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VA Maryland Health Care System


Baltimore VA Medical Center Participates in Multi-Center Study of Vitamin E and Alzheimer’s

With more than 5.1 million Americans affected by Alzheimer’s disease and another 5.4 million serving as caregivers, difficulty with basic daily living activities can be among a caregiver’s worst nightmares. New research conducted by 14 Department of Veterans Affairs (VA) medical centers across the nation—including the Baltimore VA Medical Center— have found that vitamin E (alpha-tocopherol) may have functional benefits in patients with mild to moderate Alzheimer’s, possibly decreasing some of the stress involved in the care of these patients.

The double-blind, placebo-controlled, parallel-group, randomized clinical trial ran from August 2007 to September 2012 and included a group of more than 600 patients struggling with Alzheimer’s disease. The study, led by Dr. Maurice W. Dysken at the Minneapolis VA Medical Center as a Cooperative Studies Program project, sought to determine if vitamin E, memantine (the first in a novel class of Alzheimer’s disease medications), or a combination thereof, improve memory and function in patients with mild to moderate Alzheimer’s disease. Participants were already taking the most commonly prescribed class of medication for the disease, the acetylcholinesterase inhibitors, (also known as ACI’s).

The research findings, reported in the January 1 issue of Journal of the American Medical Association, surprised researchers, showing that the vitamin E group did 19 percent better after one year in measures of function such as dressing, bathing, and other measures of hygiene or daily care.

“Nineteen percent is a modest rate, but it’s certainly a significant enough benefit and result to look much closer at the potential value of vitamin E as an Alzheimer’s disease treatment,” says Dr. David Loreck, a geriatric neuropsychiatrist at the VA Maryland Health Care System who has also helped develop and run the health care system’s outpatient clinic for comprehensive assessments of Alzheimer’s disease and memory disorders. Loreck, an assistant professor at the University of Maryland School of Medicine, served as the site principle investigator for the study at the Baltimore VA Medical Center. “There has been a debate in medicine for more than 20 years whether antioxidants such as vitamin E have any real benefit as a treatment for diseases such as Alzheimer’s. This is an important chapter in this debate and will definitely rekindle both clinical and research interest in vitamin E,” Loreck says. “On a cautionary note, however, this study does not show any evidence that it improves memory or cognition, delays the progression of memory or cognition loss, or slows the overall progression of Alzheimer’s disease,” Loreck adds.

For the study, patients were randomly selected to be part of four different subgroups. Although every patient in the study received the ACI drugs, one subgroup received the ACI drugs in combination with the vitamin E. A second received the ACI drugs in conjunction with a placebo. A third group received the ACI drugs in conjunction with vitamin E and memantine. A fourth group received the ACI drugs, memantine and placebo. At the Baltimore VA Medical Center, approximately 60 Veterans who had received a diagnosis of probable Alzheimer’s disease volunteered for the study.

“The outcomes were surprising. Of all the groups, we were not expecting the strongest benefit from the one that received only the ACI plus 2000 International Units (IU) daily of vitamin E. Still, it’s too early to tell all patients with mild to moderate Alzheimer’s disease to rush out to take vitamin E pills,” Loreck says, explaining that vitamin E can have cardiac-related side effects such as increased bleeding risk, and patients shouldn’t start taking it without a discussion with their doctor. “On the other hand, a lot of clinicians start patients on an ACI and memantine as soon as they are diagnosed, and this study further questions the value of adding memantine in the early stage of the illness, and provides more support to revisit a role for vitamin E.”

“Given the current 5 to 6 million cases of Alzheimer’s disease, and with the number doubling over the next 20 years, the importance of finding effective treatments and increasing research for Alzheimer’s disease is clear,” says Loreck. “These large clinical trials comparing basic treatment options are critical to better understand the disease and develop clinical guidelines,” Loreck says.

Loreck developed the Baltimore VA Medical Center Alzheimer’s Disease and Memory Disorders Clinic more than 20 years ago with Dr. Conrad May, a Baltimore VA Medical Center/University of Maryland Medical School geriatrician, to meet the rising tide of Maryland Veterans with Alzheimer’s disease or other dementias. Today, the clinic provides a multidisciplinary assessment team of geriatrician internists, neuropsychologists, neuropsychiatry, geriatric nursing, social work, and geriatric doctors of pharmacy to provide the comprehensive assessment critical for effective care of patients with Alzheimer’s disease as well as other frail, medically complex elderly patients. Loreck notes that tremendous progress has been made in the understanding of Alzheimer’s disease in the 23 years since he began working with these patients, but that research needs to be stepped up as currently no drugs or vitamins can prevent, cure, or slow the overall course of Alzheimer’s disease or related dementias.