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September 25, 2012; 79 (13) Views and Reviews

Vitamin D, cognition, and dementia

A systematic review and meta-analysis

Cynthia Balion, Lauren E. Griffith, Lisa Strifler, Matthew Henderson, Christopher Patterson, George Heckman, David J. Llewellyn, Parminder Raina
First published September 24, 2012, DOI: https://doi.org/10.1212/WNL.0b013e31826c197f
Cynthia Balion
From the Departments of Pathology and Molecular Medicine (C.B., M.H.), Clinical Epidemiology and Biostatistics (L.E.G., L.S., P.R.), and Medicine (C.P.), and R. Samuel McLaughlin Center on Gerontological Research and Education (P.R.), McMaster University, Hamilton; Department of Health Studies and Gerontology (G.H.), University of Waterloo, Schlegel-UW Research Institute for Aging, Kitchener, Canada; and Peninsula College of Medicine and Dentistry (D.J.L.), University of Exeter, Devon, UK.
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Lauren E. Griffith
From the Departments of Pathology and Molecular Medicine (C.B., M.H.), Clinical Epidemiology and Biostatistics (L.E.G., L.S., P.R.), and Medicine (C.P.), and R. Samuel McLaughlin Center on Gerontological Research and Education (P.R.), McMaster University, Hamilton; Department of Health Studies and Gerontology (G.H.), University of Waterloo, Schlegel-UW Research Institute for Aging, Kitchener, Canada; and Peninsula College of Medicine and Dentistry (D.J.L.), University of Exeter, Devon, UK.
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Lisa Strifler
From the Departments of Pathology and Molecular Medicine (C.B., M.H.), Clinical Epidemiology and Biostatistics (L.E.G., L.S., P.R.), and Medicine (C.P.), and R. Samuel McLaughlin Center on Gerontological Research and Education (P.R.), McMaster University, Hamilton; Department of Health Studies and Gerontology (G.H.), University of Waterloo, Schlegel-UW Research Institute for Aging, Kitchener, Canada; and Peninsula College of Medicine and Dentistry (D.J.L.), University of Exeter, Devon, UK.
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Matthew Henderson
From the Departments of Pathology and Molecular Medicine (C.B., M.H.), Clinical Epidemiology and Biostatistics (L.E.G., L.S., P.R.), and Medicine (C.P.), and R. Samuel McLaughlin Center on Gerontological Research and Education (P.R.), McMaster University, Hamilton; Department of Health Studies and Gerontology (G.H.), University of Waterloo, Schlegel-UW Research Institute for Aging, Kitchener, Canada; and Peninsula College of Medicine and Dentistry (D.J.L.), University of Exeter, Devon, UK.
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Christopher Patterson
From the Departments of Pathology and Molecular Medicine (C.B., M.H.), Clinical Epidemiology and Biostatistics (L.E.G., L.S., P.R.), and Medicine (C.P.), and R. Samuel McLaughlin Center on Gerontological Research and Education (P.R.), McMaster University, Hamilton; Department of Health Studies and Gerontology (G.H.), University of Waterloo, Schlegel-UW Research Institute for Aging, Kitchener, Canada; and Peninsula College of Medicine and Dentistry (D.J.L.), University of Exeter, Devon, UK.
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George Heckman
From the Departments of Pathology and Molecular Medicine (C.B., M.H.), Clinical Epidemiology and Biostatistics (L.E.G., L.S., P.R.), and Medicine (C.P.), and R. Samuel McLaughlin Center on Gerontological Research and Education (P.R.), McMaster University, Hamilton; Department of Health Studies and Gerontology (G.H.), University of Waterloo, Schlegel-UW Research Institute for Aging, Kitchener, Canada; and Peninsula College of Medicine and Dentistry (D.J.L.), University of Exeter, Devon, UK.
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David J. Llewellyn
From the Departments of Pathology and Molecular Medicine (C.B., M.H.), Clinical Epidemiology and Biostatistics (L.E.G., L.S., P.R.), and Medicine (C.P.), and R. Samuel McLaughlin Center on Gerontological Research and Education (P.R.), McMaster University, Hamilton; Department of Health Studies and Gerontology (G.H.), University of Waterloo, Schlegel-UW Research Institute for Aging, Kitchener, Canada; and Peninsula College of Medicine and Dentistry (D.J.L.), University of Exeter, Devon, UK.
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Parminder Raina
From the Departments of Pathology and Molecular Medicine (C.B., M.H.), Clinical Epidemiology and Biostatistics (L.E.G., L.S., P.R.), and Medicine (C.P.), and R. Samuel McLaughlin Center on Gerontological Research and Education (P.R.), McMaster University, Hamilton; Department of Health Studies and Gerontology (G.H.), University of Waterloo, Schlegel-UW Research Institute for Aging, Kitchener, Canada; and Peninsula College of Medicine and Dentistry (D.J.L.), University of Exeter, Devon, UK.
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Citation
Vitamin D, cognition, and dementia
A systematic review and meta-analysis
Cynthia Balion, Lauren E. Griffith, Lisa Strifler, Matthew Henderson, Christopher Patterson, George Heckman, David J. Llewellyn, Parminder Raina
Neurology Sep 2012, 79 (13) 1397-1405; DOI: 10.1212/WNL.0b013e31826c197f

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Abstract

Objective: To examine the association between cognitive function and dementia with vitamin D concentration in adults.

Methods: Five databases were searched for English-language studies up to August 2010, and included all study designs with a comparative group. Cognitive function or impairment was defined by tests of global or domain-specific cognitive performance and dementia was diagnosed according to recognized criteria. A vitamin D measurement was required. Two authors independently extracted data and assessed study quality using predefined criteria. The Q statistic and I2 methods were used to test for heterogeneity. We conducted meta-analyses using random effects models for the weighted mean difference (WMD) and Hedge's g.

Results: Thirty-seven studies were included; 8 contained data allowing mean Mini-Mental State Examination (MMSE) scores to be compared between participants with vitamin D <50 nmol/L to those with values ≥50 nmol/L. There was significant heterogeneity among the studies that compared the WMD for MMSE but an overall positive effect for the higher vitamin D group (1.2, 95% confidence interval [CI] 0.5 to 1.9; I2 = 0.65; p = 0.002). The small positive effect persisted despite several sensitivity analyses. Six studies presented data comparing Alzheimer disease (AD) to controls but 2 utilized a method withdrawn from commercial use. For the remaining 4 studies the AD group had a lower vitamin D concentration compared to the control group (WMD = −6.2 nmol/L, 95% CI −10.6 to −1.8) with no heterogeneity (I2 < 0.01; p = 0.53).

Conclusion: These results suggest that lower vitamin D concentrations are associated with poorer cognitive function and a higher risk of AD. Further studies are required to determine the significance and potential public health benefit of this association.

GLOSSARY

AD=
Alzheimer disease;
CI=
confidence interval;
CPBA=
competitive protein binding assay;
GDNF=
glial cell derived neurotrophic factor;
iNOS=
nitric oxide synthase;
MMSE=
Mini-Mental State Examination;
NGF=
nerve growth factor;
NINCDS-ADRDA=
National Institute of Neurological and Communicative Disorders and Stroke–Alzheimer's Disease and Related Disorders Association;
PTH=
parathyroid hormone;
RCT=
randomized controlled trial;
RIA=
radioimmunoassay;
WMD=
weighted mean difference

Footnotes

  • Study funding: Ontario Research Coalition of Research Institutes/Centres on Health & Aging, Ontario Ministry of Long-Term Care. Parminder Raina holds a Canada Research Chair in GeroScience and Raymond and Margaret Labarge Chair in Research and Knowledge Application for Optimal Aging.

  • Supplemental data at www.neurology.org

  • Received August 11, 2011.
  • Accepted May 1, 2012.
  • Copyright © 2012 by AAN Enterprises, Inc.
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