Alzheimers Disease

Dementia and Alzheimers Disease in Community-Dwelling

Elders Taking Vitamin C and/or Vitamin E
Gerda G Fillenbaum, Maragatha N Kuchibhatla, Joseph T Hanlon, Margaret B Artz, Carl F Pieper,
Kenneth E Schmader, Maurice W Dysken, and Shelly L Gray

BACKGROUND:

Since increased oxidative stress may impair cognition and be a risk factor for dementia, there has been interest in
determining whether use of antioxidants could protect against such events.

OBJECTIVE:

To determine whether supplement use of vitamins C and/or E in a community-based sample of older African American
and white individuals delayed incident dementia or Alzheimers disease (AD).

METHODS:

We selected a subgroup from the Duke Established Populations for Epidemiologic Studies of the Elderly, a longitudinal
study of community-representative persons aged 65105 years living in 5 adjacent counties in North Carolina, and followed them
for dementia (19861987 through June 2000). Information gathered during in-home interviews included sociodemographic
characteristics, health status, health service use, and vitamin use. Diagnosis of dementia and AD was based on evaluations using
the clinical and neuropsychological batteries of the Consortium to Establish a Registry for Alzheimers Disease, with final
determination by consensus agreement of specialists using Diagnostic and Statistical Manual of Mental Disorders, third revision,
and National Institute for Neurological and Communicative Disorders and StrokeAlzheimers Disease and Related Disorders
criteria.

RESULTS:

Of 616 persons initially dementia-free (mean age 73 y; 62% female; 62% African American), 141 developed dementia, of
whom 93 developed AD. Increased age and mobility problems were risk factors for dementia (only age for AD), while an increased
number of outpatient visits reduced the likelihood of developing dementia. Neither use of any vitamins C and/or E (used by 8% of
subjects at baseline) nor high-dose use reduced the time to dementia or AD.

CONCLUSIONS:

In this community in the southeastern US where vitamin supplement use is low, use of vitamins C and/or E did not
delay the incidence of dementia or AD.

KEY WORDS: Alzheimers disease, antioxidant, dementia, vitamin C, vitamin E.

Ann Pharmacother 2005;39:2009-14.

Published Online, 14 Oct 2005, www.theannals.com, DOI 10.1345/aph.1G280

constellation of factors has resulted in interest in deterA

mining whether, in older age, antioxidants could prevent or delay cognitive impairment and dementia, as well
as progression of dementing disorders. This has been fueled by growing evidence that oxidative stress leading to
formation of free radicals results in neuronal degeneration
seen with dementia. Antioxidants (eg, vitamins C and E)
may scavenge free radicals, converting them to less-reactive compounds and thus delaying the possible adverse im-

Author and support information provided at the end of the text.

www.theannals.com

pact of increased oxidative stress on cognitive and functional status and dementia.1,2 Additionally, findings suggest
that lower plasma vitamin E concentrations may be a risk
factor for dementia,3 while higher supplemental or nutritional intake of vitamin E may be related to better cognitive performance and a reduced rate of cognitive decline.4,5
Further, higher nutritional intake of vitamins C or E has
been found to reduce risk for Alzheimers disease (AD)6;
higher supplemental vitamin E intake was found to reduce
progression of AD as measured by functional endpoints.7
There are, however, many studies in which findings are
mixed (ie, significant for some cognitive measures but not

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GG Fillenbaum et al.

for others), modest, or risk reducing for only selected subgroups.1,8-13 Thus, the picture is quite confused, and there is
question whether vitamin Emay prevent dementia in
elderly individuals who are minimally or not yet cognitively impaired.2
We present findings based on a sample of African
American and white participants in the 5-county, 10-year
EPESE (Established Populations for Epidemiologic Studies of the Elderly) at Duke University.14 This study was designed to determine whether, with a broad range of factors
related to the development of dementia controlled, use of
the antioxidant vitamins C and/or E increases the time to
incident dementia or AD.
Methods
PARENT STUDY

This is a secondary analysis of a sub-sample of cases enrolled in the

Duke EPESE project. Duke EPESE is a 10-year prospective cohort study
of community-dwelling elderly (19861987 to 19961997) whose purpose was to describe and identify predictors of mortality, health service
use, and risk factors for chronic diseases and loss of functioning.14
The Duke EPESE sample was selected using a 4-stage stratified
household sampling design. Of contacted community residents aged 65
years living in a 5-county urban and rural area of the Piedmont region of
North Carolina, 80% participated (4162; 69% female; 54% self-reported
African American; 45% self-reported white).14
DATA GATHERING

In-person interviews were held at the participants home at baseline

and 3, 6, and 10 years later using structured questionnaires. The information gathered included demographic characteristics, health insurance status, health conditions and behaviors, functional status, health service use
including use of prescription and over-the-counter medications, and level
of cognitive functioning as determined by the Short Portable Mental Status Questionnaire (SPMSQ).15
SUB-SAMPLE OF MEMBERS WITH AND WITHOUT
DEMENTIA

Following the second and third in-person waves, a stratified random

sample was drawn based on SPMSQ scores. Sampling was done within
3 groups based on scores (1) below the cut-point indicating impaired cognition or a 2-point decline in performance on the SPMSQ since the previous in-person wave, (2) 1 point above the cut-point, and (3) 2 points above
the cut-point. All participants were evaluated at home by trained personnel,
primarily clinical research nurses or a geriatric nurse practitioner, using the
standardized procedures of the Consortium to Establish a Registry for
Alzheimers Disease16,17 to ascertain the presence (and type) of dementia.
Medical records were sought from the primary care providers. A diagnosis
consensus committee, which included a senior neurologist, one or more
geriatricians, and a geriatric nurse practitioner, reviewed all data. Final determination of dementia relied on Diagnostic and Statistical Manual of
Mental Disorders, third revision,18 and National Institute for Neurological
and Communicative Disorders and StrokeAlzheimers Disease and Related Disorders19 criteria for Alzheimers disease. Estimated year of onset was
based on clinical information.
Of the 653 sample members evaluated, 178 were found to have dementia, of whom 37 had dementia at baseline (1986 1987), and were
dropped from further consideration for the present study, while dementia
developed in 141 subjects after baseline and before June 2000. Thus, the
sample for the present study consisted of 475 persons who were cognitively
intact and 141 with incident dementia. Of the 141 persons with incident dementia, 93 were diagnosed with AD, 30 with vascular dementia, and 18
with other dementias, including dementia of unknown etiology.

2010

The Annals of Pharmacotherapy

These studies were approved by the Duke Institutional Review Board

and had the informed consent of the participants or their legal representatives.
DATA COLLECTION AND MANAGEMENT

At each of the 4 in-person interviews, participants were asked to

show the interviewer all drugs taken during the previous 2 weeks that
had been prescribed by a physician or any other medicines obtained
from a store.20 The interviewer recorded the drugs name, dosage form,
and number of dosage forms the respondent reported taking the previous
day. Drug data were coded using a computerized and updated version of
the Drug Product Information Coding System21 and the Iowa Nonprescription Drug Product Information Coding System.22 Previous evaluation has found this drug data entry system to be reliable, with an error
rate of 1.6% (95% CI 0.7 to 2.6).20
For the present study, we identified all vitamins and minerals with an
antioxidant effect, concentrating on reports of vitamins C and E. Because
of limited use of antioxidant vitamins in this sample, we combined use
of any vitamin C with use of any vitamin E, classifying use in a multivitamin preparation as low dose and single supplement use of either vitamin C or E as high dose.
INDEPENDENT VARIABLES

The independent variables were baseline demographic characteristics

and time-varying health status, functional status, health behaviors, and
health service use. The demographic characteristics included age, education (both continuous), gender (female = 1), marital status (married [1]
vs not married), and income (dichotomized at less than $5000 vs $5000
or more). Health status included presence of self-reported hypertension,
myocardial infarction, stroke, diabetes, and cancer (excluding skin cancer), each coded 1 if present. Body mass index (BMI; weight/height)
was used as an indicator of nutritional status (persons at <15th percentile
and those at >85th percentile were compared with the intermediate
group). Severe depressive symptomatology was measured as 9 endorsements on the Duke EPESE version of the Center for Epidemiologic
Studies-Depression where items are dichotomized.14 Functional status
was assessed by the Katz activities of daily living (ADL) scale,23 a 5item instrumental ADL (IADL) scale,24 and the abbreviated 3-item
RosowBreslau scale,25 each coded 1 if there was a problem performing
any item and 0 otherwise.
Health behaviors included alcohol use, being a current smoker, and
use of drugs that reduce risk of adverse events (nonsteroidal antiinflammatory drugs and calcium, each coded 1 if present). Health service use
included number of outpatient visits in the past 12 months (categorized
as 0, 1 4, 5), number of prescription drugs (0, 1 4, 5), and number of
over-the-counter drugs excluding vitamins and minerals (0, 1, 2).
STATISTICAL ANALYSIS

Following descriptive analyses (means, SD, percentages), we ran bivariate analyses to determine the unadjusted association at baseline of
antioxidant vitamin use and each of the independent variables with incident dementia, using Cox proportional hazards.26 In these analyses, we
took into account time to dementia, calculated as the time in years to diagnosis of dementia since baseline, with censoring at the last interview.
Nondemented sample members were censored at the last interview. In
the multivariate analyses, in addition to antioxidant vitamin use, we included only variables that were significant in the bivariate Cox proportional hazards analysis.
With the exception of demographic characteristics (for which baseline data were always used), variables were set to their values at the inperson wave immediately before identification as demented or before
they were censored. This kept as consistently as feasible the time interval
between assessment of independent variable status and identification of
dementia. If values were missing, the values from the previous timepoint were substituted in the model. Analyses were repeated substituting
vitamin use at EPESE enrollment (instead of at the wave immediately
prior to dementia incidence), permitting examination of use up to 14
years before dementia incidence.

2005 December, Volume 39

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Effect of Vitamins C and E on Dementia and Alzheimers Disease

Results
At baseline, the 141 participants with incident dementia
were older, averaged less education, and were less likely to
be married, but otherwise did not differ significantly regarding specific health conditions, functional status, or
health habits from those who did not develop a dementing
disorder within the time of the study (Table 1). The groups
differed with respect to health service use, but not with respect to use of vitamins C and/or E.

Bivariate (unadjusted) risk ratios (Table 1), which took

into account time to dementia, indicated that higher age was
a risk factor, while increased education, greater income, and
being married reduced the risk of developing dementia.
However, gender and race, the health conditions examined,
and health behaviors were not related to dementia onset.
Poorer mobility and problems with IADL were marginally
significant risk factors for dementia. Increased use of health
services (outpatient visits, prescription drugs) tended to reduce risk. The point estimates for any vitamin C and/or E in-

Table 1. Baseline Characteristics of Sample Members (all nondemented at baseline) and

Unadjusted Risk for Time to Dementiaa

Variable

No Dementia
(n = 475)

Incident Dementia
(n = 141)

p Valueb
(baseline
comparison)

Unadjusted
RR (95% CI)c
(time to dementia)

Demographic characteristic
age, y, mean (SD)
education, y, mean (SD)
gender (female), %
race (black), %
marital status (married), %
income >$5000, %

72.3 (6.2)
8.3 (8.0)
62.1
61.7
43.2
59.6

74.9 (6.4)
7.4 (4.1)
62.4
63.8
33.6
51.1

0.001
0.019
0.948
0.645
0.041
0.072

1.07 (1.04 to 1.10)

0.94 (0.90 to 0.99)
1.07 (0.74 to 1.55)
1.05 (0.73 to 1.50)
0.65 (0.45 to 0.93)
0.69 (0.49 to 0.98)

Health status, %
hypertension
diabetes (self-report)
MI
cancer (excluding skin)
stroke

59.9
20.6
12.8
9.3
7.2

52.9
23.4
10.6
8.5
7.8

0.137
0.480
0.485
0.785
0.797

0.77 (0.54 to 1.08)

1.17 (0.78 to 1.76)
0.82 (0.47 to 1.43)
0.91 (0.49 to 1.68)
1.11 (0.58 to 2.12)

BMI, %
underweight (<15th percentile)
overweight (>85th percentile)

13.6
11.2

15.0
8.6

0.663
0.279

1.22 (0.75 to 1.98)

0.73 (0.40 to 1.35)

Functional status, mean (SD)

Katz ADL (5-item)
IADL (5-item)
RosowBreslau

0.13 (0.53)
0.51 (1.07)
0.74 (1.83)

0.17 (0.61)
0.64 (1.21)
0.87 (1.10)

0.363
0.206
0.224

1.18 (0.88 to 1.57)

1.15 (0.99 to 1.33)
1.17 (0.99 to 1.37)

Health behaviors
alcohol use (oz), mean (SD)
current smoker, %
NSAID use, %
calcium use, %

0.13 (0.54)
16.0
15.1
55.4

0.08 (0.31)
12.1
12.3
54.6

0.238
0.251
0.106
0.941

0.81 (0.49 to 1.32)

0.74 (0.44 to 1.26)
0.67 (0.40 to 1.13)
0.98 (0.41 to 2.35)

Health services use

outpatient visits, %
0
14
5

19.8
48.4
31.8

34.0
42.6
23.4

0.002

Prescription drugs, %
0
14
5

24.6
61.3
14.1

38.3
56.0
5.7

0.001

OTC drugs, %
0
1
2

34.5
38.3
27.2

41.1
36.9
22.0

0.287

8.4
3.3

6.4
1.4

0.432
0.278

Vitamin C and/or E use

any
high-dose

0.81 (0.57 to 1.14)

0.67 (0.45 to 1.00)

0.82 (0.58 to 1.16)

0.40 (0.19 to 0.82)

0.95 (0.66 to 1.36)

0.78 (0.52 to 1.18)
0.79 (0.39 to 1.59)
0.38 (0.09 to 1.57)

ADL = activities of daily living; BMI = body mass index; IADL = instrumental activities of daily living; MI = myocardial infarction; NSAID = nonsteroidal
antiinflammatory drug; OTC = over-the-counter.
a
Bold items used in final model.
b
Percentages compared using 2; means compared using Wilcoxon test.
c
These values may differ in statistical significance from p value baseline comparisons since risk ratios take into account time to dementia.

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GG Fillenbaum et al.

take and for high-dose use indicated that such use increased
time to dementia, but did not reach statistical significance.
The multivariate analyses included the variables significant in bivariate analyses and vitamin C and/or vitamin E
use (the primary independent variable). We also included
problems with mobility, in preference to problems with
IADL since the point estimate for mobility was slightly
greater. Multivariate analysis (Table 2) indicated that higher
age and poor mobility were risk factors for incident dementia, while an increased number of outpatient visits delayed
time to dementia; use of more prescription medications,
while not statistically significant, also delayed dementia.
Neither use of any dose nor of high-dose vitamins C and/or
E at EPESE enrollment or later was significantly associated
with risk of incident dementia or AD, although at enrollment
they reduced the risk of dementia, albeit nonsignificantly.
Discussion
We found that neither self-reported intake of low-dose
nor high-dose vitamins C and/or E was associated with a
reduced incidence of dementia or AD over either a 3- or
14-year interval.
This finding agrees with several, but not all, previous
epidemiologic studies of supplement use and dietary intake
of antioxidants. In one study, higher intake of vitamin E
(but not vitamin C) from food alone (but not from food
plus supplements) was associated with reduced decline in
cognitive function in controlled analyses.4 Regarding AD,
higher dietary intake of vitamins C and E was each significantly associated with lower risk of AD after antioxidant

supplement use had been taken into account.6 This was not
confirmed by another study, which found that dietary, supplemental, or combined intake did not decrease the risk of
AD.27 Unlike a previous study,11 dietary antioxidant use did
not reduce the risk of AD as a function of apolipoprotein
E4 status.6 Among older Japanese men who may have taken supplemental vitamin C or E (but not both) for 8
years, a protective effect was found only for vascular and
for mixed/other dementias, and not for AD.5
Contrary to a casecontrol study,28 which found that use
of supplemental vitamin C reduced risk for incident AD,
Zandi et al.29 reported a reduction in AD incidence only
among persons who used both high-dose vitamin C and
high-dose vitamin E. Neither was protective alone. An effect on all dementias was not reported. Thus, while intake
of antioxidants from food or supplements may ameliorate
cognitive decline, the effect on dementia remains unclear.
Indeed, a recent report indicated that, once the dementing
process is underway, vitamin E (other antioxidant supplements were not examined) fails to reduce progression to
AD.30 However, in an earlier study, substantial antioxidant
use delayed progression to functional endpoints in AD.7
While all previous studies have controlled for demographic characteristics and several controlled for variables
closely related to dietary, health, and genetic status (eg,
smoking, alcohol use, BMI, health conditions, APOE
genotype), we also controlled for use of health services.
Our data suggest that poor mobility increases the risk for
dementia, perhaps because it is a general harbinger of adverse health conditions, while medical care delays the onset of dementia. Higher use of prescription medications

Table 2. Final Model: Predictors of Incident Dementia and Alzheimers Disease

Predicting Dementia (n = 141)
Vitamin C and/or E Use, RR (95% CI)
Variable

Any

Predicting Alzheimers Diseasea (n = 93)

Vitamin C and/or E Use, RR (95% CI)

High Dose

Any

High Dose

Demographic characteristics
age, y
1.05 (1.02 to 1.08)
education, y
0.97 (0.92 to 1.01)
married
0.90 (0.60 to 1.34)
income
1.01 (0.69 to 1.49)

1.05 (1.02 to 1.08)

0.97 (0.93 to 1.01)
0.90 (0.60 to 1.33)
1.02 (0.70 to 1.50)

1.06 (1.02 to 1.09)

1.01 (0.96 to 1.07)
0.92 (0.56 to 1.52)
0.89 (0.54 to 1.46)

1.06 (1.02 to 1.10)

1.01 (0.96 to 1.07)
0.92 (0.56 to 1.51)
0.91 (0.56 to 1.50)

Functional status
RosowBreslau

1.18 (1.00 to 1.39)

1.18 (1.00 to 1.38)

1.05 (0.85 to 1.30)

1.05 (0.85 to 1.30)

Health service use

outpatient visits
0
14
5

reference
0.65 (0.43 to 0.99)
0.52 (0.32 to 0.86)

reference
0.66 (0.44 to 0.99)
0.53 (0.32 to 0.87)

reference
0.59 (0.35 to 0.98)
0.64 (0.35 to 1.17)

reference
0.60 (0.36 to 1.01)
0.65 (0.36 to 1.19)

Prescription drugs
0
14
5

reference
0.94 (0.79 to 1.12)
0.54 (0.28 to 1.06)

reference
0.94 (0.79 to 1.12)
0.55 (0.29 to 1.07)

reference
0.88 (0.69 to 1.12)
0.47 (0.20 to 1.10)

reference
0.88 (0.69 to 1.13)
0.48 (0.21 to 1.14)

Vitamin use
at EPESE enrollment
wave prior to diagnosis

0.80 (0.40 to 1.58)

1.14 (0.64 to 2.03)

0.46 (0.11 to 1.89)

0.65 (0.20 to 2.05)

0.83 (0.36 to 1.92)

1.48 (0.78 to 2.81)

0.32 (0.04 to 2.30)

0.58 (0.14 to 2.39)

EPESE = Established Populations for Epidemiologic Studies of the Elderly.

a
In analyses focused on Alzheimers disease, non-Alzheimers disease dementia cases have been dropped.

2012

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2005 December, Volume 39

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Effect of Vitamins C and E on Dementia and Alzheimers Disease

and seeing the physician more frequently would usually be

considered indicators of poor health. Such activities, however, may also ensure that treatable conditions (eg, diabetes, hypertension, heart conditions) are maintained at the
best level possible and so delay the onset of dementia. Alternatively, persons in whom dementia is developing may
be less likely to seek medical care.
Our data have limitations. We did not record intensity of
vitamin use, although we know whether vitamins C and E
were constituents of a multivitamin (and so likely to be low
dose) or were reported as being taken as single-entity supplements (and so likely to be higher dose). Neither do we know
duration of use. Duration may be important, since there are
indications that long-term combined use of vitamins C and E
may be related to improved cognitive performance.11,18
Our study may lack power since only a very small proportion (<10%) of our sample members used these supplements. This is a smaller proportion than that reported by
other studies and probably reflects our geographic location
and the constitution of the sample. Vitamin supplement use
is lowest in the South and is lower in African American
than in white individuals. By comparison, in comparable
age samples elsewhere, 1738% took supplements.4,10,11,29
Nevertheless, the prevalence of dementia appears to be no
greater in our area than elsewhere in the US.16
There is a strong biological basis for assuming that reduction in oxidative stress may be important in retaining cognitive functioning and reducing the risk of dementia.1,2 However, we should not assume that vitamins C and E are the
only antioxidants of importance or that vitamins are the only
sources of antioxidants. Different antioxidants operate in different ways; use of complementary antioxidants at lower
levels of intensity may be more effective than a single micronutrient at higher doses.13 Additionally, oxidative insult is
not the only risk factor for cognitive impairment and dementia. Inflammatory and other factors may be involved. It is
only by examining and combining all approaches, together
with the practice of advisable health habits and good medical care, that we may be able to increase the likelihood of reducing risks for cognitive decline and dementia.
Conclusions
As age increases, oxidative stress and damage occur,
potentially increasing risk for dementia and AD. It has
been postulated that use of dietary or supplemental antioxidants may reduce the risk of such adverse events. Our examination of a representative community-resident older
population in the southeastern US found that supplemental
intake of vitamins C and/or E did not delay time to dementia
or AD, although use of medical care was associated with delay. Our findings suggest that supplemental vitamin C and/or
E use alone is inadequate to delay dementia or AD.
Gerda G Fillenbaum PhD, Research Professor of Medical Psychology and Research Professor in Nursing, Duke University Medical
Center and Geriatric Research, Education and Clinical Center, Veterans Affairs Medical Center, Durham, NC; Center for the Study of Aging and Human Development, Duke University Medical Center, Durham

www.theannals.com

Maragatha N Kuchibhatla PhD, Assistant Research Professor,

Department of Biostatistics and Bioinformatics, Duke University Medical Center; Center for the Study of Aging and Human Development,
Duke University Medical Center
Joseph T Hanlon PharmD, Visiting Professor, University of Pittsburgh and Center for Health Equity and Promotion, Veterans Affairs
Pittsburgh Health Care Center, Pittsburgh, PA; Department of
Medicine (Geriatrics), University of Pittsburgh
Margaret B Artz PhD, Assistant Professor, Department of Pharmaceutical Care and Health Systems, College of Pharmacy, University of Minnesota, Minneapolis, MN
Carl F Pieper DrPH, Assistant Research Professor, Department of
Biostatistics and Bioinformatics, Duke University Medical Center;
Center for the Study of Aging and Human Development, Duke University Medical Center
Kenneth E Schmader MD, Associate Professor, Duke University
Medical Center and Geriatric Research, Education and Clinical Center, Veterans Affairs Medical Center, Durham; Department of
Medicine, Division of Geriatrics, Duke University Medical Center
Maurice W Dysken MD, Professor, University of Minnesota and
Director, Geriatric Research, Education, and Clinical Center Program, Minneapolis Veterans Affairs Medical Center, Minneapolis
Shelly L Gray PharmD MS BCPS, Associate Professor, Geriatric
Pharmacy Program, School of Pharmacy, University of Washington,
Seattle, WA
Reprints: Dr. Fillenbaum, Center for the Study of Aging and Human Development, Duke University Medical Center, Box 3003,
Durham, NC 27710-3003, fax 919/684-8569, ggf@geri.duke.edu
The data on which this publication is based were obtained pursuant
to contract N01-AG-12102 from the National Institute on Aging in
Support of the Established Populations for Epidemiologic Studies
of the Elderly (Duke), R01-AG12765, and R37-AG08937. The context of this publication does not necessarily reflect the views or policies of the US Department of Health and Human Services.
In addition, authors were supported as follows: Dr. Fillenbaum: National Institute on Aging Research Grants R37-AG08937, 5P60
AG11268 (Claude D Pepper Older Americans Independence Center,
Duke University); Drs. Kuchibhatla, Hanlon, Artz, and Pieper: VFW
Endowed Chair in Pharmacotherapy for the Elderly, College of Pharmacy, University of Minnesota; Dr. Hanlon: National Institute on Aging Research Grants R01-AG15432, R01-AG14158; Dr. Schmader: National Institute of Allergy and Infectious Diseases Grant
K24-AI51324-01; and Dr. Gray: National Institute on Aging Research
Grant K08-AG00808-01.

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EXTRACTO

MTODOS: Se seleccion un subgrupo dentro de la Poblacin Establecida

para Estudios Epidemiolgicos en Ancianos (EPESE) en la Universidad
de Duke, un estudio longitudinal de personas de 65 a 105 aos
representativas de su comunidad que viven en 5 condados adyacentes en
Carolina del Norte, haciendo un seguimiento de la demencia (desde
19861987 hasta junio 2000). La informacin recogida durante las
entrevistas domiciliarias incluy caractersticas sociodemogrficas,
estado de salud, utilizacin de servicios sanitarios, y uso de vitaminas.
El diagnstico de demencia y EA se bas en evaluaciones realizadas
empleando las bateras clnicas y neuro-psicolgicas del Consorcio para
Establecer un Registro de la EA, con determinacin final por consenso
entre especialistas utilizando el DSM-III-R y los criterios NINCDSADRDA.
RESULTADOS: De las 616 personas inicialmente libres de demencia
(media de edad 73 aos; 62% mujeres, 62% Afro-Americanos), 141
desarrollaron demencia, de los cuales 93 EA. La edad avanzada y los
trastornos de movilidad fueron factores de riesgo para la demencia (slo
la edad para la EA), mientras que el aumento del nmero de visitas a los
centros sanitarios redujo la probabilidad de desarrollar demencia. El uso
de vitaminas C y/o E (empleadas por el 8% al inicio del estudio) no se
asoci a una reduccin de la incidencia de demencia o de EA, ni a bajas
ni a altas dosis.
CONCLUSIONES: En esta comunidad del sudeste de US, donde el consumo
de suplementos vitamnicos es bajo, el uso de vitaminas C y/o E no
retras la aparicin de la demencia o la EA.

Juan del Arco

RSUM

Dans la mesure o laugmentation du stress oxydatif peut altrer

les capacits cognitives et tre un facteur de risque de dmence, on sest
intress de savoir si lutilisation dantioxydants pouvait protger contre
de telles atteintes.
OBJECTIF: Dterminer si lutilisation complmentaire des vitamines C
et/ou E dans une population ge ambulatoire de blancs et dAfroamricains retardait lapparition de dmences ou de maladie
dAlzheimer (AD).
MTHODES: Nous avons slectionn un sous-groupe des cohortes de
populations tablies par lUniversit Duke pour les tudes
pidmiologiques chez les personnes ges, tude longitudinale de
personnes reprsentatives de la communaut, ges de 65 105 ans,
vivant dans 5 comts adjacents de Caroline du Nord, et qui sont suivies
pour des tats de dmence (de 19861987 juin 2000). Les
informations recueillies au cours dentretiens domicile comprenaient
des caractristiques sociodmographiques, des donnes sur ltat de
sant, le recours au service de sant et lutilisation de vitamines. Le
diagnostic de dmence et AD a t fait partir dvaluations bases sur
les batteries de tests cliniques et neuropsychologiques du Consortium
pour la tenue du registre pour la maladie dAlzheimer, avec une
dtermination finale sur accord consensuel de spcialistes laide des
critres DSM III-R et NINCDSADRDA.
RESULTATS: Sur 616 personnes, au dpart exemptes de dmence (ge
moyen 73 ans; 62% de femmes; 62% dAfro-amricains), 141 ont
dvelopp une dmence, dont 93 une AD. Le vieillissement et les
problmes de mobilit taient des facteurs de risque de dmence
(seulement lge pour AD), tandis quune frquentation accrue du
service de sant rduisait la probabilit de dvelopper une dmence. Ni
lemploi de vitamine C et/ou E (utilises par 8% des personnes au
dpart), ni la consommation de doses leves, ne modifiaient le dlai
dapparition de dmence ou AD.
CONCLUSIONS: Dans cette communaut du Sud-est des USA, o lemploi
de supplments vitaminiques est faible, lutilisation de vitamines C et/ou
E na pas retard lincidence de dmence ou AD.
RAPPEL:

Dado que el incremento del estrs oxidativo puede

dificultar la cognicin y ser un factor de riesgo para la demencia, existe
un inters en determinar hasta que punto el uso de antioxidantes puede
proteger frente a estos trastornos.
OBJETIVO: Averiguar hasta que punto el uso de suplementos de vitamina C
y/o E ha retrasado la aparicin de demencia o enfermedad de Alzheimer
(EA) en una muestra poblacional de ancianos blancos y afro-americanos.
INTRODUCCIN:

2014

The Annals of Pharmacotherapy

2005 December, Volume 39

Michel Le Duff

www.theannals.com