Science

Maurice W. Dysken, MD; Mary Sano, PhD; Sanjay Asthana, MD; Julia E. Vertrees, PharmD, BCPP; Muralidhar Pallaki, MD; Maria Llorente, MD; Susan Love, MA; Gerard D. Schellenberg, PhD; J. Riley McCarten, MD; Julie Malphurs, PhD; Susana Prieto, MD; Peijun Chen, MD, MPH, PhD; David J. Loreck, MD; George Trapp, MD, JD; Rajbir S. Bakshi, MD; Jacobo E. Mintzer, MD; Judith L. Heidebrink, MD; Ana Vidal-Cardona, MD; Lillian M. Arroyo, MD; Angel R. Cruz, MD; Sally Zachariah, MD; Neil W. Kowall, MD; Mohit P. Chopra, MD; Suzanne Craft, PhD; Stephen Thielke, MD; Carolyn L. Turvey, PhD; Catherine Woodman, MD; Kimberly A. Monnell, MD; Kimberly Gordon, MSN, RN, FNP-BC; Julie Tomaska, PhD; Yoav Segal, MD, PhD; Peter N. Peduzzi, PhD; Peter D. Guarino, MPH, PhD

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(alphatocopherol),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 2000IU/dofalphatocopherol(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 Over the mean(SD) follow-up of 2.27(1.22)years, participants receiving alpha tocopherol had slower decline than those receiving placebo as measured by the ADCS-ADL. The change translates into a delay in clinical progression of 19% per year compared with placebo (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,2000IU/dof 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.