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To the Editor: The randomized controlled trial by Dr Aisen and colleagues¹ provided evidence that treatment with high-dose B vitamin supplements for 18 months does not slow cognitive decline in individuals with mild to moderate Alzheimer disease (AD). The rationale behind the study was that hyperhomocysteinemia (levels of homocysteine >15 µmol/L) is associated with a higher risk of dementia and AD^2-3 and that homocysteine levels can be reduced by use of high-dose B vitamins and folate. Thus, the study was designed to determine in patients with AD whether a regimen of high-dose B vitamins and folate would slow their cognitive decline by reducing homocysteine levels. However, despite a 20% to 25% reduction in homocysteine level and an increase in B vitamin and folate levels associated with the active treatment, the trial found no effect.

While the reasons for these findings remain unclear, there are 2 important considerations that need to . . . [Full Text of this Article]

Domenico Pratico, MD
praticod@temple.edu
Department of Pharmacology
Temple University
Philadelphia, Pennsylvania

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