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ALZHEIMER'S DISEASE

Vitamin C and Vitamin E for Alzheimer's Disease

¹ Affiliate Clinical Assistant Professor, Harrison School of Pharmacy, Auburn University, Auburn, AL; Coordinator, Drug Information Services, Columbus Regional Healthcare System, Columbus, GA
² Distinguished Service Professor of Pharmacy Practice; CoDirector, Drug Information and Pharmacy Resource Center, College of Pharmacy, University of Florida, Gainesville, FL

Reprints: Dr. Boothby, Drug Information Services, 710 Center St., Columbus, GA 31902-0950, fax 706/571-1625, lisa.boothby{at}crhs.net

OBJECTIVE: To evaluate the literature on supplemental vitamin C and vitamin E therapy in the prevention and treatment of Alzheimer's disease (AD).

DATA SOURCES: Literature retrieval was accessed through MEDLINE (1966-March 2005) using the key words antioxidants, vitamin C, vitamin E, Alzheimer's disease, and dementia. International Pharmaceutical Abstracts (1970-March 2005), Current Contents (1996-March 2005), Cochrane Database of Systematic Reviews (1994-March 2005), and Ebsco's Academic Search Elite (1975-March 2005) were searched with the same key words.

STUDY SELECTION AND DATA EXTRACTION: Articles related to the objective that were identified through PubMed were included.

DATA SYNTHESIS: Oral supplementation of vitamin C (ascorbic acid) and vitamin E (D-alfa-tocopherol acetate) alone and in combination have been shown to decrease oxidative DNA damage in animal studies in vivo, in vitro, and in situ. Recent results of a prospective observational study (n = 4740) suggest that the combined use of vitamin E 400 IU daily and vitamin C 500 mg daily for at least 3 years was associated with the reduction of AD prevalence (OR 0.22; 95% CI 0.05 to 0.60) and incidence (HR 0.36; 95% CI 0.09 to 0.99). Contradicting this is a previous prospective observational study (n = 980) evaluating the relationship between 4 years of vitamin C and E intake and the incidence of AD, which detected no difference in the incidence of AD during the 4-year follow-up. Recent meta-analysis results suggest that doses of vitamin E 400 IU daily for more than one year are associated with increased all-cause mortality. Mega-trial results suggest that vitamin E doses 400 IU daily for 6.9 years in patients with preexisting vascular disease or diabetes mellitus increase the incidence of heart failure, with no other outcome benefits noted.

CONCLUSIONS: In the absence of prospective, randomized, controlled clinical trials documenting benefits that outweigh recently documented morbidity and mortality risks, vitamin E supplements should not be recommended for primary or secondary prevention of AD. Although the risks of taking high doses of vitamin C are lower than those with vitamin E, the lack of consistent efficacy data for vitamin C in preventing or treating AD should discourage its routine use for this purpose.

Key Words: antioxidants: vitamin C, vitamin E, Alzheimer's disease, dementia

Published Online, October 14, 2005. www.theannals.com, DOI 10.1345/aph.1E495

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