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To the Editor: The randomized trial by Dr Aisen and colleagues¹ evaluating the use of high-dose B vitamins in patients with AD suggested that there is no cognitive benefit from such a treatment approach. Although this study provides some assistance in selection of potential combination therapies, several questions arise.

Prior studies have shown a relationship between low cerebrospinal fluid folate levels in patients with AD compared with normal controls. Low levels of L-methyl folate and methyl B₁₂ have correlated with increased risk of cognitive impairment.² It is possible that the patients in the study by Aisen et al were too advanced beyond a potential time window for benefit from B vitamin intervention to see a beneficial result.

The article suggests studying efficacy for mild cognitive impairment. Alternatively, consider the deleterious effect of high-dose oral folate (5 mg daily) on cerebrospinal fluid folate levels. At doses of 400 µg and above, . . . [Full Text of this Article]

Bennett I. Machanic, MD
bimachanic@aol.com
Department of Neurology
University of Colorado
Denver

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