The state of Vitamin D in Iraqi Patients With Parkinson Disease

Al-Kindy College Medical Journal 2017: Vol.13 No. 1 137 www.kmjub.com ABSTRACT Background: A role for vitamin D deficiency in Parkinson disease (PD) has recently been suggested. Objective:: To estimate the state of vitamin D in PD with an age-matched healthy control. Type of the study: A case control study. Method: The study randomly comparison of plasma 25hydroxyvitamin D (25[OH] D) concentrations of collected samples in a clinical neurology department ward / Baghdad teaching hospital / Medical City and Parkinson disease movement disorder clinic. Participants were registered into the study from October 2015 to October 2016. We was study serum vitamin D level in 40 consecutive patients with Parkinson disease and 40 age-matched healthy controls after matching for age, sex, race, and geographic location. Occurrence of suboptimal vitamin D 25(OH) concentrations in Parkinson patients. Results: Significantly, more patients with PD (62.5%) had deficient vitamin D than did controls (27.5%). The mean 25(OH) D concentration in PD was (18.09) significantly lower than in the control (24.89).. Conclusions: This study demonstrates a significantly lower vitamin D level in PD than healthy controls. These data support a possible role of vitamin D deficiency in PD.

problems may also occur.Dementia becomes common in the advanced stages of the disease.Depression and anxiety are also common occurring in more than a third of people with PD. [2] other symptoms include sensory, sleep, and emotional problems. [1][2]The main motor symptoms are collectively called "parkinsonism", or a "parkinsonian syndrome".[3]   Table (1) [4]   The cause of Parkinson's disease is generally unknown, but believed to involve both genetic and environmental factors.Those with a family member affected are more likely to get the disease themselves. [3]There is also an increased risk in people exposed to certain pesticides and among those who have had prior head injuries while there is a reduced risk in tobacco smokers and those who drink coffee or tea. [3][5]Vitamins D Important for maintaining many physiologic functions and vitamin D deficiency is associated with increased risk of disease.Optimal balance, muscle strength, and innate immunity require adequate vitamin D levels.[6] [7] [8] vitamin D deficiency is associated with increased risk for several types of cancer, as well as autoimmune and cardiovascular disorders.Given the high prevalence rates of vitamin D deficiency in such varied populations as elderly patients, chronically ill patients, healthy young adults and the widespread distribution of the VDRs and 1_-OHase in brain and muscle, [15] [16] optimal vitamin D status may be important for preventing or treating neurodegenerative disorders.Active  [16] In the brain, VDRs localize in the nucleus, whereas 1_-OHase is distributed throughout the cytosol.In particular, hippocampal and substantia nigra cells demonstrate high concentrations of VDRs and 1_-OHase. [15]Finally the American geriatric society recommended vitamin D and calcium supplement to prevent fall in elderly .theyrecommended that 65 years old or older should consume 1000 I.U.vitamin D daily along with Calcium 1000-1200 mg daily. [17]one recent review of multiple study that vitamin D supplement in old people reduce fall by 20%. [18]both biological plausibility and epidemiology data indicate that vitamin D level deficiency may contribute to the development of PD .
[  [19] Patients having a weight range from (45-85) kg.Patients are aged more than 40 years old.

UK Parkinson's Disease Society Brain Bank Clinical
Diagnostic Criteria [19]   Step 1: Establish the presence of bradykinesia (slowness of initiation of voluntary movement with reduced speed and amplitude of movements and/or the loss or decrease of automatic movements) plus at least one of the following:Rigidity, 4Y6 Hz resting tremor, Postural instability (not otherwise explained by primary visual, vestibular, cerebellar, or proprioceptive dysfunction) Step All patients were screened according to a strict protocol consisting of a full neurological examination, standardized blood tests and electrolytes included serum Calcium and phosphate and parathyroid hormone, magnetic Resonance imaging of the brain and cardiac analysis including standard 12-lead electrocardiography in all patients and serum vitamin D3.Serum levels of 25(OH) D were stratified into normal (≥30 ng/ml), insufficient (≥20 to <30 ng/ml) and deficient (<20 ng/ml).[21]   Statistical Analysis: Data were analyzed by means of statistical package for social sciences (SPSS) software programs.Values were expressed as mean +\-SD.a comparison of continuous variables was performed by unpaired two-tailed Student's t test.A level of P<.05 (two-sided testing) was considered statistically significant.
Result: We was study 40 patients in-group I (PD patients), the Mean age of the patients was 59.225 ± 5.968 years and 40 healthy patient in-group II (control) with mean age 59.750 ± 5.674.In the group I (PD patients), there was 24 Male and 16 female, with mean BMI 21.958 and residency distributed in to 23 urban and 17 rural.In the group II (control), there was 23 male and 17 female, with mean BMI 23.277 and residency distributed in to 28 urban and 12 rural (Table 2).This study, show there is no significant difference between the two groups regarding the age, sex, BMI, or residency (Table 2).We found that is a significant relationship between the two groups regarding the vitamin D level.In-group I (PD patients) the mean vitamin D level was 18    However, the finding of low levels of 25(OH) D in individuals with Parkinson could be explained by the insufficient synthesis in the skin as PD patients experience mobility problems more frequently than control healthy persons this make a PD patient less likely to get sun exposure and account for the higher prevalence of vitamin D deficiency.In addition, inadequate intake or absorption of vitamin D, low seafood intake, limited outdoor activities, and decreased awareness about fortification with vitamin D may affect vitamin D status in these groups. [24]An alternative aspect was ruled out such as age, sex and BMI, the impacts of these factors on vitamin D status, were no significant.Several lines of evidence point to possible role of vitamin D in PD ,Studies of brain tissue show that receptors for vitamin D are widely distributed in brain are affected by PD suggested an important role in normal function.[15] [25] This result agree with study done in 2008 at Emory University School of Medicine establish both patients with Parkinson disease and Alzheimer disease had significantly lower vitamin D level. [26]Also, approve in Study by Dr. Yoshihiro Sato, Department of Neurology, Kurume University Medical Center that found a High prevalence of vitamin D deficiency and reduced bone mass in Parkinson's disease. [27]Furthermore this study is compatible with study done In Iran, at 2013 study include Eighty-three patients with Parkinson's disease (PD) were recruited using simple non-random sampling.25  [ 29] The vitamin D receptors found in high concentration in substetia nigra, the region of brain affected by PD .vitaminD exhibit a neuroprotective effect through antioxidant mechanism, neuronal calcium regulation, immunomodulation lead to enhance nerve conduction and detoxification mechanism.[25]   According to gender in current study, there is no significant difference between male and female with Parkinson patients in VDL.This finding reported by Isfahan Neurosciences Research Center study 109 patient of PD at 2013 the result High prevalence of 25OHD insufficiency but no sex difference in VDL with Mean ± SD levels of 25OHD were 28.5 ± 1.4 and 27.1 ± 1.5, for males and females, respectively.

Figure 1
Figure 1 state of VDL in PD and control

Figure 2
Figure 2 frequency of VDL in PD according to severity of deficiency.
-hydroxyvitamin D [25(OH) D3] was measured by Electro chemilumine scence immunoassay (ECLIA) The mean 25(OH) D3 concentration was lower in the PD population than in the normal group.

[ 28 ]
Accumulating data have provided evidence that 1α,25 dihydroxyvitamin D3 [1,25-(OH)2D3] is involved in brain function.Thus, the nuclear receptor for 1,25-(OH)2D3 has been localized in neurons and glial cells.The reported biological effects of 1,25-(OH)2D3 in the nervous system include the biosynthesis of neurotrophic factors and at least one enzyme involved in neurotransmitter synthesis.1,25-(OH)2D3 can also inhibit the synthesis of inducible nitric oxide synthase and increase glutathione levels, suggesting a role for the hormone in brain detoxification pathways.Neuroprotective and immunomodulatory effects of this hormone have been described in several experimental models, indicating the potential value of 1,25-(OH)2D3 and pharmacological analogs in neurodegenerative and neuroimmune diseases.
Chronic renal failure.4. Patients have other diseases like DM, cardiovascular and CNS diseases.5. Patients take vitamins supplements.6. Patients with abnormal parathyroid hormone.
2: Evaluate for exclusionary criteria for the diagnosis of Parkinson disease.The absence of a history of: Repeated strokes with a stepwise progression of Parkinsonism, Repeated head injury, Definite encephalitis, Neuroleptic treatment at onset of symptoms, More than one affected relative (although this exclusion criterion is no longer commonly used), Any period of sustained remission, Oculogyric crises 2. Secondary Parkinsonism (drug-induced, vascular, structural, infectious, immunologic, toxic, traumatic, metabolic).The state of Vitamin D …. Aqeel Kareem Hatem and Hayder Fadhil Lateef Al-Kindy College Medical Journal 2017: Vol.13 No. 1 139 www.kmjub.com3.

Table 4 .
relation VDL between male and female in PD