At 03:22  24/04/97 -0400, Margie Nestler wrote:
>HI ALL- In today's Pittsburgh Post Gazette Washington- High doses of
Vitamin E may slow the deterioration of some patients suffering with
Alzheimer's disease,..It also found selegiline, a commonly prescribed
medicine for Parkinson's disease under the brand name Eldepryl, was
virtually as effetive as the vitamin.<

Hi Margie,
I caught the tail end of a report re the above on TV last night. Did they
say that the two (vitamin E and seligilene) should not be taken together?

Judith
------------------------

Hello Judith, et al --
The Reuters article states: "But the combination of the drugs showed less of
an effect, with a delay of only 145 days." This is certainly an interesting
finding given the previous studies'
results that were done using Eldepryl & Vit. E with Parkinson's subjects.
Margaret


Thursday April 24 1:26 PM EDT

Treatments Slow Alzheimer's Progression

NEW YORK (Reuters) -- Two drug treatments may help slow the progression of
Alzheimer's disease, researchers say.

Taken separately, either selegiline (Eldepryl) or a high daily dose of
vitamin E (alpha-tocopherol) slowed deterioration in the ability to perform
basic daily tasks -- such as bathing, dressing, and handling money -- by
about 25%. People with moderately severe Alzheimer's disease taking the
drugs were able to delay entering nursing homes by about seven months.

"We looked at the signs and symptoms of Alzheimer's disease that can worsen
over time and found that in patients taking these drugs, these signs
occurred later," says Dr. Mary Sano, lead study author and associate
professor of clinical neuropsychology at Columbia University in New York City.

However, the researchers found no improvement in cognitive function -- that
is, memory, attention, language, and comprehension -- in any of the treated
patients.

The study, published in this week's issue of The New England Journal of
Medicine, examined the effects of the two drugs in 341 patients with
severely moderate Alzheimer's disease. Participants were divided into four
groups, each group received a different drug regimen: either 10 milligrams
of selegiline per day; 2,000 IU (international units) of vitamin E per day;
a combination of both drugs; or placebo (inactive) pills.

All patients were evaluated every three months for two years with particular
attention paid to four important milestones of disease progression -- loss
of the ability to perform basic daily activities, progression to severe
dementia, institutionalization, and death.

A significant delay in the onset of these Alzheimer's milestones was found
after treatment with either drug. With selegiline, compared to placebo, it
took 215 days longer to reach any of the four milestones. With vitamin E,
the delay was about 230 days. But the combination of the drugs showed less
of an effect, with a delay of only 145 days.

Looking at the milestones separately, the treatment groups did somewhat
better in most categories than the placebo group. However, the findings were
not statistically significant -- that is, they could have happened by chance
-- except for a 13% reduction in nursing home entry among people taking
vitamin E.

But when it came to everyday activities, people in the three treatment
groups showed a 25% slower deterioration in abilities such as eating,
dressing, or cooking.

But the treatment had a downside. "Falls and syncope (fainting) were more
frequent in the treatment groups." write the researchers. "However, these
events did not lead to the discontinuation of treatment, and we conclude
that each agent alone may be relatively well tolerated by patients with
Alzheimer's disease."

According to the researchers, the study results suggest that the effects of
the drugs in delaying disease milestones may be due to their antioxidant
properties leading to improvements in general health. Both selegiline and
vitamin E may work to maintain health by fighting oxidative damage in heart
and blood vessel tissue cells, and by improving immune system functioning.

"This study reinforces the thinking that oxidative damage plays a role in
Alzheimer's disease, and we are actively pursuing this line of research,"
says Dr. Neil Buckholtz, acting chief of the dementias of aging branch at
the National Institute on Aging in Bethesda,
Maryland.

But the researchers note that additional studies are needed to establish the
usefulness of these drugs in the long-term management of Alzheimer's
disease. They caution that "little is known about the efficacy of these
compounds in other patients, such as those with mild cognitive impairment,
early dementia, or the very late stages of Alzheimer's disease."

Commenting on the two-year study, which is the longest so far for testing
drugs that might slow progression of Alzheimer's, Department of Health and
Human Services Secretary Donna E. Shalala is somewhat more optimistic. She
says the findings are "very good news. Each piece of the Alzheimer's disease
puzzle that falls into place moves us one step closer to relieving the
burden of this
devastating disease."

Both selegiline (a drug widely used to treat Parkinson's disease) and
vitamin E are available in the U.S.

Experts at the National Institutes of Health caution that selegiline has
potential side-effects, and can interfere with the action of other drugs.
And the dose of vitamin E used in this study was much greater than that
usually taken on a daily basis. Large doses of the vitamin can cause
bleeding in some people. They advise Alzheimer's disease patients and their
families to consult with their doctors about drug therapy.

SOURCE: The New England Journal of Medicine (1997;336:1216-1222)

Margaret Tuchman (55yrs, Dx 1980)- NJ-08540
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