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The study findings indicated modest improvements in cognitive and functional measures compared to placebo but were accompanied by risk of serious adverse events, particularly for carriers of two copies the APOE4 allele (van Dyck et al., 2023)

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There are case reports of reactions to papain and bromelain including sneezing, wheezing, skin rash, or, rarely, more serious symptoms especially in people already sensitive to papaya or pineapple

A double-blind, placebo-controlled randomized clinical trial of alpha-tocopherol (vitamin E) in the treatment of amyotrophic lateral sclerosis