Evidence for the Importance of Vitamin D Status in Neurologic Conditions
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Vitamin D status has been proposed as relevant to many neurological disorders. Data suggest that vitamin D may be important for the development of the nervous system, and it also plays a role in neuroimmunology and neuroprotection. Lower levels of circulating 25-hydroxyvitamin D have been linked with increased risk of multiple sclerosis (MS) and Alzheimer’s disease (AD). While people with amyotrophic lateral sclerosis (ALS), Parkinson’s disease (PD), and stroke have lower vitamin D levels than those without the diseases, it is unclear if this is because hypovitaminosis D contributes to disease risk or is a consequence of immobility and other factors caused by the disease. Lower levels of vitamin D have been associated with worse prognosis in MS, PD, ALS, and stroke, while no longitudinal studies have been performed to evaluate such an association in AD. Small pilot trials have been performed to evaluate vitamin D supplementation for some of these diseases, but there have been no phase III studies to support vitamin D supplementation in these patient populations; further, ideal levels of 25-hydroxyvitamin D are not known. Thus, while some expert panels or individuals have suggested routine testing and supplementation for patients with these neurological conditions, it is our opinion that there are currently insufficient data to support high-dose vitamin D supplementation to specifically treat or prevent these conditions.
KeywordsVitamin D Central nervous system Multiple sclerosis Alzheimer’s disease Parkinson’s disease Amyotrophic lateral sclerosis Stroke
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Conflict of Interest
Anusha K. Yeshokumar and Deanna Saylor declare that they have no conflict of interest.
Michael D. Kornberg reports grants from NINDS and from National Multiple Sclerosis Society-American Academy of Neurology.
Ellen M. Mowry reports grants from Biogen Idec and received free medication for a clinical trial from Teva Neuroscience, and Dr. Mowry is PI of a multicenter randomized controlled trial of vitamin D supplementation in people with MS (sponsored by the National MS Society). She is site PI for a clinical trial sponsored by Sun Pharma.
Human and Animal Rights and Informed Consent
This article does not contain any studies with human or animal subjects performed by any of the authors.
References and Recommended Reading
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- 6.Tohda C et al. Diosgenin-induced cognitive enhancement in normal mice is mediated by 1,25D3-MARRS. Sci Rep. 2013;5:3395.Google Scholar
- 19.••Korf H et al. 1,25-Dihydroxyvitamin D3 curtails the inflammatory and T cell stimulatory capacity of macrophages through an IL-10-dependent mechanism. Immunobiology. 2012;217(12):1292–300. This article provided strong evidence for the anti-inflammatory effect of vitamin D on macrophages.PubMedCrossRefGoogle Scholar
- 37.••Kang SW et al. 1,25-Dihydroxyvitamin D3 promotes FOXP3 expression via binding to vitamin D response elements in its conserved noncoding sequence region. J Immunol. 2012;188:5276–82. This article provided the first evidence of direct effect of vitamin D on T lymphoctyes.PubMedCentralPubMedCrossRefGoogle Scholar
- 58.••Mowry EM et al. Vitamin D status predicts new brain MRI activity in multiple sclerosis. Ann Neurol. 2012;72(2):234–40. This study demonstrated that serum vitamin D levels are inversely associated with the development of new T2-weighted lesions on MRI in patients with MS.PubMedCentralPubMedCrossRefGoogle Scholar
- 64.••Soilu-Hanninen M et al. A randomised, double blind, placebo controlled trial with vitamin D3 as an add on treatment to interferon β-1b in patients with multiple sclerosis. J Neurol Neurosurg Psychiatry. 2012;83(5):565–71. This double-blind, placebo-controlled, randomized study demonstrated that patients with MS receiving vitamin D supplementation had fewer new T2-weighted lesions and a significantly lower number of T1 enhancing lesions as well as a tendency for reduced disability accumulation and improved timed tandem walk compared to controls not receiving vitamin D supplementation.PubMedCrossRefGoogle Scholar
- 76.Brouwer-Brolsma EM et al. Serum 25-hydroxyvitamin D is associated with cognitive executive function in Dutch prefrail and frail elderly: a cross-sectional study exploring the associations of 25-hydroxyvitamin D with glucose metabolism, cognitive performance and depression. J Am Med Dir Assoc. 2013;14(852):e859–817.Google Scholar
- 81.••Littlejohns TJ et al. Vitamin D and the risk of dementia and Alzheimer disease. Neurology. 2014;83:920–8. This large prospective cohort study showed that hypovitaminosis D resulted in a markedly increased risk of incident Alzheimer’s disease and all-cause dementia.PubMedCentralPubMedCrossRefGoogle Scholar
- 99.Kim JS et al. 1alpha,25-Dihydroxyvitamin D(3) Protects dopaminergic neurons in rodent models of Parkinson’s disease through inhibition of microglial activation. J Clin Neurol. 2006;2:252–7.Google Scholar
- 105.••Camu W et al. Vitamin D confers protection to motoneurons and is a prognostic factor of amyotrophic lateral sclerosis. Neurobiol Aging. 2014;35:1198–205. This study showed that lower levels of vitamin D correlated with faster functional decline in ALS patients, even after excluding non-ambulatory patients.PubMedCrossRefGoogle Scholar