The Association Between Serum Vitamin D Level and Cognitive Function in Older Adults

* This study determined the relationship between serum vitamin D levels and cognition as measured by the Montreal Cognitive Assessment instrument (is a widely used screening assessment used to detect cognitive dysfunction in the areas of attention, memory, concentration and much more) in a healthy older population. The authors examined 4358 individuals from the Cooper Clinic in Dallas, Texas, and determined that a low Montreal Cognitive Assessment score was directly associated with a higher age, whereas it was inversely associated with female gender and years of education. The group with low vitamin D levels was significantly more likely to have low Montreal Cognitive Assessment scores. Additionally, poor cardiorespiratory fitness was a significant predictor of a low Montreal Cognitive Assessment score, and the vitamin D effect remained significant when cardiorespiratory fitness was added to the model.
* More research is needed to determine if vitamin D supplementation would be effective in mitigating these effects.
– Michael Allen, MD
Low vitamin D is associated with low Montreal Cognitive Assessment  scores
The Cooper Clinic in Dallas, Texas, evaluated 4358 relatively healthy, educated people and found that low vitamin D (<30 ng/mL) was associated with low Montreal Cognitive Assessment scores. The authors also assessed cardiorespiratory fitness with graded exercise stress testing. After controlling for confounding variables, they found that the hazard ratio for low Montreal Cognitive Assessment scores was 1.54 for age, 0.55 for being female, 0.88 for a higher education, 0.94 for being fit, and 1.24 for having a low vitamin D level. There was a 26% risk of having a low Montreal Cognitive Assessment score if the vitamin D level was low.
Cardiorespiratory fitness negated some of this risk. For every increase by 1 MET of fitness, the risk of having a low Montreal Cognitive Assessment score decreased by 6%.
The authors state that vitamin D has been found to be neuroprotective by regulating calcium homeostasis, reducing amyloid deposits, and reversing inflammatory changes in the brain. Adding cardiorespiratory fitness appears to enhance brain volume.
Below is a summary of what our current research says works best to stabilize or improve mild cognitive impairment (MCI).
* Remove medications. There are no medications found to be helpful for mild cognitive impairment. But we can remove some that can make cognition worse. Start with those that have anticholinergic side effects.1Remember that chronic proton pump inhibition can reduce the absorption of many of the things associated with poor cognitive function (iron, magnesium, calcium, and B vitamins).
* Screen for and treat depression
* Treat hypertension and reduce blood pressure variability which is associated with more rapid cerebral lesion progression. Calcium channel blockers and thiazide diuretics control this the best.
* Treat metabolic syndrome, insulin resistance, and prediabetes.
* Correct vitamin D deficiency? This study can only suggest an association, not causation.
As we stress the importance of early detection of these chronic diseases by using the prefix “pre” (predementia, prediabetes, prehypertension), it is important to remember that these conditions can be reversed. In fact, 15% to 20% of those with mild cognitive impairment can show improvement. And the best evidence-based treatments for all three is not for things we take, but for things we do….
* Exercise the mind and the body
* Eat healthy (Mediterranean-type diet)
* Increase social support and connection
* Maintain optimal weight
At Botanica Medica our Naturopaths are well aware of the importance of  exercise, a good diet and the effect it can have on your life both physically and mentally. They come across lots of interesting studies and are always updating their knowledge. If you would like to make an appointment with one of our Naturopaths call Botanica Medica on 8271-1827 today. They are only to happy to share the knowledge they have gained through their studies and patient outcomes, and get you feeling better. Botanica Medica is located at 97 Glen Osmond Road, Eastwood and appointments are available Monday to Saturday including some after hours.
1. Gray SL, Anderson ML, Dublin S, et al. Cumulative Use of Strong Anticholinergics and Incident Dementia: A Prospective Cohort Study. JAMA Intern Med. 2015;175(3):401-407.
Primary Care Written by David Rakel MD, FAAFP
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