Ask the Doctor: Vitamin E & AD; Blood Pressure & Stroke; Insomnia & Alcohol

Find if vitamin E can slow the advance of Alzheimer's disease.

Q: Is it true that vitamin E can slow the advance of Alzheimer’s disease?

A: A recent study has associated high daily doses of vitamin E with significantly slower progression of Alzheimer’s disease (AD), although the findings do not suggest that the vitamin is a cure. The research, which was published in the Dec. 31, 2013 issue of the Journal of the American Medical Association, involved 600 patients at VA medical centers who had been diagnosed with mild to moderate AD. The participants were divided into four groups, one of which received 2,000 international units of alpha tocopherol, a form of vitamin E. Other participants received vitamin E plus the AD drug memantine, memantine alone, or an inactive placebo. After a little more than two years, the participants who took large doses of vitamin E experienced a 19 percent reduction in their annual rate of decline compared to placebo, with no unwanted side effects—the equivalent of a delay of more than six months in disease progression. Participants who received other treatments experienced no significant benefits, the study found.

The findings suggest that vitamin E might be a helpful treatment for people with AD, and warrant further research. However, I don’t advise vitamin E supplementation for AD without the supervision of a medical professional, since large doses of vitamin E might interact with other medications, including blood thinners and cholesterol medications.

Q: My blood pressure levels swing wildly despite my medications. Could my high blood pressure levels lead to a stroke?

A: Some blood pressure variability is normal, but dramatic fluctuations that continue for weeks or months should be professionally assessed and treated, as they may increase risk for mini-stroke, ischemic stroke, and negative effects on brain function. Your doctor will first verify your blood pressure measurements. If these are accurate, 24-hour ambulatory monitoring will likely be recommended o determine the pattern of blood pressure variability and possible causes. Your doctor may suggest changing medications (calcium channel blockers, for example, appear to help smooth out the highs and lows of blood pressure variability), or spreading out dosages over the course of the day. A thorough medical assessment should also aim at ruling out health problems such as obstructive sleep apnea, kidney disease, or tumors of the adrenal gland, all of which may be associated with blood pressure variability.

Q: I have been having trouble with insomnia, and my doctor suggests that I consider forgoing my nightly cocktail hour. Isn’t it true that a few drinks can help improve sleep?

A: While initially alcohol consumption may be associated with feelings of relaxation and drowsiness, and perhaps help individuals fall asleep more quickly, research suggests that later on in the night it disrupts sleep, and the more alcohol consumed, the greater the disruption. According to a review of 27 studies on sleep and alcohol published in the April 2013 issue of Alcholism: Clinical & Experimental Research, alcohol consumption can interfere with the restorative rapid eye movement (REM) stage of sleep stage that begins about an hour and a half after an individual falls asleep, and lead to poorer sleep quality and periods of wakefulness. The depressive effects of alcohol may also cause or exacerbate sleep disorders such as sleep apnea, in which the individual experiences brief halts in breathing that can interrupt sleep. The effects of alcohol on sleep quality may also show up the following day with symptoms such as drowsiness, poor concentration, and memory problems.

—Dr. Maurizio Fava, MD

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