Early Intervention With Nutrient Supplementation May Be Beneficial to Patients with Alzheimer Disease

Alzheimer disease (AD) is the leading neurodegenerative disease among the aging population and a growing health challenge. The development of the disease is believed to involve various mechanisms such as oxidative stress, excitotoxicity, inflammation, cell death, genetic factors, protein accumulation, and degradation, though this is still undetermined.

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Although there is not currently a cure for AD, there are FDA-approved drugs including donepezil, galantamine, rivastigmine, memantine, and donepezil plus memantine to help treat cognitive symptoms with the intention of preventing progression. Further, aducanumab is approved by the FDA to help treat mild cognitive impairment and mild dementia stages of AD.

In a study published in Cureus, investigators explored previous research on nutrient supplementation and AD. The analysis included clinical trials and randomized controlled trials that studied adults aged ≥ 19 years, whereas articles without a diagnosis of AD and negative outcomes were not taken into consideration.

A previous study examined the efficacy of the combination of phosphatidylserine (PS) and phosphatidic acid (PA) with placebo in participants with AD. The researchers found individuals receiving PS+PA treatment showed improvement in the Wechsler Memory Scale (WMS) and List of Depression symptoms scale. Functioning elderly who had scored higher on the WMS scale showed more significant memory improvements during the trial compared to their counterparts and those on placebo, indicating early intervention with these supplements is necessary in AD pathology, according to the investigators.

Further, another study conducted a trial of a nutraceutical formulation (NF) for individuals with AD to examine the benefits of early nutritional interventions. NF consisted of a combination of folate, alpha-tocopherol, vitamin B12, S-adenosyl methionine, N-acetylcysteine, and acetyl-L-carnitine. Patients either received NF or a placebo over the course of the study.

The investigators found that patients who received NF intervention showed significant improvement in cognitive performance (scored on the Clox-1 and Dementia Rating Scale-2) within 3 months, with a 1.86-fold improvement in total Neuropsychiatric Inventory scores; however, the impact was more significant on those with mild or moderate dementia and earlier stages of AD than those with severe dementia.

Following these findings, an open-label extension trial with 24 participants with AD took place. Although there weren’t significant improvements in cognitive performance during this extension trial, there were not any drastic decreases presented. These findings further emphasize that early intervention with nutritional supplements may be beneficial to patients with AD.

Each of the referenced studies had indicated improvements in self-reported or physician-tested measures of AD severity, establishing the benefit of supplementation. Some supplements are used in combination with anticholinesterase inhibitors, which show a favorable role. Because of the diversity of purification, marketing, and labeling standards for supplements and nutraceuticals depending on the country or provider, it is necessary that more uniform standards are adopted to improve the quality and safety of these supplements, according to the authors of the current study.

Some of the studies analyzed by investigators were limited by a small sample size and exclusion of comorbid conditions, and future studies should incorporate a larger, more diverse sample population. Further, longitudinal studies with individuals in different stages of AD should be included to better examine the role of these supplements in improving clinical outcomes.

Although evidence shows there are improvements in older adults with AD when intervening early, there is a lack of research on nutrient supplementation and whether that may delay the onset or progression of AD risk factors in healthy young adults with a family history of the disease. The current study authors note that research on the potential for long-term systemic toxicity of those supplements in addition to their interactions with other AD treatments should be conducted to identify potential drug-drug interactions, allowing for more accurate, rational prescribing.

Reference

Chimakurthy A, Lingam S, Reddy S, Copeland B. A Systematic Review of Dietary Supplements in Alzheimer’s Disease. Cureus. doi:10.7759/cureus.33982