A 64-Year-Old Woman Comes to the Office for a Health

A 64-year-old woman comes to the office for a health maintenance visit.  Her medical issues include hypothyroidism treated with levothyroxine and postmenopausal vaginal dryness treated with estrogen cream.  The patient exercises 3 times a week and eats a well-balanced diet.  She does not use tobacco and drinks a glass of wine 3-5 days a week.  She works as a volunteer at her local public library.  The patient's 88-year-old father has Alzheimer disease and was recently placed in a nursing facility.  She mentions that it has been difficult to see her father decline and was upset when he failed to recognize her at her last visit.  She says, "I do crossword puzzles every day because I am afraid I will develop Alzheimer disease" and mentions that she has seen information on the internet and television describing beneficial effects from ginkgo biloba, fish oil, and vitamins.  The patient asks, "Will any of these supplements help prevent dementia?"  Which of the following is the most appropriate advice for this patient?

A) B₁₂ and folate supplements are recommended in moderate dosages to help prevent dementia.
B) Gingko biloba has shown some benefit, but it is important to choose a brand with guaranteed purity.
C) Omega-3 fatty acid supplements can improve cognitive function and reduce risk of dementia.
D) There is no evidence that supplements are beneficial and they are not routinely recommended.
E) Vitamin E has shown modest benefit in preventing dementia in patients with normal cognition.