Omega-3 supplementation in mild to moderate Alzheimer's disease: effects on neuropsychiatric symptoms

• Published in: International journal of geriatric psychiatry 2008-02, Vol.23 (2), p.161-169
• Main Authors: Freund-Levi, Yvonne, Basun, Hans, Cederholm, Tommy, Faxén-Irving, Gerd, Garlind, Anita, Grut, Mikaela, Vedin, Inger, Palmblad, Jan, Wahlund, Lars-Olof, Eriksdotter-Jönhagen, Maria
• Format: Article
• Language: English
• Subjects: Activities of Daily Living; Aged; Agitation; Alzheimer Disease - drug therapy; Alzheimer Disease - genetics; Alzheimer Disease - psychology; Alzheimer's disease; Analysis of Variance; APOE; Apolipoproteins E - genetics; Biological and medical sciences; Cholinesterase Inhibitors - therapeutic use; Degenerative and inherited degenerative diseases of the nervous system. Leukodystrophies. Prion diseases; Dementia; Depression; Depression - drug therapy; DHA; Dietary Supplements; Double-Blind Method; Effects; EPA; Fatty acids; Fatty Acids, Omega-3 - therapeutic use; Female; Fundamental and applied biological sciences. Psychology; Galantamine - therapeutic use; Genotype; Geriatric psychiatry; Geriatrics; Humans; Indans - therapeutic use; Male; Medical sciences; MEDICIN; Medicin och hälsovetenskap; MEDICINE; Mental depression; Neurology; Neuropsychiatric; Omega-3; Phenylcarbamates - therapeutic use; Piperidines - therapeutic use; Psychiatric Status Rating Scales; Psychoanalysis; Psychology. Psychoanalysis. Psychiatry; Psychopathology. Psychiatry; Rivastigmine; Statistics, Nonparametric; Treatment Outcome
• ISSN: 0885-6230; 1099-1166; 1099-1166
• DOI: 10.1002/gps.1857

Background Epidemiological and animal studies have suggested that dietary fish or fish oil rich in omega‐3 fatty acids (ω3), docosahexaenoic acid (DHA) and eicosapentaenoic acid (EPA), may have effects in psychiatric and behavioral symptoms in Alzheimer's disease (AD). An association with APOEω4 carriers and neuropsychiatric symptoms in AD has also been suggested. Objective To determine effects of dietary ω3 supplementation to AD patients with mild to moderate disease on psychiatric and behavioral symptoms, daily functions and a possible relation to APOEgenotype. Methods Randomized, double‐blind, placebo‐controlled clinical trial where 204 AD patients (74 ± 9 years) with acetylcholine esterase inhibitor treatment and a MMSE >15 points were randomized to daily intake of 1.7 g DHA and 0.6 g EPA (ω3 group) or placebo for 6 months. Then, all received the ω3 supplementation for 6 more months. Neuropsychiatric symptoms were measured with Neuropsychiatric Inventory (NPI) and Montgomery Åsberg Depression Scale (MADRS). Caregivers burden and activities of daily living (Disability Assessment for Dementia, DAD) were also assessed. Results One hundred and seventy‐four patients fulfilled the trial. 72% were APOEω4 carriers. No significant overall treatment effects on neuropsychiatric symptoms, on activities of daily living or on caregiver's burden were found. However, significant positive treatment effects on the scores in the NPI agitation domain in APOEω4 carriers (p = 0.006) and in MADRS scores in non‐APOEω4 carriers (p = 0.005) were found. Conclusions Supplementation with ω3 in patients with mild to moderate AD did not result in marked effects on neuropsychiatric symptoms except for possible positive effects on depressive symptoms (assessed by MADRS) in non‐APOEω4 carriers and agitation symptoms (assessed by NPI) in APOEω4 carriers. ClinicalTrials.gov identifier: NCT00211159 Copyright © 2007 John Wiley & Sons, Ltd.