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Witamina E w otępieniu typu Alzheimera i łagodnych zaburzeniach poznawczych

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Appendices

Appendix 1. Source, search strategy and hits retrieved: June 2012 search

Source

Search strategy

Hits received

1. ALOIS (www.medicine.ox.ac.uk/alois)

Advanced search: [Study design: RCT OR CCT] AND [Health condition: Alzheimer OR MCI] AND [Intervention: "vitamin E"] (all dates)

Jun 2012: 39 (all dates)

2. MEDLINE In‐process and other non‐indexed citations and MEDLINE 1950 to present (OvidSP)

1. *Vitamin E/

2. "vitamin E".ti,ab.

3. "alpha‐tocopherol".ti,ab.

4. or/1‐3

5. Alzheimer*.ti,ab.

6. Alzheimer Disease/

7. AD.ti,ab.

8. "cognit* impair*".ti,ab.

9. MCI.ti,ab.

10. (AACI or memory or CIND or ARCD or ACMI).ti,ab.

11. ("N‐MCI" or "A‐MCI" or "M‐MCI").ti,ab.

12. (nMCI or aMCI or mMCI).ti,ab.

13. (CDR adj2 "0.5").ab.

14. or/5‐13

15. 4 and 14

16. randomized controlled trial.pt.

17. controlled clinical trial.pt.

18. randomi?ed.ab.

19. placebo.ab.

20. drug therapy.fs.

21. randomly.ab.

22. trial.ab.

23. groups.ab.

24. or/16‐23

25. (animals not (humans and animals)).sh.

26. 24 not 25

27. 15 and 26

Jun 2012: 16

3. EMBASE

1980 to 2011 week 27 (OvidSP)

1. *Vitamin E/

2. "vitamin E".ti,ab.

3. "alpha‐tocopherol".ti,ab.

4. or/1‐3

5. Alzheimer*.ti,ab.

6. Alzheimer Disease/

7. AD.ti,ab.

8. "cognit* impair*".ti,ab.

9. MCI.ti,ab.

10. (AACI or memory or CIND or ARCD or ACMI).ti,ab.

11. ("N‐MCI" or "A‐MCI" or "M‐MCI").ti,ab.

12. (nMCI or aMCI or mMCI).ti,ab.

13. (CDR adj2 "0.5").ab.

14. or/5‐13

15. 4 and 14

16. randomi?ed.ab.

17. placebo.ab.

19. trial.ab.

20. groups.ab.

21. randomized controlled trial/

22. controlled clinical trial/

23. ("double‐blind*" or "single‐blind*").ti,ab.

24. or/16‐23

25. 15 to 24

Jun 2012: 28

4. PsycINFO

1806 to July week 2 2011 (OvidSP)

1. "vitamin E".ti,ab.

2. "alpha‐tocopherol".ti,ab.

3. Alzheimer*.ti,ab.

4. Alzheimer Disease/

5. AD.ti,ab.

6. "cognit* impair*".ti,ab.

7. MCI.ti,ab.

8. (AACI or memory or CIND or ARCD or ACMI).ti,ab.

9. ("N‐MCI" or "A‐MCI" or "M‐MCI").ti,ab.

10. (nMCI or aMCI or mMCI).ti,ab.

11. (CDR adj2 "0.5").ab.

12. randomi?ed.ab.

13. placebo.ab.

14. randomly.ab.

15. trial.ab.

16. groups.ab.

17. ("double‐blind*" or "single‐blind*").ti,ab.

18. Clinical Trials/

19. 1 or 2

20. or/3‐11

21. or/12‐18

22. 19 and 20 and 21

Jun 2012: 6

5. CINAHL (EBSCOhost)

S1 (MM "Vitamin E") 

S2 TX "vitamin E"

S3 TX "alpha‐tocopherol"

S4 S1 or S2 or S3 

S5 (MH "Alzheimer's Disease")

S6 TX AD OR alzheimer* 

S7 "mild cognitive impairment"

S8 TX "cognit* impair*" 

S9 TX AACI OR memory OR CIND OR ARCD OR ACMI 

S10 TX MCI 

S11 TX nMCI OR aMCI OR mMCI 

S12 S5 or S6 or S7 or S8 or S9 or S10 or S11 

S13 S4 and S12 

S14 TX random*

S15 TX placebo*

S16 TX trial 

S17 TX groups 

S18 TX RCT OR CCT 

S19 (MH "Randomized Controlled Trials") 

S20 S14 or S15 or S16 or S17 or S18 or S19

S21 S13 and S20 

S22 EM 2009 

S23 EM 2010 

S24 EM 2011 

S25 S22 or S23 or S24 

S26 S21 and S25 

Jun 2012: 6

6. ISI Web of Knowledge – all databases [includes: Web of Science (1945 to present); BIOSIS Previews (1926 to present); MEDLINE (1950 to present); Journal Citation Reports]

#1 Topic=(alzheimer* OR AD OR MCI OR memory OR cognitive OR "cognit* impair*") AND Topic=("vitamin e" OR "alpha‐tocopherol") AND Year Published=(2009‐2011)

Timespan=All Years

#2 Topic=(random* OR placebo* OR "double‐blind*" OR "single‐blind*")

Timespan=All Years

#3 #2 AND #1

Timespan=All Years

Jun 2012: 174

7. LILACS (BIREME)

vitamin‐e OR alpha‐tocopherol

Jun 2012: 0

8. CENTRAL (the Cochrane Library) (Issue 4 of 4, Oct 2010)

#1 “vitamin e”

#2 “alpha‐tocopherol”

#3 (#1 OR #2)

#4 MeSH descriptor Vitamin E, this term only

#5 (#3 OR #4)

#6 alzheimer* OR AD OR “cognit* impair*” OR MCI

#7 (#5 AND #6), from 2011 to 2012

Jun 2012: 9

9. Clinicaltrials.gov (www.clinicaltrials.gov)

Interventional Studies | alzheimer OR alzheimer's OR alzheimers OR MCI OR cognitive OR cognition OR memory | vitamin E OR alpha‐tocopherol | received from 01/01/2011 to 07/15/2012

Jun 2012: 2

10. ICTRP Search Portal (apps.who.int/trialsearch) (includes: Australian New Zealand Clinical Trials Registry; ClinicalTrilas.gov; ISRCTN; Chinese Clinical Trial Registry; Clinical Trials Registry – India; Clinical Research Information Service – Republic of Korea; German Clinical Trials Register; Iranian Registry of Clinical Trials; Japan Primary Registries Network; Pan African Clinical Trial Registry; Sri Lanka Clinical Trials Registry; The Netherlands National Trial Register)

Interventional Studies | alzheimer OR alzheimer's OR alzheimers OR MCI OR cognitive OR cognition OR memory | vitamin E OR alpha‐tocopherol | received from 01/07/2011 to 15/07/2012

Jun 2012: 2

TOTAL before de‐duplication

282

TOTAL after de‐duplication and first assessment

14

Appendix 2. Sources searched, search strategies and hits retrieved: October 2014, May 2015, April 2016

Source

Search strategy

Hits received

1. ALOIS (www.medicine.ox.ac.uk/alois)

Advanced search: [Study design: RCT OR CCT] AND [Health condition: Alzheimer OR MCI] AND [Intervention: "vitamin E"] (all dates)

Oct 2014: 11

May 2015: 0

Apr 2016: 0

2. MEDLINE In‐process and other non‐indexed citations and MEDLINE 1950 to present (OvidSP)

1. *Vitamin E/

2. "vitamin E".ti,ab.

3. "alpha‐tocopherol".ti,ab.

4. or/1‐3

5. Alzheimer*.ti,ab.

6. Alzheimer Disease/

7. AD.ti,ab.

8. "cognit* impair*".ti,ab.

9. MCI.ti,ab.

10. (AACI or memory or CIND or ARCD or ACMI).ti,ab.

11. ("N‐MCI" or "A‐MCI" or "M‐MCI").ti,ab.

12. (nMCI or aMCI or mMCI).ti,ab.

13. (CDR adj2 "0.5").ab.

14. or/5‐13

15. 4 and 14

16. randomized controlled trial.pt.

17. controlled clinical trial.pt.

18. randomi?ed.ab.

19. placebo.ab.

20. drug therapy.fs.

21. randomly.ab.

22. trial.ab.

23. groups.ab.

24. or/16‐23

25. (animals not (humans and animals)).sh.

26. 24 not 25

27. 15 and 26

Oct 2014: 51

May 2015: 6

Apr 2016: 43

3. EMBASE

1980 to 2011 week 27 (OvidSP)

1. *Vitamin E/

2. "vitamin E".ti,ab.

3. "alpha‐tocopherol".ti,ab.

4. or/1‐3

5. Alzheimer*.ti,ab.

6. Alzheimer Disease/

7. AD.ti,ab.

8. "cognit* impair*".ti,ab.

9. MCI.ti,ab.

10. (AACI or memory or CIND or ARCD or ACMI).ti,ab.

11. ("N‐MCI" or "A‐MCI" or "M‐MCI").ti,ab.

12. (nMCI or aMCI or mMCI).ti,ab.

13. (CDR adj2 "0.5").ab.

14. or/5‐13

15. 4 and 14

16. randomi?ed.ab.

17. placebo.ab.

19. trial.ab.

20. groups.ab.

21. randomized controlled trial/

22. controlled clinical trial/

23. ("double‐blind*" or "single‐blind*").ti,ab.

24. or/16‐23

25. 15 to 24

Oct 2014: 100

May 2015: 65

Apr 2016: 40

4. PsycINFO

1806 to July week 2 2011 (OvidSP)

1. "vitamin E".ti,ab.

2. "alpha‐tocopherol".ti,ab.

3. Alzheimer*.ti,ab.

4. Alzheimer Disease/

5. AD.ti,ab.

6. "cognit* impair*".ti,ab.

7. MCI.ti,ab.

8. (AACI or memory or CIND or ARCD or ACMI).ti,ab.

9. ("N‐MCI" or "A‐MCI" or "M‐MCI").ti,ab.

10. (nMCI or aMCI or mMCI).ti,ab.

11. (CDR adj2 "0.5").ab.

12. randomi?ed.ab.

13. placebo.ab.

14. randomly.ab.

15. trial.ab.

16. groups.ab.

17. ("double‐blind*" or "single‐blind*").ti,ab.

18. Clinical Trials/

19. 1 or 2

20. or/3‐11

21. or/12‐18

22. 19 and 20 and 21

Oct 2014: 10

May 2015: 4

Apr 2016: 0

5. CINAHL (EBSCOhost)

S1 (MM "Vitamin E")

S2 TX "vitamin E"

S3 TX "alpha‐tocopherol"

S4 S1 or S2 or S3

S5 (MH "Alzheimer's Disease")

S6 TX AD OR alzheimer*

S7 "mild cognitive impairment"

S8 TX "cognit* impair*"

S9 TX AACI OR memory OR CIND OR ARCD OR ACMI

S10 TX MCI

S11 TX nMCI OR aMCI OR mMCI

S12 S5 or S6 or S7 or S8 or S9 or S10 or S11

S13 S4 and S12

S14 TX random*

S15 TX placebo*

S16 TX trial

S17 TX groups

S18 TX RCT OR CCT

S19 (MH "Randomized Controlled Trials")

S20 S14 or S15 or S16 or S17 or S18 or S19

S21 S13 and S20

S22 EM 2009

S23 EM 2010

S24 EM 2011

S25 S22 or S23 or S24

S26 S21 and S25

Oct 2014: 7

May 2015: 5

Apr 2016: 3

6. ISI Web of Knowledge – all databases [includes: Web of Science (1945 to present); BIOSIS Previews (1926 to present); MEDLINE (1950 to present); Journal Citation Reports]

#1 Topic=(alzheimer* OR AD OR MCI OR memory OR cognitive OR "cognit* impair*") AND Topic=("vitamin e" OR "alpha‐tocopherol") AND Year Published=(2009‐2011)

Timespan=All Years

#2 Topic=(random* OR placebo* OR "double‐blind*" OR "single‐blind*")

Timespan=All Years

#3 #2 AND #1

Timespan=All Years

Oct 2014: 91

May 2015: 58

Apr 2016: 54

7. LILACS (BIREME)

vitamin‐e OR alpha‐tocopherol

Oct 2014: 1

May 2015: 0

Apr 2016: 0

8. CENTRAL (the Cochrane Library) (Issue 4 of 4, Oct 2010)

#1 “vitamin e”

#2 “alpha‐tocopherol”

#3 (#1 OR #2)

#4 MeSH descriptor Vitamin E, this term only

#5 (#3 OR #4)

#6 alzheimer* OR AD OR “cognit* impair*” OR MCI

#7 (#5 AND #6), from 2011 to 2012

Oct 2014: 33

May 2015: 15

Apr 2016: 0

9. Clinicaltrials.gov (www.clinicaltrials.gov)

Interventional Studies | alzheimer OR alzheimer's OR alzheimers OR MCI OR cognitive OR cognition OR memory | vitamin E OR alpha‐tocopherol | received from 01/01/2011 to 07/15/2012

Oct 2014: 1

May 2015: 2

Apr 2016: 1

10. ICTRP Search Portal (apps.who.int/trialsearch) (includes: Australian New Zealand Clinical Trials Registry; ClinicalTrilas.gov; ISRCTN; Chinese Clinical Trial Registry; Clinical Trials Registry – India; Clinical Research Information Service – Republic of Korea; German Clinical Trials Register; Iranian Registry of Clinical Trials; Japan Primary Registries Network; Pan African Clinical Trial Registry; Sri Lanka Clinical Trials Registry; The Netherlands National Trial Register)

Interventional Studies | alzheimer OR alzheimer's OR alzheimers OR MCI OR cognitive OR cognition OR memory | vitamin E OR alpha‐tocopherol | received from 01/07/2011 to 15/07/2012

Oct 2014: 14

May 2015: 4

Apr 2016: 1

TOTAL before de‐duplication

Oct 2014: 321

May 2015: 159

Apr 2016: 142

TOTAL after de‐duplication and first assessment

Oct 2014: 41

May 2015: 8

Apr 2016: 8

Study flow diagram for study for the search April 2016.
Figuras y tablas -
Figure 1

Study flow diagram for study for the search April 2016.

Risk of bias summary: review authors' judgements about each risk of bias item for each included study.
Figuras y tablas -
Figure 2

Risk of bias summary: review authors' judgements about each risk of bias item for each included study.

Risk of bias graph: review authors' judgements about each risk of bias item presented as percentages across all included studies.
Figuras y tablas -
Figure 3

Risk of bias graph: review authors' judgements about each risk of bias item presented as percentages across all included studies.

Comparison 1 Vitamin E (capsules 2000 IU/day in two divided doses) versus placebo in people with Alzheimer's disease, Outcome 1 Alzheimer's Disease Assessment Scale ‐ Cognitive subscale (ADAS‐Cog) (least square (LS) mean change from baseline at 6 to 48 months): completers.
Figuras y tablas -
Analysis 1.1

Comparison 1 Vitamin E (capsules 2000 IU/day in two divided doses) versus placebo in people with Alzheimer's disease, Outcome 1 Alzheimer's Disease Assessment Scale ‐ Cognitive subscale (ADAS‐Cog) (least square (LS) mean change from baseline at 6 to 48 months): completers.

Comparison 1 Vitamin E (capsules 2000 IU/day in two divided doses) versus placebo in people with Alzheimer's disease, Outcome 2 Alzheimer's Disease Cooperative Study/Activities of Daily Living (ADCS‐ADL) (LS mean change from baseline at 6 to 48 months): completers.
Figuras y tablas -
Analysis 1.2

Comparison 1 Vitamin E (capsules 2000 IU/day in two divided doses) versus placebo in people with Alzheimer's disease, Outcome 2 Alzheimer's Disease Cooperative Study/Activities of Daily Living (ADCS‐ADL) (LS mean change from baseline at 6 to 48 months): completers.

Comparison 1 Vitamin E (capsules 2000 IU/day in two divided doses) versus placebo in people with Alzheimer's disease, Outcome 3 Deaths (number of deaths over 48 months).
Figuras y tablas -
Analysis 1.3

Comparison 1 Vitamin E (capsules 2000 IU/day in two divided doses) versus placebo in people with Alzheimer's disease, Outcome 3 Deaths (number of deaths over 48 months).

Comparison 1 Vitamin E (capsules 2000 IU/day in two divided doses) versus placebo in people with Alzheimer's disease, Outcome 4 Serious adverse events (number of participants reporting ≥ 1 serious adverse event over 48 months).
Figuras y tablas -
Analysis 1.4

Comparison 1 Vitamin E (capsules 2000 IU/day in two divided doses) versus placebo in people with Alzheimer's disease, Outcome 4 Serious adverse events (number of participants reporting ≥ 1 serious adverse event over 48 months).

Comparison 1 Vitamin E (capsules 2000 IU/day in two divided doses) versus placebo in people with Alzheimer's disease, Outcome 5 Neuropsychiatric Inventory (NPI) (LS mean change from baseline at 6 to 48 months): completers.
Figuras y tablas -
Analysis 1.5

Comparison 1 Vitamin E (capsules 2000 IU/day in two divided doses) versus placebo in people with Alzheimer's disease, Outcome 5 Neuropsychiatric Inventory (NPI) (LS mean change from baseline at 6 to 48 months): completers.

Comparison 1 Vitamin E (capsules 2000 IU/day in two divided doses) versus placebo in people with Alzheimer's disease, Outcome 6 Mini‐Mental State Examination (MMSE) (LS mean change from baseline at 6 to 48 months): completers.
Figuras y tablas -
Analysis 1.6

Comparison 1 Vitamin E (capsules 2000 IU/day in two divided doses) versus placebo in people with Alzheimer's disease, Outcome 6 Mini‐Mental State Examination (MMSE) (LS mean change from baseline at 6 to 48 months): completers.

Comparison 1 Vitamin E (capsules 2000 IU/day in two divided doses) versus placebo in people with Alzheimer's disease, Outcome 7 Adverse events (number of participants reporting ≥ 1 adverse event over 48 months).
Figuras y tablas -
Analysis 1.7

Comparison 1 Vitamin E (capsules 2000 IU/day in two divided doses) versus placebo in people with Alzheimer's disease, Outcome 7 Adverse events (number of participants reporting ≥ 1 adverse event over 48 months).

Comparison 2 Vitamin E (capsules 2000 IU/day in two divided doses) versus placebo in people with mild cognitive impairment, Outcome 1 Progression to Alzheimer's disease (AD) (number of people progressing to AD by 36 months).
Figuras y tablas -
Analysis 2.1

Comparison 2 Vitamin E (capsules 2000 IU/day in two divided doses) versus placebo in people with mild cognitive impairment, Outcome 1 Progression to Alzheimer's disease (AD) (number of people progressing to AD by 36 months).

Comparison 2 Vitamin E (capsules 2000 IU/day in two divided doses) versus placebo in people with mild cognitive impairment, Outcome 2 Deaths (number of deaths over 36 months).
Figuras y tablas -
Analysis 2.2

Comparison 2 Vitamin E (capsules 2000 IU/day in two divided doses) versus placebo in people with mild cognitive impairment, Outcome 2 Deaths (number of deaths over 36 months).

Summary of findings for the main comparison. Vitamin E (capsules 2000 IU/day in two divided doses) compared to placebo for people with Alzheimer's disease

Vitamin E (capsules 2000 IU/day in 2 divided doses) compared to placebo for people with Alzheimer's disease

Patient or population: people with Alzheimer's disease

Settings: multicentre, US

Intervention: vitamin E (capsules 2000 IU/day in 2 divided doses)

Comparison: placebo

Outcomes

Illustrative comparative risks* (95% CI)

Relative effect
(95% CI)

No of participants
(studies)

Quality of the evidence
(GRADE)

Comments

Assumed risk

Corresponding risk

Placebo

Vitamin E (capsules 2000 IU/day in 2 divided doses)

Cognitive function
LS mean change from baseline using the ADAS‐Cog

Scale from: 0 to 70

Follow‐up: 6 to 48 months

The LS mean change from baseline in cognitive function in placebo group was 7.78

The LS mean change from baseline in cognitive function in the intervention group was 1.81 lower
(3.75 lower to 0.13 higher)

272
(1 study)

⊕⊕⊕⊝
Moderate1

Higher scores represent worse cognitive function.

A 4‐point difference in ADAS‐cog has been considered the MCID.

Adverse events

Number of participants reporting ≥ 1 serious adverse event

Follow‐up: 6 to 48 months

625 per 1000

538 per 1000
(444 to 656)

RR 0.86
(0.71 to 1.05)

304
(1 study)

⊕⊕⊕⊝
Moderate1

Deaths

Number of deaths

Follow‐up: 6 to 48 months

204 per 1000

171 per 1000
(106 to 273)

RR 0.84
(0.52 to 1.34)

304
(1 study)

⊕⊕⊕⊝
Moderate1

Activities of daily living
LS mean change from baseline using the ADCS‐ADL

Scale from: 0 to 78

Follow‐up: 6 to 48 months

The LS mean change from baseline in activities of daily living in the placebo group was ‐16.96

The LS mean change from baseline in activities of daily living in the intervention group was 3.15 higher
(0.07 to 6.23 higher)

280
(1 study)

⊕⊕⊕⊝
Moderate1

Higher scores represent better activities of daily living.

*The basis for the assumed risk (e.g. the median control group risk across studies) is provided in footnotes. The corresponding risk (and its 95% confidence interval) is based on the assumed risk in the comparison group and the relative effect of the intervention (and its 95% CI).

ADAS‐Cog: Alzheimer Disease Assessment Scale ‐ Cognitive Subscale; ADCS‐ADL: Alzheimer's Disease Cooperative Study/Activities of Daily Living Inventory;CI: confidence interval; LS: least square; MCID: minimum clinically important difference; RR: risk ratio.

GRADE Working Group grades of evidence
High quality: Further research is very unlikely to change our confidence in the estimate of effect.
Moderate quality: Further research is likely to have an important impact on our confidence in the estimate of effect and may change the estimate.
Low quality: Further research is very likely to have an important impact on our confidence in the estimate of effect and is likely to change the estimate.
Very low quality: We are very uncertain about the estimate.

1Quality downgraded one level due to imprecision. Evidence from a single study of modest size. This is supported by dichotomous data not reaching the optimal information size criterion (assuming α of 0.05, and β of 0.2) (Guyatt 2011).

Figuras y tablas -
Summary of findings for the main comparison. Vitamin E (capsules 2000 IU/day in two divided doses) compared to placebo for people with Alzheimer's disease
Summary of findings 2. Vitamin E (capsules 2000 IU/day in two divided doses) compared to placebo for people with mild cognitive impairment

Vitamin E (capsules 2000 IU/day in 2 divided doses) compared to placebo for people with mild cognitive impairment

Patient or population: people with mild cognitive impairment
Settings: US and Canada
Intervention: vitamin E (capsules 2000 IU/day in 2 divided doses)
Comparison: placeb

Outcomes

Illustrative comparative risks* (95% CI)

Relative effect
(95% CI)

No of participants
(studies)

Quality of the evidence
(GRADE)

Comments

Assumed risk

Corresponding risk

Placebo

Vitamin E (capsules 2000 IU/day in 2 divided doses)

Progression to Alzheimer's disease

Number of people progressing to AD

Follow‐up: 36 months

284 per 1000

293 per 1000
(224 to 383)

RR 1.03
(0.79 to 1.35)

516
(1 study)

⊕⊕⊕⊝
Moderate1

Cognitive function

Mean change from baseline of ADAS‐Cog

Scale from: 0 to 70

Follow‐up: 36 months

Not possible to extract data for analysis.

Not possible to extract data for analysis.

Unable to evaluate quality of evidence.

Uncertainty about how missing data were handled. Study reports no significant difference between intervention and control groups.

Adverse events

Number of participants reporting ≥ 1 serious adverse event.

Follow‐up: 36 months

Not possible to extract data for analysis.

516
(1 study)

Unable to evaluate quality of evidence.

Overall adverse event rates not reported.

Death

Number of deaths over 36 months

Follow‐up: 36 months

19 per 1000

19 per 1000
(6 to 66)

RR 1.01
(0.3 to 3.44)

516
(1 study)

⊕⊕⊕⊝
Moderate1

Activities of daily living

Mean change from baseline using the ADCS
Mild Cognitive Impairment Activities of Daily Living

Scale from: 0 to 53

Follow‐up: 36 months

Not possible to extract data for analysis.

Not possible to extract data for analysis.

Unable to evaluate quality of evidence.

Uncertainty about how missing data were handled. Study reports no significant difference between intervention and control groups.

*The basis for the assumed risk (e.g. the median control group risk across studies) is provided in footnotes. The corresponding risk (and its 95% confidence interval) is based on the assumed risk in the comparison group and the relative effect of the intervention (and its 95% CI).

ADAS‐Cog: Alzheimer Disease Assessment Scale ‐ Cognitive Subscale; ADCS‐ADL: Alzheimer's Disease Cooperative Study/Activities of Daily Living Inventory;CI: confidence interval; RR: risk ratio.

GRADE Working Group grades of evidence
High quality: Further research is very unlikely to change our confidence in the estimate of effect.
Moderate quality: Further research is likely to have an important impact on our confidence in the estimate of effect and may change the estimate.
Low quality: Further research is very likely to have an important impact on our confidence in the estimate of effect and is likely to change the estimate.
Very low quality: We are very uncertain about the estimate.

1Quality downgraded one level due to imprecision. Evidence from a single study of modest size. This was supported by dichotomous data not reaching the optimal information size criterion (assuming α of 0.05, and β of 0.2) (Guyatt 2011).

Figuras y tablas -
Summary of findings 2. Vitamin E (capsules 2000 IU/day in two divided doses) compared to placebo for people with mild cognitive impairment
Comparison 1. Vitamin E (capsules 2000 IU/day in two divided doses) versus placebo in people with Alzheimer's disease

Outcome or subgroup title

No. of studies

No. of participants

Statistical method

Effect size

1 Alzheimer's Disease Assessment Scale ‐ Cognitive subscale (ADAS‐Cog) (least square (LS) mean change from baseline at 6 to 48 months): completers Show forest plot

1

272

Mean Difference (IV, Random, 95% CI)

‐1.81 [‐3.75, 0.13]

2 Alzheimer's Disease Cooperative Study/Activities of Daily Living (ADCS‐ADL) (LS mean change from baseline at 6 to 48 months): completers Show forest plot

1

280

Mean Difference (IV, Fixed, 95% CI)

3.15 [0.07, 6.23]

3 Deaths (number of deaths over 48 months) Show forest plot

1

304

Risk Ratio (M‐H, Fixed, 95% CI)

0.84 [0.52, 1.34]

4 Serious adverse events (number of participants reporting ≥ 1 serious adverse event over 48 months) Show forest plot

1

304

Risk Ratio (M‐H, Fixed, 95% CI)

0.86 [0.71, 1.05]

5 Neuropsychiatric Inventory (NPI) (LS mean change from baseline at 6 to 48 months): completers Show forest plot

1

280

Mean Difference (IV, Fixed, 95% CI)

‐1.47 [‐4.26, 1.32]

6 Mini‐Mental State Examination (MMSE) (LS mean change from baseline at 6 to 48 months): completers Show forest plot

1

273

Mean Difference (IV, Fixed, 95% CI)

0.19 [‐0.72, 1.10]

7 Adverse events (number of participants reporting ≥ 1 adverse event over 48 months) Show forest plot

1

304

Risk Ratio (M‐H, Fixed, 95% CI)

1.02 [0.85, 1.23]

Figuras y tablas -
Comparison 1. Vitamin E (capsules 2000 IU/day in two divided doses) versus placebo in people with Alzheimer's disease
Comparison 2. Vitamin E (capsules 2000 IU/day in two divided doses) versus placebo in people with mild cognitive impairment

Outcome or subgroup title

No. of studies

No. of participants

Statistical method

Effect size

1 Progression to Alzheimer's disease (AD) (number of people progressing to AD by 36 months) Show forest plot

1

516

Risk Ratio (M‐H, Fixed, 95% CI)

1.03 [0.79, 1.35]

2 Deaths (number of deaths over 36 months) Show forest plot

1

516

Risk Ratio (M‐H, Fixed, 95% CI)

1.01 [0.30, 3.44]

Figuras y tablas -
Comparison 2. Vitamin E (capsules 2000 IU/day in two divided doses) versus placebo in people with mild cognitive impairment