TUESDAY, April 15 (HealthDay News) -- Alzheimer's patients who consume very high levels of vitamin E seem to live longer than those who do not, new research suggests.

The study comes on the heels of growing concerns regarding the safety and efficacy of giving any patient -- whether suffering from Alzheimer's or another illness -- the high dosage in question: 2,000 international units (IUs) per day.

"The concern is that vitamin E will actually have a harmful affect, because a recent review of prior studies found that it had a slightly negative impact on mortality," said study author Valory Pavlik, an associate professor with the Alzheimer's Disease and Memory Disorders Center at Baylor College of Medicine in Houston.

"But I think -- to our surprise -- the message really is that for the treatment of Alzheimer's in clinical practice, we did not find evidence that high doses of vitamin E reduced survival," she said. "In fact, patients who took vitamin E seemed to live longer, particularly when they took it in combination with a cholinesterase inhibitor."

Pavlik and her colleagues were expected to present their research Tuesday at the American Academy of Neurology meeting in Chicago.

Their findings stem from almost 15 years spent tracking survival rates among 847 men and women already diagnosed with various stages of Alzheimer's.

Just over two-thirds of the patients were women, and the average age was almost 74. On average, patient outcome was followed for about five years.

About two-thirds of the patients had been prescribed two daily doses of 1,000 IUs of vitamin E, in conjunction with an Alzheimer medication from the class of drugs known as cholinesterase inhibitors.

Cholinesterase inhibitors are designed to halt the breakdown of the neurotransmitter acetylcholine, which is key to nerve pulse function in the brain. Alzheimer's patients suffer from a drop in acetylcholine production, so this class of drugs prevents the otherwise normal elimination of excess transmitters among those who have none to spare.

Fewer than 10 percent of patients took just vitamin E, while about 15 percent took neither the vitamin nor the medication.

The researchers found that patients who consumed the prescribed daily dosage of vitamin E appeared to extend their life span by 26 percent, compared with those not taking vitamin E.

The finding took into account age, gender, years of education, race, ethnicity, co-morbidities and severity of dementia at the start of the study.

Though there were some preliminary indications that the enhanced survival benefit associated with vitamin E was even greater among patients taking both the vitamin and a cholinesterase inhibitor, Pavlik and her team noted that the 26 percent bump held up even without the Alzheimer's drug.

However, those taking a cholinesterase inhibitor alone did not appear to gain any survival benefit.

"Much more research needs to be devoted to the effects of vitamin E on Alzheimer's patients," said Pavlik. "But for now, the door should not be closed on the option".

She pointed out, however, that although 2,000 IUs of vitamin E was the standard supplementary dosage of vitamin E given to Alzheimer's patients during the study period -- from 1990 through 2004 -- such high levels are no longer considered for routine therapy, as a result of studies suggesting that such a dosage might carry unwarranted health risks.

She also stressed that consumption of such high amounts of vitamin E on a daily basis has never been appropriate for the average person.

Eric J. Hall, president and founding CEO of the Alzheimer's Foundation of America in New York City, described the finding as "interesting" and worthy of continued investigation.

"I think the medical community is very open to the possibility that natural ingredients -- therapies outside the realm of FDA-approved drugs, if you will -- can be very helpful to treatment," he said. "For example, everyone agrees that socialization and cognitive stimulation, while neither drugs nor supplements, are important ingredients in Alzheimer's therapy, and almost constitute a kind of treatment."

"But of course," Hall added, "I'm aware that vitamin E, specifically, has come under fire in the last few years, and that there is concern about the possible dangers of taking too high a dosage. So, I think we have to be careful. And probably more research is necessary to find out how vitamin E might be useful in treatment."

Another study presented at the meeting found that people who had larger hippocampuses were spared the ravaging symptoms of Alzheimer's disease.

"This larger hippocampus may protect these people from the effects of Alzheimer's disease-related brain changes," study author Dr. Deniz Erten-Lyons, with the Oregon Health and Science University in Portland, said in a statement. "Hopefully, this will lead us eventually to prevention strategies."

More information

For more on Alzheimer's and treatment therapies, visit the U.S. National Institute on Aging.

TUESDAY, April 15 (HealthDay News) -- Loop diuretics, drugs commonly prescribed to treat heart failure and hypertension, increase the risk of hip bone loss in older men, says a U.S. study.

Researchers evaluated 3,269 men, aged 65 and older, who underwent an initial examination between 2000 and 2002, with a follow-up visit an average of 4.6 years later. They collected information about all the medications being taken by the men and checked bone mineral density in the men's hips.

Among the men in the study, 84 continuously used loop diuretics between the initial and follow-up examinations, 181 used the drugs intermittently, and 3,004 never used them. After adjusting for other factors, the researchers found that the average annual rate of decline in total hip bone mineral density was -0.78 among continuous users, -0.58 among intermittent users, and -0.33 among non-users.

"Compared with rates of hip bone loss among non-users of diuretics, adjusted rates of loss were about twofold greater among intermittent loop diuretic users and about 2.5-fold greater among continuous loop diuretic users," wrote Dr. Lionel S. Lim, of Griffin Hospital in Derby, Conn., and his colleagues.

"We conclude that loop diuretic use in older men is associated with increased rates of hip bone loss," wrote the authors, who said future research should examine the underlying mechanisms of this bone loss.

"Our findings suggest that health care providers should take into account loop diuretic use when evaluating older men for risk factors for bone loss and fracture risk," they said.

The study was published in the April 14 issue of the Archives of Internal Medicine.

The researchers noted that loop diuretics are one of the most commonly prescribed medications among older adults. These drugs increase the amount of calcium excreted in urine, and long-term use may harm bones. Previous observational studies have found an association between the use of loop diuretics and increased risk of fractures.

But the researchers said there's been "uncertainty as to whether this increased fracture risk is attributable to negative effects on bone mineral density, fall-related mechanisms (e.g., dizziness and orthostatis [low blood pressure when standing up]), or associated comorbidities (co-occurring illnesses)."

More information

The U.S. Food and Drug Administration has more about diuretics and other drugs used to treat hypertension.

FRIDAY, April 11 (HealthDay News) -- More than one-third of Americans are now getting hospice care services before they die, but that care still isn't available to many people in the country, a new study finds.

Communities with people with low incomes and education levels, and those with sizeable elderly populations, are less likely to have access to hospice care than areas with wealthier, more educated people, the study said.

"The way most hospices are constructed is using charity. They have to exist before Medicare will pay for their services," said lead researcher Dr. Maria J. Silveira, an assistant professor of internal medicine at the University of Michigan.

This requirement has limited access to hospice care for people in poorer areas, Silveira said. "If Medicare was truly interested in improving access to hospice, what it would need to do is find a way to break the reliance on charity in order to build hospices in the communities that are underserved."

Silveira also thinks Medicare reimbursement is too low for many hospices to make money. While the reimbursement for home hospice care is probably adequate, reimbursement for in-hospice care is too low, she said.

For the study, Silveira and her colleagues used Medicare data, along with county data from the 2000 Census, to create a computer model of hospice care in the United States.

The researchers found the availability of hospice care was high in the Northeast, upper Midwest and in much of California. Hospice care was less available in states along the Mississippi River, in the Rocky Mountain region, and the Southwest. The South, Texas, Florida, and the Plains states had the lowest average availability of hospice care.

The researchers said the availability of hospice care was associated with average income level, education level, and the number of people over 65 living in a particular county. People with incomes of more than $100,000, or people who had at least a high school diploma, had better access to hospice care, the study found.

One surprising finding was that older people had less access to hospice care, said Silveira, who was to present the findings Friday at the Society of General Internal Medicine's annual meeting, in Pittsburgh.

One expert said the study may not be entirely accurate, because it relied on data from 2000, and hospice care has become more available in the last decade, although disparities still exist.

"There has been very significant growth in the hospice benefit use under Medicare since 2000," said Vincent Mor, chairman of the Department of Community Health at Brown University School of Medicine. "Thus, the data are relatively old regarding the distribution of hospices around the country. And the hospice provider of service files that they [the study authors] used tend to be even more out of date, which means that they may have undercounted hospices in existence even in 2000," he added.

"However, the general principles underlying the findings certainly are consistent with my own research in the long-term care arena, Mor said. "Rural and poor communities have worse access to all sorts of medical care."

Donald Schumacher, president and chief executive officer of the National Hospice and Palliative Care Organization, said charity is playing less of a role in hospice care than it once did.

"There's been a lot of growth in for-profit hospices," he said. "There are organizations that offer hospice care without being dependent on donations."

Schumacher said Medicare reimbursement is about $125 a day for home hospice care and $600 a day for in-hospice care. "Generally, in-hospice care is short-term care," he said. "Typically, it might be for five to seven days."

Schumacher acknowledged that there are geographic differences in the availability of hospice care but that also has improved in the last eight years.

More information

To learn more about hospice care, visit the National Hospice and Palliative Care Organization  .