Serum Vitamin D And Cognitive Function And Depression In Parkinson’s Disease

Part I Clinical relationship between serum vitamin D and different cognitive domains in parkinson’s diseaseObjective To observe serum vitamin D level and different cognitive domains in patients with Parkinson’s disease(PD).To assess the correlation between serum vitamin D and specific cognitive domains in patients with PD.Methords Serum 25-hydroxy vitamin D level were detected in 77 PD patients and 34 healthy controls who were recruited form the second affiliated hospital of Soochow university from Dce 2014 to Jun 2016.Mini-mental state examination(MMSE),Montreal cognitive assessment scale(Mo CA)and complete scales of cognitive function were used to evaluate the cognitive function of PD patients and healthy controls.Unified Parkinson’s Disease Rating Scale III(UPDRS-III)and Hoehn & Yahr(H-Y)stage were administered to evaluate the motor function.Hamilton depression rating scale(HAMD)was administered to evaluate the degree of depression on PD patients.Results(1)Serum vitamin D levels of PD patientss(37.5±13.2nmol/L)were significantly lower than those of healthy controls(47.2±17.1nmol/L)(t=-3.154,P=0.002).MMSE and Mo CA score of PD patients in demented and non-demented subsets were significantly lower than those of health controls(all P<0.05).There were significant differences in several cognitive domains between PD demented(PDD)subset and PD non-demented(PDND)subset when compared to health controls(all P<0.05).(2)There were significantly negative correlation between serum vitamin D and disease duration and H-Y stage in PD patients(r1=-0.372,P1=0.002;r2=-0.292,P2=0.010).Significant positive associations were respectively found between vitamin D levels and the scores of immediate memory,short delay memory,and long delay memory(P1=0.005;P2=0.007;P3=0.014)in non-demented PD subset.Conclusion The serum vitamin D levels in PD patients were significantly lower than those of healthy controls.The serum vitamin D level had a decreased tendency with disease duration and severity in PD patients.The increase of serum vitamin D had protective effect on the memory function of PDND.Part Ⅱ Relative analysis between serum vitamin D and cognitive function and gray matter volume in non-dementia patients with Parkinson’s diseaseObjectives To measure the volume of cerebral gray matter(GMV)in PD non-dementia patients(PDND)with Magnetic resonance imaging-voxel based morphometry(MRI-VBM)technology.To analyze the correlation between vitamin D levels and GMV of brain and cognitive function in PDND patients.To explore the neuropathological basis for the effect of vitamin D on cognitive function in PDND patients.Methords Baseline neuropsychiatric performance and serum 25-hydroxy vitamin D level were examined in 24 outpatient or hospitalized patients with PDND and 24 healthy controls in the second affiliated hospital of Soochow university from January 2016 to March 2017.Mini-mental state examination(MMSE),Montreal cognitive assessment scale(Mo CA)and complete scales of cognitive function were used to evaluate the cognitive function of PD patients and healthy controls.Unified Parkinson’s Disease Rating Scale III(UPDRS-III)and Hoehn & Yahr(H-Y)stage were administered to evaluate the motor function.Hamilton depression rating scale(HAMD)was administered to evaluate the degree of depression in PD patients.The images were conducted with Philips Achieva 3.0 Tesla MR system,and the high resolution 3D T1-weighted structural images were achieved on 24 PD patients.We applied VBM analysis to preprocess the 3D-T1 WI whole brain structure images(including standardization,excision,smooth and so on).Data were attained from the images by using Statistical Parametric Mapping(SPM),to explore the relativity between GMV in whole brains and serum vitamin D level and cognitive function scores.Results(1)Serum vitamin D levels of PDND group(41.8±16.0 nmol/L)were significantly lower than those of healthy controls(50.5±9.3 nmol/L)(t=-2.301,P=0.027).(2)The scores of symbol digit modalities test,clock drawing test,Rey-Osterrieth complex figure test,animal words flow test,Boston naming test were lower,and the scores of trail marking test A and B were higher in PDND patients compared with healthy controls(all P<0.05).(3)Higher vitamin D levels were associated with better performance on some neuropsychiatric tests in PDND patients.Significant positive correlations were specifically found between serum vitamin D levels and the scores of symbol digit modalities test and Rey auditory verbal learning test(all P<0.05).Significant negative correlations were found between serum vitamin D levels and the scores of trail marking test A(P<0.05).(4)The results of multiple regression analysis showed that GMV in the right fusiform gyrus positively correlated with serum vitamin D level(P<0.001).There were significantly positive correlations between GMV in the right fusiform gyrus and the scores of immediate recall,short delay recall of auditory verbal learning test(P1=0.019,P2=0.046).Conclusions The serum vitamin D levels in PDND patients were significantly lower than those of healthy controls.As the levels of serum vitamin D decreased,the GMV of the right fusiform gyrus reducted in PDND patients.Moreover,PD patients with reducted GMV of right fusiform gyrus had worse scores of immediate recall and short delay recall in auditory verbal learning test.Therefore it was speculated that the low level of serum vitamin D in PDND patients may reduce the patients’ auditory understanding and memory function by reducing the volume of the right fusiform gyrus.Part Ⅲ Relative analysis between serum vitamin D and depression and cerebral blood perfusion in Parkinson’s diseaseObjectives To observe depression,serum vitamin D level and 99mTc-ECD SPECT/CT cerebral blood perfusion imaging in patients with Parkinson’s disease(PD).To evaluate the correlations between depression and serum vitamin D level and cerebral blood perfusion in PD patients.Methords From October 2015 to March 2017,80 patients with PD hospitalized in the second affiliated hospital of Soochow university were recruited.Baseline neuropsychiatric performance and serum 25-hydroxyvitamin D level were examined,and 99mTc-ECD SPECT/CT cerebral blood perfusion imaging were performed.Mini-mental state examination(MMSE),Montreal cognitive assessment scale(Mo CA)and complete scales of cognitive function were used to evaluate the cognitive function.Unified Parkinson’s Disease Rating Scale III(UPDRS-III)and Hoehn & Yahr(H-Y)stage were administered to evaluate the motor function.Hamilton depression rating scale(HAMD)was administered to evaluate the degree of depression.According to the scores of HAMD,PD patients were divided into depression group and none depression group.The differences of serum vitamin D level,various scores,and 99mTc-ECD SPECT/CT cerebral blood perfusion tomography between two PD groups were analyzed.The relationships between serum vitamin D level,and depression score,and 99mTc-ECD SPECT/CT cerebral blood perfusion tomography in PD patients was evaluated.Results(1)Serum vitamin D levels of PD depression group(36.66±13.95nmol/L)were little lower than those of PD none depression group(39.91±12.68nmol/L)(t=-0.958,P=0.341).The duration,H-Y stage,UPDRS III and levodopa equivalent doses of PD depression group were significantly higher than those of PD non-depression group(P<0.01).(2)The HAMD scores of PD patients were significantly positively correlated with PD courses and UPSRS-III scores(P1=0.019,P2<0.001),which had significant negative correlation with serum vitamin D levels(P=0.022).(3)HAMD scores were significantly negatively correlated with cerebral blood flow perfusion of both bilateral frontal lobes and left temporal lobe(all P<0.05).(4)Serum vitamin D levels were significantly positively correlated with cerebral blood flow perfusion of bilateral frontal lobe and occipital lobe and right parietal lobe(all P<0.05).Conclusions Depression became more serious in PD patients with longer course,with more severity,and with lower levels of serum vitamin D.As cerebral blood perfusion of bilateral frontal lobe and left temporal lobe decreased,depression reduced in PD patients.Moreover,PD patients with decreased levels of serum vitamin D had reducted cerebral blood perfusion of bilateral frontal lobe and occipital lobe and right parietal lobe.Therefore it was speculated that the low levels of serum vitamin D in PD patients may affect the PD associated depressive symptoms by reducing the cerebral blood perfusion of bilateral frontal lobe.