Effect of vitamin E and memantine on functional decline in Alzheimer disease: the TEAM-AD VA cooperative randomized trial

Prevention would probably be better.
This is what I'm doing for prevention.
This is what the Harvard Medical School suggests.
Generic dementia prevention here. 
Alpha tocopherol is not standard vitamin E. You know the drill, ask your doctor.
http://www.ncbi.nlm.nih.gov/pubmed/24381967

Dysken MW¹, Sano M², Asthana S³, Vertrees JE⁴, Pallaki M⁵, Llorente M⁶, Love S¹, Schellenberg GD⁷, McCarten JR¹, Malphurs J⁸, Prieto S⁸, Chen P⁵, Loreck DJ⁹, Trapp G¹⁰, Bakshi RS¹⁰, Mintzer JE¹¹, Heidebrink JL¹², Vidal-Cardona A¹³, Arroyo LM¹³, Cruz AR¹⁴, Zachariah S¹⁴, Kowall NW¹⁵, Chopra MP¹⁵, Craft S¹⁶, Thielke S¹⁶, Turvey CL¹⁷, Woodman C¹⁷, Monnell KA¹⁸, Gordon K¹⁸, Tomaska J¹, Segal Y¹, Peduzzi PN¹⁹, Guarino PD¹⁹.

Author information

• ¹Minneapolis VA Health Care System, Minneapolis, Minnesota.
• ²James J. Peters VA Medical Research Center, New York, New York.
• ³William S. Middleton Memorial Veterans Hospital, Madison, Wisconsin.
• ⁴Cooperative Studies Program Clinical Research Pharmacy Coordinating Center, Albuquerque, New Mexico.
• ⁵Louis Stokes Cleveland VA Medical Center, Cleveland, Ohio6Case Western Reserve University School of Medicine, Cleveland, Ohio.
• ⁶Washington DC VA Medical Center, Washington, DC.
• ⁷University of Pennsylvania School of Medicine, Philadelphia.
• ⁸Miami VA Healthcare System, Miami, Florida.
• ⁹VA Maryland Healthcare System, Baltimore11University of Maryland Medical School, Department of Psychiatry, Baltimore.
• ¹⁰VA North Texas Health Care System, Dallas.
• ¹¹Ralph H. Johnson VA Medical Center, Charleston, South Carolina14Department of Health Studies, Medical University of South Carolina, Charleston15Roper St Francis Healthcare, Charleston, South Carolina.
• ¹²VA Ann Arbor Healthcare System, Ann Arbor, Michigan.
• ¹³VA Caribbean Healthcare System, San Juan, Puerto Rico.
• ¹⁴Bay Pines VA Healthcare System, Bay Pines, Florida.
• ¹⁵VA Boston Healthcare System, Boston, Massachusetts.
• ¹⁶VA Puget Sound Health Care System, Seattle, Washington21Department of Psychiatry and Behavioral Sciences, University of Washington, Seattle.
• ¹⁷Iowa City VA Medical Center, Iowa City, Iowa23University of Iowa, Iowa City.
• ¹⁸W. G. (Bill) Hefner VA Medical Center, Salisbury, North Carolina.
• ¹⁹Cooperative Studies Program Coordinating Center, VA Connecticut Healthcare System, West Haven26Yale University School of Public Health, New Haven, Connecticut.

Abstract

IMPORTANCE:

Although vitamin E and memantine have been shown to have beneficial effects in moderately severe Alzheimer disease (AD), evidence is limited in mild to moderate AD.

OBJECTIVE:

To determine if vitamin E (alpha tocopherol), memantine, or both slow progression of mild to moderate AD in patients taking an acetylcholinesterase inhibitor.

DESIGN, SETTING, AND PARTICIPANTS:

Double-blind, placebo-controlled, parallel-group, randomized clinical trial involving 613 patients with mild to moderate AD initiated in August 2007 and concluded in September 2012 at 14 Veterans Affairs medical centers.

INTERVENTIONS:

Participants received either 2000 IU/d of alpha tocopherol (n = 152), 20 mg/d of memantine (n = 155), the combination (n = 154), or placebo (n = 152).

MAIN OUTCOMES AND MEASURES:

Alzheimer's Disease Cooperative Study/Activities of Daily Living (ADCS-ADL) Inventory score (range, 0-78). Secondary outcomes included cognitive, neuropsychiatric, functional, and caregiver measures.

RESULTS:

Data from 561 participants were analyzed (alpha tocopherol = 140, memantine = 142, combination = 139, placebo = 140), with 52 excluded because of a lack of any follow-up data. Over the mean (SD) follow-up of 2.27 (1.22) years, ADCS-ADL Inventory scores declined by 3.15 units (95% CI, 0.92 to 5.39; adjusted P = .03) less in the alpha tocopherol group compared with the placebo group. In the memantine group, these scores declined 1.98 units less (95% CI, -0.24 to 4.20; adjusted P = .40) than the placebo group's decline. This change in the alpha tocopherol group translates into a delay in clinical progression of 19% per year compared with placebo or a delay of approximately 6.2 months over the follow-up period. Caregiver time increased least in the alpha tocopherol group. 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 participants) and combination groups (44 events in 31 participants) compared with placebo (13 events in 11 participants).

CONCLUSIONS AND RELEVANCE:

Among patients with mild to moderate AD, 2000 IU/d of alpha tocopherol compared with placebo resulted in slower functional decline. There were no significant differences in the groups receiving memantine alone or memantine plus alpha tocopherol. These findings suggest benefit of alpha tocopherol in mild to moderate AD by slowing functional decline and decreasing caregiver burden.

TRIAL REGISTRATION:

clinicaltrials.gov Identifier: NCT00235716.