Vitamin D-Mentia: Randomized Clinical Trials Should Be the Next Step
Vitamin D-Mentia: Randomized Clinical Trials Should Be the Next Step
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DOI：
10.1159/000334177
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发表时间：
2011-01-01
影响因子：
5.7
通讯作者：
Beauchet, Olivier
中科院分区：
文献类型：
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作者：
Annweiler, Cedric;Beauchet, Olivier
维生素D缺乏症在老年人中非常普遍。它在阿尔茨海默病（AD）发病机制中的可能作用尤为重要，因为AD仍然是一个公共卫生问题，目前尚无有效的治疗方法。维生素D可以作为一种多靶点稳定治疗AD的方法，因为维生素D同时通过免疫调节、抗氧化和抗缺血作用，以及调节神经营养因子、乙酰胆碱神经递质和清除淀粉样蛋白肽，从而靶向导致神经退行性变的多种因素，避免甲状旁腺功能亢进。通过预防神经元丧失，问题是纠正老年人维生素D缺乏症是否也能预防ad相关的认知能力下降。维生素D摄入量（无论是通过饮食、阳光照射还是药物补充）与认知之间的横断面关联强化了这一假设，但阻碍了因果关系的发现。前后研究表明，认知能力的改善伴随着25-羟基维生素D浓度的增加。一项随机试验发现，超生理剂量的维生素D在改善AD患者认知方面并不比生理剂量更好。在这个阶段，只有临床试验测试维生素D补充剂与安慰剂，才能进一步确定维生素D给药对认知和AD的影响，证据水平更高。巴塞尔S. Karger股份有限公司版权所有
Hypovitaminosis D is highly prevalent in the elderly. Its possible role in the pathogenesis of Alzheimer's disease (AD) is particularly important, as AD remains a public health concern with no current efficient treatment. Vitamin D administration could be a multitarget stabilizing treatment for AD since vitamin D simultaneously targets several factors leading to neurodegeneration through immunoregulatory, antioxidant and anti-ischemic actions, as well as the regulation of neurotrophic factors, acetylcholine neurotransmitter and clearance of amyloid beta peptide, and the avoidance of hyperparathyroidism. By preventing neuronal loss, the question is whether correcting hypovitaminosis D among older adults could also prevent AD-related cognitive decline. The cross-sectional associations between the vitamin D intakes - whether from diet, sun exposure or drug supplements - and cognition strengthened this hypothesis, but prevented the finding of a cause and effect link. Pre-post studies showed an improvement of cognition concomitant with the increase in 25-hydroxyvitamin D concentrations. One randomized trial found that supraphysiological doses of vitamin D were not better than physiological doses at improving cognition in AD. At this stage, only clinical trials testing vitamin D supplements versus placebo can further determine the impact of vitamin D administration on cognition and AD with higher levels of evidence. Copyright (C) 2011 S. Karger AG, Basel