Manzo Ciro, Castagna Alberto, Palummeri Ernesto, Traini Enea, Cotroneo Antonino Maria, Fabbo Andrea, Natale Maria, Gareri Pietro, Putignano Salvatore
Centro delle Demenze, Distretto Sanitario 51, ASL NA 3 Sud, Pomigliano d'Arco (NA) - Coordinatore dello studio COGNIDAGE.
Casa della Salute di Chiaravalle, Azienda Sanitaria Provinciale, Catanzaro - Co-coordinatori dello studio COGNIDAGE.
Recenti Prog Med. 2016 Feb;107(2):75-83. doi: 10.1701/2152.23270.
The aim of the COGNIDAGE study was to examine the association between 25(OH)D and cognitive status in a group of elderly patients with vitamin D deficiency and high burden of comorbidities attending Geriatric Outpatient Clinics.
We studied the relationship between 25(OH)D and cognitive functions taking into account comorbidities and cognitive functions assessed by MMSE (Mini Mental State Examination), CDT (Clock Drawing Test) and CIRS (Cumulative Illness Rating Scale), in 132 consecutive elderly patients with low levels of 25(OH)D (<10 ng/ml) compatible with the condition of vitamin deficiency. The association among 25(OH)D levels, MMSE score, CDT score and CIRS scores were analyzed using Pearson correlation. All the elderly patients received an adequate vitamin D supplementation and were reassessed after 6 months.
At baseline, mean MMSE and CIRS scores were: 21.8+5.56 and 2.96 +1.63 respectively. Mean CDT score was 3,66+-2.05. No associations were found between 25(OH)D levels and global cognitive function. A significant relationship was observed between the total CIRS score and 25(OH)D levels (r=0.305; p=0.000) as well as between total CIRS score and MMSE (r=-0.375; p=0.000). After 6 months, 83.9 % had 25(OH)D levels >20 ng/ml. Mean MMSE and CDT scores were 22.20+-5.76 and 3.90+-2.06 respectively. There was no significant correlation among 25(OH)D, MMSE and CDT scores while a significant correlation was found between 25(OH)D and CIRS- severity score (r=0.275; p=0.001) and between MMSE and total CIRS scores (r=-0.247; p=0.005 for CIRS-comorbidities; r=-0.184; p=0.04 for CIRS-severity). A post hoc evaluation on two subgroups of elderly patients (the first with vitamin D deficiency without cognitive impairment, the second with vitamin D deficiency and dementia) showed a statistically significant difference (p=0.00001) regarding the CIRS-comorbidities scores.
In our cohort of elderly patients with a high burden of comorbidities, 25(OH)D low levels (<10 ng/ml) are not associated with MMSE and CDT scores. There is no statistically difference among the levels of 25(OH)D and MMSE and CDT scores after 6 months. The strong correlation we found regarding CIRS-comorbidities in the two sub-groups suggests that vitamin D deficiency may play a role in promoting cognitive impairment only with comorbidities.
COGNIDAGE研究的目的是在一组患有维生素D缺乏症且合并症负担较重的老年患者中，研究25(OH)D与认知状态之间的关联，这些患者在老年门诊就诊。
我们研究了132例连续的25(OH)D水平低（<10 ng/ml）且符合维生素缺乏症情况的老年患者中，25(OH)D与认知功能之间的关系，同时考虑了合并症以及通过简易精神状态检查表（MMSE）、画钟试验（CDT）和累积疾病评定量表（CIRS）评估的认知功能。使用Pearson相关性分析25(OH)D水平、MMSE评分、CDT评分和CIRS评分之间的关联。所有老年患者均接受了充足的维生素D补充，并在6个月后重新进行评估。
基线时，MMSE和CIRS的平均得分分别为：21.8 + 5.56和2.96 + 1.63。CDT的平均得分为3.66 ± 2.05。未发现25(OH)D水平与整体认知功能之间存在关联。观察到CIRS总分与25(OH)D水平之间存在显著关系（r = 0.305；p = 0.000），以及CIRS总分与MMSE之间存在显著关系（r = -0.375；p = 0.000）。6个月后，83.9%的患者25(OH)D水平>20 ng/ml。MMSE和CDT的平均得分分别为22.20 ± 5.76和3.90 ± 2.06。25(OH)D、MMSE和CDT评分之间无显著相关性，而25(OH)D与CIRS严重程度评分之间存在显著相关性（r = 0.275；p = 0.001），MMSE与CIRS总分之间也存在显著相关性（CIRS合并症方面r = -0.247；p = 0.005；CIRS严重程度方面r = -0.184；p = 0.04）。对两组老年患者亚组（第一组为无认知障碍的维生素D缺乏症患者，第二组为维生素D缺乏症合并痴呆患者）进行的事后评估显示，在CIRS合并症评分方面存在统计学显著差异（p = 0.00001）。
在我们这组合并症负担较重的老年患者中，25(OH)D低水平（<10 ng/ml）与MMSE和CDT评分无关。6个月后，25(OH)D水平与MMSE和CDT评分之间无统计学差异。我们在两个亚组中发现的CIRS合并症方面的强相关性表明，维生素D缺乏可能仅在合并症存在时才在促进认知障碍中起作用。
