risk of prostate cancer: the Selenium and Vitamin E Cancer Prevention Trial (SELECT). JAMA. 2011;306:1549-1556.
  4. Miller III ER, Pastor-Barriuso R, Dalal D, Riemersma RA, Appel LJ, Guallar E. Meta-analysis: high-dosage vitamin E supplementation may increase all-cause mortality. Ann Intern Med. 2005;142(1):37-46.

Low Levels of Vitamin D May be a Risk Factor for MS Progression

Low levels of vitamin D in patients who experienced an event indicative of multiple sclerosis (MS) were an indicator for long-term progression of the disease, according to a study in JAMA Neurology.1 Patients with high levels of vitamin D showed lower levels of disease progression.

Alberto Ascherio, MD, DrPH, of the Harvard School of Public Health in Boston, and colleagues tracked 465 patients who had symptoms indicative of MS based on magnetic resonance imaging, brain volume, the number of new brain lesions, and the volume of T2 lesions.

Higher serum levels of 25-hydroxyvitamin D, or 25(OH)D, predicted reduced MS activity and a slower rate of progression. Patients with 20 ng/mL of 25(OH)D over 12 months showed a 0.41% lower yearly loss of brain volume P =.07), a 57% lower rate of new active lesions (P <.001), and a 25% lower yearly increase in T2 lesion volume (P <.001). The 20 ng/mL regimen over 12 months “predicted lower disability (Expanded Disability Status Scale score, -0.17; P = .004) during the subsequent 4 years,” the study authors wrote, concluding that “low 25(OH)D levels early in the disease course are a strong risk factor for long-term MS activity and progression.”

  1. Ascherio A, Munger K, White R, et al. Vitamin D as an Early Predictor of Multiple Sclerosis Activity and Progression [published online ahead of print January 20, 2014]. JAMA Neurol. doi:10.1001/jamaneurol.2013.5993.

High Omega-3 Levels Correlated With Larger Brain Volume

Higher omega-3 levels in postmenopausal women correlated with larger total normal brain volume and hippocampal volume, according to a study in Neurology.1

James V. Pottala, PhD, of the University of South Dakota, and colleagues measured omega-3 levels and brain volumes in 1,111 postmenopausal women at baseline and 8 years later. Linear mixed models included multiple imputations of fatty acids and were adjusted for hormone therapy, time since randomization, demographics, intracranial volume, and cardiovascular disease risk factors.

Patients with higher levels of omega-3s had larger total brain volumes and 2.7% larger volume in the hippocampus area of the brain 8 years later. Those with twice as high levels of fatty acids (7.5% vs 3.4%) had a 0.7% larger brain volume.

“These higher levels of fatty acids can be achieved through diet and the use of supplements, and the results suggest that the effect on brain volume is the equivalent of delaying the normal loss of brain cells that comes with aging by 1 to 2 years,” Dr. Pottala said in a news release.

  1. Pottala JV, Yaffe K, Robinson JG, Espeland MA, Wallace R, Harris WS. Higher RBC EPA + DHA corresponds with larger total brain and hippocampal volumes: WHIMS-MRI Study. Neurology. 2014;82(5):435-442.

–Compiled by Callan Navitsky, Senior Editor