Lack of Vitamin D Linked to Parkinson's Disease

A majority of Parkinson’s disease patients had insufficient levels of vitamin D in a new study from Emory University School of Medicine.

The fraction of Parkinson’s patients with vitamin D insufficiency, 55 percent, was significantly more than patients with Alzheimer’s disease (41 percent) or healthy elderly people (36 percent).

The results are published in the October issue of Archives of Neurology.

The finding adds to evidence that low vitamin D is associated with Parkinson’s, says first author Marian Evatt, MD, assistant professor of neurology at Emory.

Evatt is assistant director of the Movement Disorders Program at Wesley Woods Hospital. The senior author is endocrinologist Vin Tangpricha, MD, assistant professor of medicine at Emory and director of the Endocrine Clinical Research Unit.

Evatt says her team compared Parkinson’s patients to Alzheimer’s patients because they wanted to evaluate the possibility that neurodegenerative diseases in general lead to vitamin D insufficiency.

Most Americans get the majority of their vitamin D from exposure to sunlight or by dietary supplements; fortified foods such as milk and packaged cereals are a minor source. Only a few foods in nature contain substantial amounts of vitamin D, such as salmon and tuna.

The body’s ability to produce vitamin D using UV-B radiation from the sun decreases with age, making older individuals at increased risk of vitamin D deficiency.

“We found that vitamin D insufficiency may have a unique association with Parkinson’s, which is intriguing and warrants further investigation,” Evatt says.

The connection could come partly because patients with Parkinson’s have mobility problems and are seldom exposed to the sun, or because low vitamin D levels are in some way related to the genesis or progression of the disease.

She says her team saw their results as striking because their study group came from the Southeast, not a region with long gloomy winters, where vitamin D insufficiency is thought to be more of a problem.

In addition, the study found that the fraction of patients with the lowest levels of vitamin D, described as vitamin D deficiency, was higher (23 percent) in the Parkinson’s group than the Alzheimer’s group (16 percent) or the healthy group (10 percent).

The retrospective study examined 100 people in each group, who were recruited between 1992 and 2007. Every fifth Parkinson’s patient from Emory’s clinical neurology database was selected, then healthy controls and patients with Alzheimer’s disease were matched on age and state of residence.

Vitamin D insufficiency is frequently defined as less than 30 nanograms per milliliter of blood of the 25-hydroxy form (the major storage form) of the vitamin and deficiency as less than 20 nanograms per milliliter. However, most experts agree insufficiency warrants treatment and should not be ignored.

Doctors have known for decades that vitamin D plays a role in bone formation, Evatt says. More recently, scientists have been uncovering its effects elsewhere, including producing peptides that fight microbes in the skin, regulating blood pressure and insulin levels, and maintaining the nervous system. Low vitamin D levels also appear to increase the risk of several cancers and auto-immune diseases such as multiple sclerosis and diabetes.

Parkinson's disease affects nerve cells in several parts of the brain, particularly those that use the chemical messenger dopamine to control movement. The most common symptoms are tremor, stiffness and slowness of movement. These can be treated with oral replacement of dopamine.

Previous studies have shown that the part of the brain affected most by Parkinson’s, the substantia nigra, has high levels of the vitamin D receptor, which suggests vitamin D may be important for normal functions of these cells, Evatt says.

Emory clinicians are conducting further research to investigate whether vitamin D insufficiency is a cause or possibly a result of having Parkinson’s. In a pilot study, Parkinson’s patients are receiving either standard or larger doses of vitamin D, with an eye towards possibly reducing the severity of their condition.

The research was funded by the National Center for Research Resources, the National Institute of Aging and the National Institute of Environmental Health Sciences of the National Institutes of Health, and by an anonymous donor.

Reference:
Evatt M.L et al Prevalence of Vitamin D Insufficiency in Patients with Parkinson Disease and Alzheimer Disease. Arch. Neurol. Vol 65, p. 1348-1352 Oct 2008.

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HHS Announces $36 Million to Help Older Americans and Veterans Remain Independent

The U.S. Department of Health and Human Services (HHS) today announced
$36 million in new grant programs to 28 states to help older Americans
and veterans remain independent and to support people with Alzheimer's
disease to remain in their homes and communities. Just over $19 million
of this funding involves a new collaboration with the U.S. Department of
Veterans Affairs (VA).

HHS Secretary Mike Leavitt and VA Secretary James Peake, M.D., announced
the joint effort to provide essential consumer-directed home and
community-based services to older Americans and veterans of all ages, as
part of a Nursing Home Diversion (NHD) grants program. The new
initiative builds on the similar missions of HHS and the VA with regard
to caring for the populations they serve. In addition, Secretary
Leavitt announced a $17 million investment to improve the delivery of
home and community-based services to people with Alzheimer's disease and
their family caregivers.

In announcing the collaboration, Secretary Leavitt said, "This historic
HHS-VA initiative combines the expertise of the HHS' national network of
aging services providers with the resources of the Veterans Health
Administration to provide more people, including our nation's veterans,
with improved long-term care options. This unique effort supports the
President's New Freedom Initiative which calls upon all federal agencies
to help people who need long-term care and prefer to live in their own
homes and communities to do so. Through this joint program, many people
who would have previously been placed in nursing homes will be able to
remain at home."

"Our mission is to honor and support America's veterans, and this
collaboration provides an additional opportunity to do that by offering
more services, choices and control over decisions to veterans in the
least restrictive environment consistent with their needs and
preferences," Secretary Peake said.

The new program will be administered by HHS' Administration on Aging
(AoA) in collaboration with the Veterans Health Administration. Under
the program, $10.5 million is being provided by HHS through AoA, and
$5.7 million by the states. VA estimates purchasing at least $3 million
in veteran-directed home and community-based services for older veterans
and for recently returned veterans with long-term care needs. The
number of veterans over age 85 has tripled during the past decade,
creating a significant expansion in the need for long term care.

"The HHS funding is specifically designed to reach people who are not
eligible for Medicaid, but who are at high risk of nursing home
placement and spend-down to Medicaid -which often occurs when private
pay individuals enter a nursing home," said Assistant Secretary for
Aging Josefina G. Carbonell. "The program will also offer consumers
more control over their long-term care, including the ability to
determine the types of services they receive and the manner in which
they receive them, including the option of hiring their own care
workers."

The $17 million for individuals with Alzheimer's disease and their
caregivers involves grants to 22 states under AoA's Alzheimer's disease
demonstration programs. States were able to apply for two types of
grants: Innovation Grants and Evidence-Based Program Grants. Innovation
Grants will demonstrate new approaches to delivering services and
supports, and the Evidence-Based Grants will support the replication of
science-based interventions that have already proven to be effective at
helping people with Alzheimer's Disease and Related Disorders to
continue to live in the community.

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Alzheimer's Passes Diabetes As Sixth Leading Cause Of Death In U.S.

(SPM Wire) Alzheimer's disease is now the sixth leading cause of death in the United States, according to the Centers for Disease Control and Prevention (CDC) National Center for Health Statistics.

The CDC estimates that 72,914 Americans died of Alzheimer's disease in 2006. With an unprecedented historic population shift of 78 million aging baby boomers in the country and this disease poised to strike 10 million boomers -- it is clear this escalating epidemic must be addressed now.

Today, as many as 5.2 million Americans are living with Alzheimer's disease. The Alzheimer's Association's "2008 Alzheimer's Disease Facts and Figures" report revealed one out of eight baby boomers will develop this disease that currently has no effective disease-modifying treatments to halt or delay its progression.

Experts predict by 2010, there will be almost a half million new cases of Alzheimer's disease each year; and by 2050, there will be almost a million new cases each year.

"The CDC's announcement that Alzheimer's disease jumped from the seventh to the sixth leading cause of death should serve as a wake-up call to the nation," said William Thies, PhD, vice president of Medical and Scientific Relations at the Alzheimer's Association. "The fact that there are no effective treatments for Alzheimer's has allowed the disease to pass diabetes. It is vitally important that we increase Alzheimer's research funding to slow or stop the progression of this devastating disease."

Researchers are closing the gap in developing accurate ways to diagnose and treat Alzheimer's.

Although there are several promising drugs currently in Phase III clinical trials, many feel that insufficient research funds are committed to research focused on Alzheimer's disease treatment and prevention. This situation is further compounded by the fact that for the past five years the NIH budget has been essentially flat, stresses the Alzheimer's Association, which continues to push for the acceleration of research.

The CDC also reported that while deaths from Alzheimer's disease were on the rise, other chronic conditions were on the decline. Between 2005 and 2006, the largest decline in age-adjusted death rates occurred for influenza/pneumonia (12.8 percent), and also included chronic lower respiratory diseases (6.5 percent), stroke (6.4 percent), heart disease (5.5 percent) diabetes (5.3 percent), hypertension (5 percent), chronic liver disease (3.3 percent) and cancer (1.6 percent).

The Alzheimer's Association is the leading voluntary health organization in Alzheimer care, support and research. For more information, visit www.alz.org.