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Low Vitamin D Levels Linked to Added Falls, More Sleep Problems, Depression, Study Shows

low Vitamin D

Low vitamin D levels are associated with a greater tendency for falls, sleep problems, anxiety, and depression in people with Parkinson’s disease, according to a recent study.

The findings, “Relationship between 25‐Hydroxyvitamin D, bone density, and Parkinson’s disease symptoms,” were published in the journal Acta Neurologica Scandinavia.

Vitamin D deficiency and low bone mass are frequently observed in people with Parkinson’s disease (PD). In fact, one particular study found that lack of this vitamin is more common in people with Parkinson’s (55% of patients) than other populations, such as people with Alzheimer’s disease (41% of patients).

But the relationship between vitamin D levels and Parkinson’s has remained controversial. Some studies suggest that taking vitamin D3 — a form of vitamin D used in supplements — can stabilize the disease, while others see no relation with the risk of Parkinson’s.

However, most studies have focused on limited aspects of the disease and did not include important outcomes — notably, non‐motor symptoms.

Vitamin D has a vital role in bone health, since it promotes calcium absorption and bone mineralization, which keeps bones strong and healthy. It also blocks the release of parathyroid hormone (PTH), an hormone that promotes bone tissue reabsorption and bone thinning.

Some studies support that lack of vitamin D results in a greater risk of falls and fractures in Parkinson’s patients, which can increase hospitalization and even fatal disability. Its levels also have been associated with cognition and mood, as well as stomach malfunction, in people with the disease.

While it is possible that deficits in this vitamin impact several symptoms of PD, the connection remains unclear.

To shed light on this relationship, researchers at the Second Affiliated Hospital of Soochow University and Soochow University, in China, set out to determine if vitamin D levels correlated with bone mineral density (BMD) and non‐motor symptoms in Parkinson’s patients.

The team measured blood levels of 25-hydroxyvitamin D, or 25(OH)D — a precursor of the active form of vitamin D and the most accurate indicator of vitamin D levels in the body — and performed extensive clinical evaluations in 182 Parkinson’s patients as well as 185 healthy people (controls).

Participants were recruited from the Second Affiliated Hospital of Soochow University from March 2014 to December 2017.

Bone mineral density — a measure of bone mass and health — was measured at the lumbar spine and the top of the femur (thigh bone) by bone densiometry, which measures bone loss.

The data showed that people with Parkinson’s had significantly lower vitamin D levels in the blood compared with healthy controls — an average of 49.75 versus 43.40 nanomol per liter of 25(OH)D.

In agreement, low levels of vitamin D (below 50 nmol/l) also were more common in Parkinson’s patients (68.68%) than controls (54.05%).

People with lower vitamin D levels were more likely to fall and experience sleep problems, including difficulty in falling asleep (insomnia). They also had significantly more depression and anxiety.

Mean bone densities in both the spine and femur were lower in PD patients, however no correlation was seen between the levels of BMD and vitamin D.

“Together, these results indicate that vitamin D deficiency may play a role in PD pathogenesis [disease manifestations], while vitamin D supplementation may be used to treat the non‐motor symptoms of PD,” the researchers  said.

“As various non-motor symptoms place a burden on individuals with Parkinson’s disease and their caregivers, vitamin D might be a potential add-on therapy for improving these neglected symptoms,” study’s senior author Chun Feng Liu, MD, PhD, said in a press release.

However, the researchers stressed that future studies with a larger sample size are necessary to clarify the role of vitamin D in Parkinson’s disease.

The post Low Vitamin D Levels Linked to Added Falls, More Sleep Problems, Depression, Study Shows appeared first on Parkinson’s News Today.

Lack of Standardized Vitamin D Data Hampers Efforts to Determine Its Role in Parkinson’s, Review Study Says

Vitamin D, Parkinson's risk

Low vitamin D serum levels have been associated with Parkinson’s disease, but the lack of standardized data makes it difficult to determine vitamin D’s exact role in Parkinson’s pathology, according to a recent review article.

The study, “Standardized measurement of circulating vitamin D [25(OH)D] and its putative role as a serum biomarker in Alzheimer’s disease and Parkinson’s disease,” was published in Clinica Chimica Acta.

Vitamin D is essential to maintain homeostasis of the musculoskeletal system, and exists in two forms: 25-hydroxyvitamin D and 1,25-dihydroxyvitamin D. The major form found in the blood is 25-hydroxyvitamin D, and as such, testing usually quantifies these levels to monitor vitamin D status in individuals.

Low serum vitamin D levels have been associated with Parkinson’s disease, suggesting that elevated vitamin D levels could protect against this neurodegenerative disorder.

In 2010, researchers analyzed the blood concentrations of vitamin D in 3,173 men and women, 50–79 years old, and found that those with higher levels were less likely to develop Parkinson’s. Standardized techniques were used to measure these levels, which revealed that 50 out of the 3,173 people developed Parkinson’s, which is a relatively small number for scientists to draw conclusions on the “protective power” of vitamin D.

In another study, 25-hydroxyvitamin D blood concentration was found to be significantly associated with motor severity in 145 Parkinson’s patients who were followed for three years. These findings were further supported by two recent meta-analyses evaluating a total of 4,199 patients. Results revealed that serum vitamin D levels were inversely associated with Parkinson’s risk and severity, and that vitamin D supplementation did not improve subjects’ motor function. However, the methods used to quantify vitamin D levels varied between the studies included in the combined statistical analyses.

In an attempt to standardize vitamin D measurements, researchers in the current study reviewed the performance of 25-hydroxyvitamin D assays over the last three decades. So far, “only a few studies evaluating relatively small samples reported standardized data,” the researchers wrote.

“Literature studies in the field of vitamin D mainly report unstandardized results, which hampers the development of consensus guidelines defining optimal vitamin D status,” they said, adding that current data do not support the usefulness of vitamin D as a biomarker for Parkinson’s disease and that further studies “using internationally recognized measurement procedures and materials are required.”

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Vitamin D May Improve Balance in Younger Parkinson’s Patients, Pilot Study Suggests

Short-term supplementation of vitamin D in high doses may improve balance in people with Parkinson’s disease younger than 66, according to results of a Phase 2 pilot study.
The study, “A randomized, controlled pilot study of the effects of vitamin D supplementation on balance in Parkinson’s disease: Does age matter?” was published in Plos One.
Parkinson’s patients are at a high risk of falling mainly due to problems with balance — one of the primary symptoms of the disease. It is estimated that 70 percent of Parkinson’s patients fall at least once a year.
Falls are associated with substantial injury, disability, hospitalization, and reduced quality of life in Parkinson’s patients and in older people in general. However, no pharmaceutical or surgical intervention is currently known to significantly improve balance.
As a result, there is an unmet need to discover or develop therapeutic approaches to improve balance in Parkinson’s patients.
At the same time, individuals with Parkinson’s, particularly those with advanced disease, have lower levels of vitamin D, which is involved not only in bone health, but also in brain function.
Previous studies have shown that vitamin D supplementation reduces fall rates and improves balance in older people. While it has been suggested that higher doses of vitamin D are more effective than lower ones, more recent evidence suggests that higher doses in older populations may have the opposite effect, being associated with more frequent falls and fractures.
A randomized, double-blinded, placebo-controlled Phase 2 pilot study (NCT01119131) evaluated the safety and effectiveness of high-dose vitamin D supplementation on balance, gait, falls, strength, and cognition in Parkinson’s patients. Disease severity and quality of life were also assessed.
Researchers analyzed the data of 51 patients, at a mean age of 66.57 years, who were randomized to receive either a high dose of vitamin D (27 patients) or a placebo (24 patients), in addition to 1,000 mg of calcium, daily for four months.
Balance function was measured using the Sensory Organization Test (SOT), an objective test to measure impairments in postural stability or balance, which has been found to be the most suitable for assessing balance in relation to vitamin D levels.
Results showed that vitamin D supplementation doubled patients’ vitamin D blood levels after four months of treatment, while patients who received placebo showed no substantial changes in their levels.
Patients receiving the high dose of the supplement showed no significant improvements in balance, compared with those in the placebo group. In addition, no significant changes were found for gait, strength, cognition, disease severity, or quality of life between the two groups of patients.
However, when researchers divided the patients who received vitamin D into two age groups — those 66 or younger, and those 67 and older — the supplement was found to significantly improve the balance of patients in the younger group, compared with the older age group. No significant therapeutic effect of the supplement was found for any of the other measures.
High-dose vitamin D supplementation appeared to be safe, with no serious adverse events reported.
These findings highlight the possibility of an “age-dependent role for vitamin

Source: Parkinson's News Today

Nutritional Supplement Boosts Benefits of Physical Rehabilitation in Patients With Parkinson’s or Parkinsonism, Study Shows

nutritional supplement

A whey protein-based nutritional supplement improved motor functions in patients with Parkinson’s or parkinsonism who were engaged in an intensive physical rehabilitation program, according to clinical trial results.

The study, “PROtein, LEucine And vitamin D Enhancing Rehabilitation (PRO-LEADER) in patients with Parkinson’s disease or parkinsonism: An RCT,” was presented at the 2018 World Congress on Parkinson’s Disease and Related Disorders (IAPRD), held in Lyon, France.

Physical rehabilitation is a relevant approach for the treatment of motor impairment in patients with Parkinson’s or parkinsonism, a general term for neurological disorders that cause movement problems similar to those of Parkinson’s disease patients.

In the elderly, scientists have shown that muscle-targeted nutrition­al support can increase muscle mass and improve physical performance. However, no such evidence is available in patients with parkinsonian syndromes, which include Parkinson’s, progressive supranuclear palsy and multiple system atrophy, among other conditions, and are characterized by muscle dysfunction, especially weakness.

Researchers conducted a randomized clinical trial (NCT03124277) in Milan, Italy, testing the effectiveness of a specific regimen of muscle-targeted nutritional support on the functional status of patients with Parkinson’s or parkinsonism undergoing a multidisciplinary intensive rehabilitation treatment (MIRT).

The trial included 150 patients (children, adults and elderly) who received a standard hospital diet with or without a nutritional supplement called FortiFit (developed by Nutricia). Per serving (40 grams), the supplement includes 20 grams whey protein (found in dairy products), 800 IU vitamin D, 3 g total leucine (an essential amino acid, meaning it cannot be naturally produced by the body), 9 g carbohydrates, 3 g fat, and a mixture of vitamins, minerals and fibers.

Patients took the supplement twice daily for 30 days.

The team primarily focused on changes in the 6-minute walking test (6MWT), an assessment of exercise capacity. They also analyzed gait speed (with the 4-minute walking test), handgrip strength, Berg balance scale, the Self-assessment Parkinson’s Disease Disability Scale — exploring self-perceived functional status — and the timed up-and-go test (TUG), which is a measure of mobility and balance. The TUG test evaluates the time taken to stand up from an arm chair, walk a distance of three meters, turn, walk back, and sit down.

Body weight and skeletal muscle mass (SMM) also were determined.

Patients who received the supplement experienced a greater increase in the distance walked in the 6MWT (mean 69.6 vs. 51.8 meters without the supplement). When accounting for changes in dopaminergic therapy as well as in SMM, the team found a similar 18.0 meters difference.

Taking the supplement also improved gait speed (0.07 m/s), TUG test score (-1.1 s), and SMM (0.5 kg).

“In patients with [Parkinson’s] or parkinsonism, the consumption of a whey protein-based nutritional formula enriched with essential amino acids and vitamin D improved the efficacy of a MIRT, particularly lower body physical function,” researchers concluded.

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Source: Parkinson's News Today