June 20, 2018

expert reaction to study investigating nutritional compounds and Alzheimer’s disease

A new study, published in the Journal of Alzheimer’s Disease, reports positive outcomes for patients with Alzheimer’s who consumed a combination of nutritional compounds, but highlight that further study is required.

Dr James Pickett, Head of Research at Alzheimer’s Society, said:

“This early stage research raises interesting questions about whether specific supplements could help people with the disease but does not provide the answers. Only a handful of people with Alzheimer ’s disease were involved and the trial lacked important checks and balances. For example, there wasn’t a suitable placebo group, the researchers who carried out assessments knew who was taking the supplement, and the way changes in symptoms were measured is unclear.

“Researchers are undertaking a further study which will address these limitations – but until we have more convincing evidence we can’t say that these supplements have the potential to help people with Alzheimer ’s disease

“Like all causes of dementia, Alzheimer’s is a devastating disease and with no way to prevent, cure or even slow it down, it’s vital we pursue every avenue to stop it in its tracks – that’s why we’re continuing to increase our funding for research.”

Prof Naveed Sattar, Professor of Metabolic Medicine, University of Glasgow, said:

“Whilst any research in Alzheimer’s disease is to be welcomed, this is too small a trial and lacks a placebo control so that its findings are highly unlikely to true.  In fact I would place no reliance on these results, especially since we know little effect of fish oils or carotenoid supplements on other outcomes in proper trials.”

Prof Robert Howard, Professor of Old Age Psychiatry, UCL, said:

“Demonstration of disease course modification in Alzheimer’s disease is something that everyone in our field would celebrate. Recent high profile clinical trial failures have shown that we are probably still many years away from having treatments or interventions that can slow or stop progression.

“This report is sadly not much more than low-grade anecdotal evidence. Certainly, it falls seriously short of the standards of a high quality clinical trial in terms of scale and conduct.

“The accompanying claims made by Dr Howard seem irresponsible and completely unsupported by any reasonable reading of his data. Sadly, people with dementia and their carers will grasp at any straw and I would worry about the impact of media reports around what seem either naive or deeply cynical attempts to exploit this.”

Dr David Reynolds, Chief Scientific Officer at Alzheimer’s Research UK, said:

“This research involved nutrients known as xanthophylls, which can be found in food like eggs, leafy vegetables and fish, and have previously been linked to the eye health. In this small study, the researchers found that people with Alzheimer’s seemed to have higher levels of this nutrient in the blood when xanthophyll supplements were taken together with fish oil.

“The experimental design of this study makes it hard to draw meaningful conclusions about the effect of these supplements on the symptoms of Alzheimer’s. The subjective endpoints and the very small number of people with Alzheimer’s involved in this research, means that any claims about the significance of these findings should be met with caution.

“Current evidence suggests that a balanced diet as part of a healthy lifestyle can help to keep our brains healthy as we age, and it is important that well-conducted trials continue to explore the link between diet and dementia risk. Alzheimer’s Research UK is currently funding a trial to see if omega-3 fish oil could support memory and thinking skills as part of a study involving around 10,000 people at increased risk of dementia.”

Prof Tara Spires-Jones, Deputy Director of the Centre for Discovery Brain Sciences at the University of Edinburgh, said

“This paper from Dr Nolan and colleagues did not have enough people in the study to answer the question about whether their dietary supplement was useful in Alzheimer’s disease. As the authors point out in the paper, this was a preliminary study.  Healthy diet and lifestyle are strongly implicated as protective and likely to reduce risk of developing Alzheimer’s disease; however, specific dietary or lifestyle interventions have not so far been shown to improve outcomes for people who already have the disease.”

Dr Sujoy Mukherjee , Consultant Psychiatrist (Old Age), West London MH NHS Trust, said:

“This is an interesting study that adds to the growing body of evidence about the importance of nutrition to our brain health. However, there is limited evidence of such intervention in established Alzheimer’s disease (AD). One key problem in this study is a lack of details how the diagnosis of AD was confirmed in the patients participating in trial. Also, the absence of objective cognitive and functional assessment in the follow up renders the findings relatively subjective and anecdotal. It is also not clear whether the assessor was blind to the two different interventions. Also, while the group with combination nutrient (trial 2) had no dropouts and relatively more improvement, 7/13 patients in that group reported no improvement ( page 373).

“The key finding that a combination of nutrients is superior to an individual one is important and another such product is available in the UK and globally for dietary management of early Alzheimer’s disease. There is certainly a need to conduct large scale research in the role of nutritional supplements in both prevention and management of AD.”

Prof Clive Ballard, Professor of Age-Related Diseases, University of Exeter Medical School, said:

“This is a potentially promising  treatment approach using a nutritional compound. The trial presented is however very small, and it would be almost infeasible to have significant benefits due to treatment  effect in a study of this size.  It is excellent that this is moving forward to further trials, but I think we need to be very cautious about being over optimistic on the basis of a small pilot study.”

* ‘Nutritional Intervention to Prevent Alzheimer’s Disease: Potential Benefits of Xanthophyll Carotenoids and Omega-3 Fatty Acids Combined’ by Nolan et al. was published in the Journal of Alzheimer’s Disease

Declared interests

Prof Rob Howard: “I have received grant support from MRC, NIHR and Alzheimer’s Society to conduct clinical trials in dementia and am a Trustee of Alzheimer’s Research UK.”

Dr David Reynolds: No conflicts of interest

Dr Sujoy Mukherjee: I have received sponsorship to attend educational events/ conference by Nutricia ( manufacturer of Souvenaid, a product for dietary management of Alzheimer’s Disease).

None others received