A Randomized Controlled Trial of High-Dose Vitamin D2 Followed by Intranasal Insulin in Alzheimer's Disease
| Autor: | Samuel C Scherer, Kylie S Ladd, Leonard C. Harrison, Mark S. Stein |
|---|---|
| Rok vydání: | 2011 |
| Předmět: |
Male
Vitamin medicine.medical_specialty Randomization medicine.medical_treatment Pilot Projects Neuropsychological Tests Placebo Gastroenterology vitamin D deficiency law.invention chemistry.chemical_compound Cognition Double-Blind Method Randomized controlled trial Alzheimer Disease law Internal medicine medicine Vitamin D and neurology Humans Hypoglycemic Agents Insulin Dementia Administration Intranasal Aged 80 and over Depression business.industry General Neuroscience Wechsler Scales Vitamins General Medicine Middle Aged Vitamin D Deficiency medicine.disease Psychiatry and Mental health Clinical Psychology Treatment Outcome Endocrinology chemistry Dietary Supplements Ergocalciferols Linear Models Feasibility Studies Female Geriatrics and Gerontology business |
| Zdroj: | Journal of Alzheimer's Disease. 26:477-484 |
| ISSN: | 1875-8908 1387-2877 |
| DOI: | 10.3233/jad-2011-110149 |
| Popis: | Poor vitamin D nutrition is linked with dementia, but vitamin D has not been tested in a randomized controlled trial (RCT) in Alzheimer's disease (AD). Nasal insulin acutely improves cognition and vitamin D upregulates insulin receptor expression and enhances insulin action. In an RCT we examined the effect of high-dose vitamin D followed by nasal insulin on memory and disability in mild-moderate AD. 63 community-dwelling individuals aged > 60 were recruited; 32 with mild-moderate disease (Folstein Mini-Mental State Examination [MMSE] score 12-24) met entry criteria and were randomized. All took low-dose vitamin D (1000 IU/day) throughout. After run-in (8 weeks), they were randomized to additional high-dose D/placebo for 8 weeks, followed immediately by randomization to nasal insulin (60 IU qid)/placebo for 48 h. Primary outcome measures were Alzheimer's disease assessment scale-cognitive subscale (ADAS-cog) and Disability Assessment in Dementia (after high-dose D) and ADAS-cog and Wechsler Memory Scale-Revised Logical memory (WMS-R LM) for immediate and delayed recall (after nasal insulin). Baseline median (interquartile range, IR) age, MMSE, and ADAS-cog were 77.5 (69-80), 19.5 (17-22), and 25.5 (20-31), respectively. Median 25OHD increased from 49 to 60 nM (p < 0.01) after run-in and was 187 nM after high-dose vitamin D and 72 nM after placebo (p < 0.001). Neither cognition nor disability changed significantly after high-dose D. ADAS-cog improved by a median (IR) of 9 (1-11) with nasal insulin after placebo high-dose vitamin D (p = 0.02), but may represent regression to the mean as WLS-R LM did not change. We conclude that high-dose vitamin D provides no benefit for cognition or disability over low-dose vitamin D in mild-moderate AD. |
| Databáze: | OpenAIRE |
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