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Vitamin D, cognitive dysfunction and dementia in older adults.
CNS Drugs 2011; 25(8):629-39CD

Abstract

The physiologically active form of vitamin D, 1,25-dihydroxyvitamin D(3), is a fat-soluble steroid hormone with a well established role in skeletal health. A growing body of evidence suggests low vitamin D levels also play a role in the pathogenesis of a wide range of non-skeletal, age-associated diseases including cancer, heart disease, type 2 diabetes mellitus and stroke. Low levels of serum 25-hydroxyvitamin D [25(OH)D], a stable marker of vitamin D status, are also associated with increased odds of prevalent cognitive dysfunction, Alzheimer's disease and all-cause dementia in a number of studies, raising the possibility that vitamin D plays a role in the aetiology of cognitive dysfunction and dementia. To date, the majority of human studies reporting associations between vitamin D and cognition or dementia have been cross-sectional or case-control designs that do not permit us to exclude the possibility that such associations are a result of disease progression rather than being causal. Animal and in vitro experiments have identified a number of neuroprotective mechanisms that might link vitamin D status to cognitive dysfunction and dementia, including vasoprotection and amyloid phagocytosis and clearance, but the clinical relevance of these mechanisms in humans is not currently clear. Two recent, large, prospective studies go some way to establish the temporal relationship with cognitive decline. The relative risk of cognitive decline was 60% higher (relative risk = 1.6, 95% CI 1.2, 2.0) in elderly Italian adults with severely deficient 25(OH)D levels (<25 nmol/L) when compared with those with sufficient levels (≥75 nmol/L). Similarly, the odds of cognitive decline were 41% higher (odds ratio = 1.4, 95% CI 0.9, 2.2) when elderly US men in the lowest quartile (≤49.7 nmol/L) were compared with those in the highest quartile (≥74.4 nmol/L). To our knowledge, no prospective studies have examined the association between 25(OH)D levels and incident dementia or neuroimaging abnormalities. The possible therapeutic benefits of vitamin D have attracted considerable interest as over 1 billion people worldwide are thought to have insufficient 25(OH)D levels and these levels can be increased using inexpensive and well tolerated dietary supplements. However, no large randomized controlled trials have yet examined the effect of vitamin D supplements on cognitive decline or incident dementia. Further studies are urgently needed to establish which mechanisms have clinical relevance in human populations and whether vitamin D supplements are effective at minimizing cognitive decline or preventing dementia.

Authors+Show Affiliations

Peninsula Collaboration for Leadership in Applied Health Research and Care, Peninsula College of Medicine and Dentistry, University of Exeter, Exeter, UK.No affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info available

Pub Type(s)

Journal Article
Research Support, N.I.H., Extramural
Research Support, Non-U.S. Gov't

Language

eng

PubMed ID

21790207

Citation

Dickens, Andy P., et al. "Vitamin D, Cognitive Dysfunction and Dementia in Older Adults." CNS Drugs, vol. 25, no. 8, 2011, pp. 629-39.
Dickens AP, Lang IA, Langa KM, et al. Vitamin D, cognitive dysfunction and dementia in older adults. CNS Drugs. 2011;25(8):629-39.
Dickens, A. P., Lang, I. A., Langa, K. M., Kos, K., & Llewellyn, D. J. (2011). Vitamin D, cognitive dysfunction and dementia in older adults. CNS Drugs, 25(8), pp. 629-39. doi:10.2165/11593080-000000000-00000.
Dickens AP, et al. Vitamin D, Cognitive Dysfunction and Dementia in Older Adults. CNS Drugs. 2011;25(8):629-39. PubMed PMID: 21790207.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Vitamin D, cognitive dysfunction and dementia in older adults. AU - Dickens,Andy P, AU - Lang,Iain A, AU - Langa,Kenneth M, AU - Kos,Katarina, AU - Llewellyn,David J, PY - 2011/7/28/entrez PY - 2011/7/28/pubmed PY - 2011/12/13/medline SP - 629 EP - 39 JF - CNS drugs JO - CNS Drugs VL - 25 IS - 8 N2 - The physiologically active form of vitamin D, 1,25-dihydroxyvitamin D(3), is a fat-soluble steroid hormone with a well established role in skeletal health. A growing body of evidence suggests low vitamin D levels also play a role in the pathogenesis of a wide range of non-skeletal, age-associated diseases including cancer, heart disease, type 2 diabetes mellitus and stroke. Low levels of serum 25-hydroxyvitamin D [25(OH)D], a stable marker of vitamin D status, are also associated with increased odds of prevalent cognitive dysfunction, Alzheimer's disease and all-cause dementia in a number of studies, raising the possibility that vitamin D plays a role in the aetiology of cognitive dysfunction and dementia. To date, the majority of human studies reporting associations between vitamin D and cognition or dementia have been cross-sectional or case-control designs that do not permit us to exclude the possibility that such associations are a result of disease progression rather than being causal. Animal and in vitro experiments have identified a number of neuroprotective mechanisms that might link vitamin D status to cognitive dysfunction and dementia, including vasoprotection and amyloid phagocytosis and clearance, but the clinical relevance of these mechanisms in humans is not currently clear. Two recent, large, prospective studies go some way to establish the temporal relationship with cognitive decline. The relative risk of cognitive decline was 60% higher (relative risk = 1.6, 95% CI 1.2, 2.0) in elderly Italian adults with severely deficient 25(OH)D levels (<25 nmol/L) when compared with those with sufficient levels (≥75 nmol/L). Similarly, the odds of cognitive decline were 41% higher (odds ratio = 1.4, 95% CI 0.9, 2.2) when elderly US men in the lowest quartile (≤49.7 nmol/L) were compared with those in the highest quartile (≥74.4 nmol/L). To our knowledge, no prospective studies have examined the association between 25(OH)D levels and incident dementia or neuroimaging abnormalities. The possible therapeutic benefits of vitamin D have attracted considerable interest as over 1 billion people worldwide are thought to have insufficient 25(OH)D levels and these levels can be increased using inexpensive and well tolerated dietary supplements. However, no large randomized controlled trials have yet examined the effect of vitamin D supplements on cognitive decline or incident dementia. Further studies are urgently needed to establish which mechanisms have clinical relevance in human populations and whether vitamin D supplements are effective at minimizing cognitive decline or preventing dementia. SN - 1179-1934 UR - https://www.unboundmedicine.com/medline/citation/21790207/Vitamin_D_cognitive_dysfunction_and_dementia_in_older_adults_ L2 - https://dx.doi.org/10.2165/11593080-000000000-00000 DB - PRIME DP - Unbound Medicine ER -