The results of a recent study reported in the most recent journal of JAMA shows that 2000 units of Vitamin E can have beneficial effects at retarding the progression of Alzheimer’s disease.  In an older study, 2000 units of Vitamin E was shown to be equally as effective as taking a prescribed medication (10 mg of selegiline) daily at improving activities of daily living (dressing, eating, walking) and delaying placement into a nursing home.  Interestingly, in this study if the patient combined taking both vitamin E and selegiline together the beneficial effect of either substance was lost.  There are additional studies which have shown slowed cognitive decline in the elderly without dementia if they take high doses of Vitamin E.  As mentioned at the start of this paragraph, a new study was performed which enrolled 613 patients with mild to moderate dementia (mean age 79; 97% men).  The patients were broken into four groups: 2,000 units Vitamin E, 20 mg memantine, Vit E + memantine, and placebo.   They were followed for 4 years.  The group taking Vitamin E alone showed a reduction in disease production of 19% per year.  It even did better than the memantine alone (although this was not statistically significant).  Interestingly, similar to the study that used selegiline, when Vitamin E was combined with memantine then the beneficial effect was lost.

Talk to your doctor about the benefits and risks of taking high doses of Vitamin E.  One major concern is that Vitamin E can thin your blood and for patients already on anticoagulants it may not be wise to add a high dose of Vitamin E as well. 

Vitamin E is a fat-soluble vitamin that is found in fruit, vegetables and whole grains.  It is best absorbed when taken with food.  It typically is dispensed in 400 IU’s capsules. 

What is Happening in the Brain of a Person with Alzheimer’s Disease?

Theory

A) General Injury

- All brains undergo neuroplasticity in response to damage.  Neurons are one of the few cells in the body that do not replicate.  When they are exposed to damaging ions (e.g. free radicals) following smoking a cigarette they repair themselves (use an intracellular repair protein called ‘tau’) and can branch to contact neighboring neurons. However, at some point in life this neuroplasticity will be overcome and these neurons that have branched together coalesce into a ‘neurofibrillary tangle’.

There are 48 million (8% of the US population) who have some degree of hearing loss.  Almost 2/3 of all men who will ultimately lose their hearing will begin to do so as early as age 44.  Despite the large number of individuals with hearing loss, only 1 in 7 adults who could benefit from hearing aids actually use a hearing device.

This is a 59 year-old man with a 4 year history of worsening short-term memory and difficulty expressing himself.  On initial exam, he misspoke frequently and made a number of spelling errors when asked to write a sentence.  He could not draw a clock. He was unable to recall 3 words after a short delay. He scored an 18/30 on the Mini-mental exam.  An MRI of the brain was normal.


This PET CT scan shows diminished blood flow in the parietal and temporal lobes bilaterally along with decreased flow to the posterior cingulate gyrus.  This is typical for Alzheimer’s disease. 

PET CT

DIAGNOSIS: Alzheimer’s Disease

This is a 51 year-old woman who started having difficulty with her short-term memory at age 41.  She would frequently forget the names of people she met.  During the past five years, her husband has noticed that she repeats herself frequently – often asking the same questions.  On initial exam, there were no glaring abnormalities other than she could not repeat a list of 3 words that had been given to her to remember.  An MRI of the brain was normal. 

This PET CT study shows decreased blood flow to both hemispheres in the regions of the parietal and temporal lobes (right more than left).  This pattern is seen in early Alzheimer’s disease.


PET CT

DIAGNOSIS: Alzheimer’s Disease

This is a 52 year-old woman who started having difficulty calculating her monthly bills beginning at age 42.  She developed personality changes, problems with short-term memory loss and even had difficulty reading a watch by age 46.  She had to stop working as a hairdresser and go on disability at age 48 and was placed in a nursing home by age 50.   On exam, she produced no intelligible speech and followed nothing but the most simple commands (‘stand’ or ‘sit’).  She paced about the room frequently seldom making eye contact.

This PET CT study demonstrated almost complete absence of blood flow to most of the surface of the brain with the exception of the very posterior portion of both hemispheres (occipital cortex).  This part of the brain is responsible for interpreting vision.  In addition, there are some ‘islands’ neurons deep in the white matter responsible for processing incoming sensory information called the thalamus.  This study shows that the thalami were healthy.  This is compatible with end-stage dementia.  It’s impossible to speculate at the underlying disease (Alzheimer’s, Pick’s Disease, Primary Progressive Aphasia, etc) based on this imaging study as the disease is too advanced. 


PET CT

DIAGNOSIS: End-stage Dementia