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Vitamin and herbal extracts use in patients diagnosed with dementia: What do health
professionals know and think?
Naji Tabetab*, Rummana Khanb and Helen Idleb
a
Institute of Postgraduate Medicine, Brighton and Sussex Medical School, University of Brighton,
Mayfield House, Falmer, Brighton BN1 9PH, UK; bCognitive Treatment and Research Unit,
Sussex Partnership NHS Foundation Trust, Brighton, Sussex, UK
(Received 13 January 2010; final version received 28 June 2010)
Objectives: Vitamins and herbal extracts are associated with various side effects, potential serious drug
interactions and mostly unproven efficacy. Yet, research has shown that nearly half of dementia patients are
receiving such medication. Health professionals caring for older people with dementia are central to the safe
management of this practice. Therefore, the aim of this study was to assess the views, knowledge and practices of
professionals in relation to this issue. Such information is essential to identify potential problems and to inform
targeted intervention strategies.
Method: Cross-sectional survey carried out across East Sussex in the UK based on a self-administered postal
questionnaire.
Results: Out of 350 questionnaires sent, 200 responded (57%). Health professionals greatly underestimated the
prevalence of over-the-counter medication use (68% believed that less than 10% of patients receive such
medication) when compared to published data. A considerable minority (38.7%) reported that vitamins and
herbal extracts should be recommended for individuals at risk of developing dementia, despite lack of evidence to
support such use. Further, only 24.4% always or often discussed potential side effects/interactions of these
supplements with their patients.
Conclusion: The views and practices of many health professionals are inconsistent with current best practice.
Many professionals do not appear to enquire routinely about non-prescribed medicinal products and adequate
advice may not be given to patients/carers. The data highlights a significant issue and calls for urgent action
through targeted educational interventions directed not only at dementia patients and their carers, but at health
professionals as well.
Keywords: Alzheimer; dementia; over-the-counter medication; older people; vitamins; herbal extracts
Introduction
Dementia disorders are very common among older
people worldwide and their prevalence is expected to
increase further over the next few decades (Kalaria
et al., 2008). Currently, there is no available cure
although several drugs have been licensed for the
symptomatic treatment of Alzheimers disease (AD)
and other dementias (Emre, Cummings, & Lane, 2007;
Farlow, Miller, & Pejovic, 2008). As a result of the lack
of a curative treatment, a variety of alternative therapies have been used to aid in the management of these
disorders (Gray et al., 2008; Kelley & Knopman, 2008).
In many instances, the proposed therapies have not
been based on evidence-based data established through
randomised controlled trials (RCTs). Nevertheless, in
the recent years there has been a worldwide increased
interest in a variety of vitamins, herbal extracts and
other over-the-counter agents for dementia disorders
and for a host of human ailments. Many of these have
been used in response to the live longer and healthier
messages which associated these substances with health,
longevity and improved memory.
Available evidence supporting a role for vitamins
and herbal extracts in dementia has for the most part
*Corresponding author. Email: n.t.tabet@brighton.ac.uk
ISSN 13607863 print/ISSN 13646915 online
2011 Taylor & Francis
DOI: 10.1080/13607863.2010.513040
http://www.informaworld.com
been based on case reports, observational studies, nonRCTs or very small single-centre RCTs. However,
enthusiasm for the use of these agents in dementia or in
the prevention of cognitive decline has not been
supported by recent studies and systematic reviews
(Birks & Grimley Evans, 2007; Dodge, Zitzelberger,
Oken, Howieson, & Kaye, 2008; Isaac, Quinn, &
Tabet, 2008; Tabet, Birks, & Grimley Evans, 2000).
Further, many of these agents may be associated with
significant side effects (Bjelakovic, Nikolova, Gluud,
Simonetti, & Gluud, 2007; Dodge et al., 2008).
Despite the lack of clear evidence and the potential
for serious side effects, several vitamins and herbal
extracts have been widely used among older people with
dementia. Studies in some countries have already shown
that nearly half of all patients with dementia may be
receiving alternative therapy including a variety of
vitamins and herbal extracts (Coleman, Fowler, &
Williams, 1995; Hogan & Elby, 1996; Landin,
Frolich, & Schwarz, 2008). Health professionals
caring for older people with dementia are best placed
to safely manage such a practice. However, their views
and knowledge have not been clearly established in
relation to the use of over-the-counter medication
268
N. Tabet et al.
Methods
The study was carried out across East Sussex, in the
United Kingdom. Health professionals eligible to take
part in the study practiced in East Sussex and were
from professions with responsibility of care for older
people with dementia. These included general practitioners, old age psychiatrists and older people mental
health nurses. Health professionals were sent an
invitation letter, a self-administered questionnaire
and a self-addressed and stamped envelope.
Professionals who did not return the questionnaire
were not sent a subsequent reminder.
The self-administered questionnaire was specifically designed to examine the knowledge and practices
of health professionals. The questionnaire was piloted
among a small group of professionals. The questionnaire comprised of a combination of close-ended and
Likert scale-type questions. The aim was to elicit as
much as possible information about participants
views, knowledge and practice in relation to the use
of vitamins and herbal extracts among people diagnosed with dementia. The chi-square test was used to
statistically assess differences between the responses of
doctors and nurses. The study was approved by the
local research Ethics Committee and the Trust
Research and Development Department.
Results
Three hundred and fifty questionnaires were sent to
health professionals and 200 responded (response rate
of 57%). Responding professionals included 129
doctors and 71 nurses. Out of all responding professionals, 42.9% (n 85) personally believed in the use of
vitamins and herbal extracts for dementia patients
while the rest did not believe in their use or were
unsure. Professionals greatly underestimated the
number of patients taking vitamins and herbal extracts
(Figure 1) when compared to available evidence on the
issue from several previous publications. The majority
45
40
35
30
25
20
15
10
5
0
<5%
510%
1130%
3150%
>50%
Discussion
Health professionals in this study appear to greatly
underestimate the percentage of patients receiving
over-the-counter medication. To date, research has
consistently shown that nearly half of all dementia
patients receive such therapy. This clearly supports the
prevailing view that professionals are not actively
seeking such information from patients and their carers
during consultations. This result is in line with those
reported earlier about health professionals rarely
asking patients about the use of complementary and
alternative therapies (Brown et al., 2007). This apparent lack of communication with patients and carers
about the use of over-the-counter substances may carry
identifiable risk especially in view of the recognised
side effects and drug interactions associated with these
agents. It is also likely that many patients do not
volunteer information about their use of over-thecounter medication to their health professionals. One
reason for this may be that many patients and carers
do not associate over-the-counter substances with
medicinal drugs. Others may totally depend on nonmedical sources for information about alternative
medicine. It is suspected that people place a great
emphasis on media reports as a primary source of
information in relation to alternative medicinal products. The overall positive coverage in the mass media
about some alternative treatments is, in part at least,
related to the relative lack of reporting on issues such
as safety and side effects (Weeks & Strudsholm, 2008).
The last few years have witnessed an increase in the
use of alternative medicine across age groups and
269
Strongly
agree
Agree
Neither agree
nor disagree
Disagree
Strongly
disagree
9.1 (18)
47.5 (95)
26.3 (53)
17.2 (34)
2.6 (5)
13.9 (28)
68.6 (137)
12.9 (26)
2.1 (4)
8.8 (18)
42.0 (84)
43.5 (87)
4.7 (9)
1.0 (2)
7.1 (14)
31.6 (63)
51.0 (102)
8.3 (17)
2.0 (4)
7.1 (14)
40.9 (82)
41.9 (84)
8.6 (17)
1.5 (3)
7.6 (15)
41.4 (83)
46.5 (93)
3.5 (7)
1.0 (2)
2.0 (4)
26.4 (53)
48.7 (97)
17.3 (35)
5.6 (11)
Note: Data represents the percentage as well as the actual number of professionals (in parentheses).
Table 2. Vitamins and herbal extracts are helpful in which of the following according to the 200 professionals who
responded to the questionnaires.
Strongly
agree
Alzheimers dementia
Vascular dementia
Dementia with Lewy bodies
Frontotemporal dementia
2
29.1
16.3
15.8
(4)
(58)
(33)
(32)
Neither agree
nor disagree
Agree
33.3
56.6
74.5
74.5
(67)
(113)
(149)
(149)
56.6
12.8
8.2
8.7
(113)
(26)
(16)
(17)
Disagree
7.1
1.5
1
1
(14)
(3)
(2)
(2)
Strongly
disagree
1 (2)
0
0
0
Note: Data represent the percentage as well as the actual number of professionals (in parentheses).
270
N. Tabet et al.
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271
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