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Vol. 28, No. 6, 2009
Issue release date: February 2010
Section title: Original Research Article
Free Access
Dement Geriatr Cogn Disord 2009;28:536–540
(DOI:10.1159/000255105)

Vitamin E Use Is Associated with Improved Survival in an Alzheimer’s Disease Cohort

Pavlik V.N.a · Doody R.S.b · Rountree S.D.b · Darby E.J.b
Departments of aFamily and Community Medicine and bNeurology, Baylor College of Medicine, Houston, Tex., USA
email Corresponding Author

Abstract

Background: Vitamin E at a dose of 2,000 IU per day has been shown to delay Alzheimer’s disease (AD) progression, but recent studies have questioned the safety of this dose level and the overall efficacy of vitamin E in AD treatment. Methods: We analyzed the survival history of 847 probable or mixed AD patients followed in a research center between 1990 and the censoring date of December 31, 2004. Standard practice during this period was to recommend vitamin E at 1,000 IU twice daily to all patients. We used Cox proportional hazards modeling to assess the association of vitamin E alone, or in combination with a cholinesterase inhibitor (ChEI), with all-cause mortality, adjusting for important covariates. Approximately two thirds of the patients took vitamin E with a ChEI, 10% took vitamin E alone, and 15% took no antidementia drug. Results: The adjusted hazard ratio (HR) associated with vitamin E (with or without a ChEI) was 0.71 (95% CI: 0.57–0.89; p = 0.003). Compared to the no drug treatment group, the HR for vitamin E alone or with another drug was 0.77 (95% CI: 0.60–1.0); the HR for ChEI use alone was 1.2 (95% CI: 0.87–1.60). Conclusion: The results do not support a concern over increased mortality with high-dose vitamin E supplementation.

© 2009 S. Karger AG, Basel


  

Key Words

  • Alzheimer’s disease
  • Survival
  • Vitamin E

References

  1. Engelhart MJ, Geerlings MI, Ruitenberg A, et al: Dietary intake of antioxidants and risk of Alzheimer disease. JAMA 2002;287:3223–3229.
  2. Engelhart MJ, Ruitenberg A, Meijer J, et al: Plasma levels of antioxidants are not associated with Alzheimer’s disease or cognitive decline. Dement Geriatr Cogn Disord 2005;19:134–139.
  3. Zandi PP, Anthony JC, Khachaturian AS, et al: Reduced risk of Alzheimer disease in users of antioxidant vitamin supplements: the Cache County Study. Arch Neurol 2004;61:82–88.
  4. Laurin D, Masaki KH, Foley DJ, White LR, Launer LJ: Midlife dietary intake of antioxidants and risk of late-life incident dementia: the Honolulu-Asia Aging Study. Am J Epidemiol 2004;159:959–967.
  5. Cherubini A, Martin A, Andres-Lacueva C, et al: Vitamin E levels, cognitive impairment and dementia in older persons: the InCHIANTI study. Neurobiol Aging 2005;26:987–994.
  6. Sano M, Ernesto C, Thomas RG, et al: A controlled trial of selegiline, alpha-tocopherol, or both as treatment for Alzheimer’s disease: the Alzheimer’s Disease Cooperative Study. N Engl J Med 1997;336:1216–1222.
  7. Petersen RC, Thomas RG, Grundman M, et al: Vitamin E and donepezil for the treatment of mild cognitive impairment. N Engl J Med 2005;352:2379–2388.
  8. Vivekananthan DP, Penn MS, Sapp SK, Hsu A, Topol EJ: Use of antioxidant vitamins for the prevention of cardiovascular disease: meta-analysis of randomised trials. Lancet 2003;361:2017–2023.
  9. Miller ER 3rd, 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;142:37–46.
  10. Bjelakovic G, Nikolova D, Gluud LL, Simonetti RG, Gluud C: Mortality in randomized trials of antioxidant supplements for primary and secondary prevention: systematic review and meta-analysis. JAMA 2007;297:842–857.
  11. McKhann G, Drachman D, Folstein M, Katzman R, Price D, Stadlan EM: Clinical diagnosis of Alzheimer’s disease: report of the NINCDS-ADRDA Work Group under the auspices of Department of Health and Human Services Task Force on Alzheimer’s Disease. Neurology 1984;34:939–944.
  12. Doody R, Pavlik V, Massman P, et al: Changing patient characteristics and survival experience in an Alzheimer’s center patient cohort. Dement Geriatr Cogn Disord 2005;20:198–208.
  13. Doody RS, Dunn JK, Huang E, Azher S, Kataki M: A method for estimating duration of illness in Alzheimer’s disease. Dement Geriatr Cogn Disord 2004;17:1–4.
  14. Folstein M, Folstein S, McHugh P: ‘Mini-Mental State’: a practical method for grading the cognitive state of patients for the clinician. J Psychiatr Res 1975;12:189–198.
  15. Klein EA, Thompson IM, Lippman SM, et al: SELECT: the Selenium and Vitamin E Cancer Prevention Trial. Urol Oncol 2003;21:59–65.
  16. Roberts L, Oates J, Linton M, et al: The relationship between dose of vitamin E and suppression of oxidative stress in humans. Free Radic Biol Med 2007;43:1388–1393.

  

Author Contacts

Valory N. Pavlik, PhD
Department of Family and Community Medicine
Baylor College of Medicine, 3701 Kirby Dr. Suite 600
Houston, TX 77098 (USA)
Tel. +1 713 798 3639, Fax +1 713 798 7940, E-Mail vpavlik@bcm.edu

  

Article Information

Accepted: October 7, 2009
Published online: December 10, 2009
Number of Print Pages : 5
Number of Figures : 1, Number of Tables : 3, Number of References : 16

  

Publication Details

Dementia and Geriatric Cognitive Disorders

Vol. 28, No. 6, Year 2009 (Cover Date: February 2010)

Journal Editor: Chan-Palay V. (New York, N.Y.)
ISSN: 1420-8008 (Print), eISSN: 1421-9824 (Online)

For additional information: http://www.karger.com/DEM


Copyright / Drug Dosage / Disclaimer

Copyright: All rights reserved. No part of this publication may be translated into other languages, reproduced or utilized in any form or by any means, electronic or mechanical, including photocopying, recording, microcopying, or by any information storage and retrieval system, without permission in writing from the publisher or, in the case of photocopying, direct payment of a specified fee to the Copyright Clearance Center.
Drug Dosage: The authors and the publisher have exerted every effort to ensure that drug selection and dosage set forth in this text are in accord with current recommendations and practice at the time of publication. However, in view of ongoing research, changes in goverment regulations, and the constant flow of information relating to drug therapy and drug reactions, the reader is urged to check the package insert for each drug for any changes in indications and dosage and for added warnings and precautions. This is particularly important when the recommended agent is a new and/or infrequently employed drug.
Disclaimer: The statements, opinions and data contained in this publication are solely those of the individual authors and contributors and not of the publishers and the editor(s). The appearance of advertisements or/and product references in the publication is not a warranty, endorsement, or approval of the products or services advertised or of their effectiveness, quality or safety. The publisher and the editor(s) disclaim responsibility for any injury to persons or property resulting from any ideas, methods, instructions or products referred to in the content or advertisements.

Abstract

Background: Vitamin E at a dose of 2,000 IU per day has been shown to delay Alzheimer’s disease (AD) progression, but recent studies have questioned the safety of this dose level and the overall efficacy of vitamin E in AD treatment. Methods: We analyzed the survival history of 847 probable or mixed AD patients followed in a research center between 1990 and the censoring date of December 31, 2004. Standard practice during this period was to recommend vitamin E at 1,000 IU twice daily to all patients. We used Cox proportional hazards modeling to assess the association of vitamin E alone, or in combination with a cholinesterase inhibitor (ChEI), with all-cause mortality, adjusting for important covariates. Approximately two thirds of the patients took vitamin E with a ChEI, 10% took vitamin E alone, and 15% took no antidementia drug. Results: The adjusted hazard ratio (HR) associated with vitamin E (with or without a ChEI) was 0.71 (95% CI: 0.57–0.89; p = 0.003). Compared to the no drug treatment group, the HR for vitamin E alone or with another drug was 0.77 (95% CI: 0.60–1.0); the HR for ChEI use alone was 1.2 (95% CI: 0.87–1.60). Conclusion: The results do not support a concern over increased mortality with high-dose vitamin E supplementation.

© 2009 S. Karger AG, Basel


  

Author Contacts

Valory N. Pavlik, PhD
Department of Family and Community Medicine
Baylor College of Medicine, 3701 Kirby Dr. Suite 600
Houston, TX 77098 (USA)
Tel. +1 713 798 3639, Fax +1 713 798 7940, E-Mail vpavlik@bcm.edu

  

Article Information

Accepted: October 7, 2009
Published online: December 10, 2009
Number of Print Pages : 5
Number of Figures : 1, Number of Tables : 3, Number of References : 16

  

Publication Details

Dementia and Geriatric Cognitive Disorders

Vol. 28, No. 6, Year 2009 (Cover Date: February 2010)

Journal Editor: Chan-Palay V. (New York, N.Y.)
ISSN: 1420-8008 (Print), eISSN: 1421-9824 (Online)

For additional information: http://www.karger.com/DEM


Article / Publication Details

First-Page Preview
Abstract of Original Research Article

Accepted: 7/10/2009
Published online: 12/10/2009
Issue release date: February 2010

Number of Print Pages: 5
Number of Figures: 1
Number of Tables: 3

ISSN: 1420-8008 (Print)
eISSN: 1421-9824 (Online)

For additional information: http://www.karger.com/DEM


Copyright / Drug Dosage

Copyright: All rights reserved. No part of this publication may be translated into other languages, reproduced or utilized in any form or by any means, electronic or mechanical, including photocopying, recording, microcopying, or by any information storage and retrieval system, without permission in writing from the publisher or, in the case of photocopying, direct payment of a specified fee to the Copyright Clearance Center.
Drug Dosage: The authors and the publisher have exerted every effort to ensure that drug selection and dosage set forth in this text are in accord with current recommendations and practice at the time of publication. However, in view of ongoing research, changes in goverment regulations, and the constant flow of information relating to drug therapy and drug reactions, the reader is urged to check the package insert for each drug for any changes in indications and dosage and for added warnings and precautions. This is particularly important when the recommended agent is a new and/or infrequently employed drug.
Disclaimer: The statements, opinions and data contained in this publication are solely those of the individual authors and contributors and not of the publishers and the editor(s). The appearance of advertisements or/and product references in the publication is not a warranty, endorsement, or approval of the products or services advertised or of their effectiveness, quality or safety. The publisher and the editor(s) disclaim responsibility for any injury to persons or property resulting from any ideas, methods, instructions or products referred to in the content or advertisements.

References

  1. Engelhart MJ, Geerlings MI, Ruitenberg A, et al: Dietary intake of antioxidants and risk of Alzheimer disease. JAMA 2002;287:3223–3229.
  2. Engelhart MJ, Ruitenberg A, Meijer J, et al: Plasma levels of antioxidants are not associated with Alzheimer’s disease or cognitive decline. Dement Geriatr Cogn Disord 2005;19:134–139.
  3. Zandi PP, Anthony JC, Khachaturian AS, et al: Reduced risk of Alzheimer disease in users of antioxidant vitamin supplements: the Cache County Study. Arch Neurol 2004;61:82–88.
  4. Laurin D, Masaki KH, Foley DJ, White LR, Launer LJ: Midlife dietary intake of antioxidants and risk of late-life incident dementia: the Honolulu-Asia Aging Study. Am J Epidemiol 2004;159:959–967.
  5. Cherubini A, Martin A, Andres-Lacueva C, et al: Vitamin E levels, cognitive impairment and dementia in older persons: the InCHIANTI study. Neurobiol Aging 2005;26:987–994.
  6. Sano M, Ernesto C, Thomas RG, et al: A controlled trial of selegiline, alpha-tocopherol, or both as treatment for Alzheimer’s disease: the Alzheimer’s Disease Cooperative Study. N Engl J Med 1997;336:1216–1222.
  7. Petersen RC, Thomas RG, Grundman M, et al: Vitamin E and donepezil for the treatment of mild cognitive impairment. N Engl J Med 2005;352:2379–2388.
  8. Vivekananthan DP, Penn MS, Sapp SK, Hsu A, Topol EJ: Use of antioxidant vitamins for the prevention of cardiovascular disease: meta-analysis of randomised trials. Lancet 2003;361:2017–2023.
  9. Miller ER 3rd, 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;142:37–46.
  10. Bjelakovic G, Nikolova D, Gluud LL, Simonetti RG, Gluud C: Mortality in randomized trials of antioxidant supplements for primary and secondary prevention: systematic review and meta-analysis. JAMA 2007;297:842–857.
  11. McKhann G, Drachman D, Folstein M, Katzman R, Price D, Stadlan EM: Clinical diagnosis of Alzheimer’s disease: report of the NINCDS-ADRDA Work Group under the auspices of Department of Health and Human Services Task Force on Alzheimer’s Disease. Neurology 1984;34:939–944.
  12. Doody R, Pavlik V, Massman P, et al: Changing patient characteristics and survival experience in an Alzheimer’s center patient cohort. Dement Geriatr Cogn Disord 2005;20:198–208.
  13. Doody RS, Dunn JK, Huang E, Azher S, Kataki M: A method for estimating duration of illness in Alzheimer’s disease. Dement Geriatr Cogn Disord 2004;17:1–4.
  14. Folstein M, Folstein S, McHugh P: ‘Mini-Mental State’: a practical method for grading the cognitive state of patients for the clinician. J Psychiatr Res 1975;12:189–198.
  15. Klein EA, Thompson IM, Lippman SM, et al: SELECT: the Selenium and Vitamin E Cancer Prevention Trial. Urol Oncol 2003;21:59–65.
  16. Roberts L, Oates J, Linton M, et al: The relationship between dose of vitamin E and suppression of oxidative stress in humans. Free Radic Biol Med 2007;43:1388–1393.