GROUP ASSIGNMENT PROJECT Cheuk Chung (Article research, Part...

20
Running head: NTRS 417B GROUP ASSIGNMENT PROJECT 1 GROUP ASSIGNMENT PROJECT Cheuk Chung (Article research, Part I, III, VI, VII) Tin Hlaine (Article research, revised aims, part III, IV, VI, VII) Janet Chow (Article research, revised aims, part III, search criteria, part VI, VII) Eric Pau (Article research, part II, part III, V, VI, VII) NTRS 417B, Sec 02 Winter Quarter 2015 California State University, Los Angeles

Transcript of GROUP ASSIGNMENT PROJECT Cheuk Chung (Article research, Part...

Page 1: GROUP ASSIGNMENT PROJECT Cheuk Chung (Article research, Part …janetchow.weebly.com/uploads/5/2/0/5/52050405/ntrs_417b... · 2018. 8. 31. · Eric Pau (Article research, part II,

Running head: NTRS 417B GROUP ASSIGNMENT PROJECT 1

GROUP ASSIGNMENT PROJECT

Cheuk Chung (Article research, Part I, III, VI, VII)

Tin Hlaine (Article research, revised aims, part III, IV, VI, VII)

Janet Chow (Article research, revised aims, part III, search criteria, part VI, VII)

Eric Pau (Article research, part II, part III, V, VI, VII)

NTRS 417B, Sec 02

Winter Quarter 2015

California State University, Los Angeles

Page 2: GROUP ASSIGNMENT PROJECT Cheuk Chung (Article research, Part …janetchow.weebly.com/uploads/5/2/0/5/52050405/ntrs_417b... · 2018. 8. 31. · Eric Pau (Article research, part II,

NTRS 417B GROUP ASSIGNMENT PROJECT 2

Table of Contents

Title Page

1. Abstract………………………………………………………………..3

2. Introduction……………………………………………………………4

3. Literature Review……………………………………………………...7

4. Description of Population of Interest………………………....……….10

5. Summary and Overview of Proposed Work…………………………..12

6. Reference List………………………………………………………… 13

7. Appendices…………………………………………………………….16

Page 3: GROUP ASSIGNMENT PROJECT Cheuk Chung (Article research, Part …janetchow.weebly.com/uploads/5/2/0/5/52050405/ntrs_417b... · 2018. 8. 31. · Eric Pau (Article research, part II,

NTRS 417B GROUP ASSIGNMENT PROJECT 3

Abstract

Numerous research studies have found strong linkages between vitamin D deficiency and

cognitive impairment. Being the most prevalent group to dementia and Alzheimer’s disease

(AD), it is necessary to inform the elderly population as to how vitamin D deficiency may

potentially affect their quality of life mentally. 10 research studies with distinctive assessment

screening tools were carefully selected from Europe and the United States to evaluate the

legitimate association between vitamin D and cognitive impairment. These screening tools

include: Cantab neuropsych test, Cognitive Telephone Screening Instrument (COGTEL),

Mini-Mental Status Exam (MMSE), Spatial working memory test (SWM), Trail-Making Tests

(visuospatial scanning, sequential processing, motor speed, attention, and executive function). In

cooperation with cohort and cross-sectional studies, these findings provide valuable evidence for

consideration. The established goal of this project is to promote public awareness of the issue

and ultimately educate the community to maintain optimal vitamin D status by making better

food selections and extending their sunlight exposure. By doing so, incidence of vitamin D

deficiency and its possible association with cognitive impairments would be reduced, and the

older adult population could live an improved quality of life and experience healthful aging.

Page 4: GROUP ASSIGNMENT PROJECT Cheuk Chung (Article research, Part …janetchow.weebly.com/uploads/5/2/0/5/52050405/ntrs_417b... · 2018. 8. 31. · Eric Pau (Article research, part II,

NTRS 417B GROUP ASSIGNMENT PROJECT 4

Introduction

Vitamin D deficiency has always been one of the major conditions that hugely affect the

older adult population. In general, adequate intakes of vitamin D is achieved via direct sunlight

exposure and absorption from the diet. Among the older adult population, however, their ability

to obtain adequate amounts of vitamin D diminishes with age, as their cells could not efficiently

convert and metabolize vitamin D. Without adequate amounts of vitamin D, older adults’

chances of having deficiency implications increase.

When speaking consequences associated with vitamin D deficiency, researches have

begun establishing possible connections between vitamin D deficiency and dementia. According

to the Vitamin D Council (n.d.), people who are age 65 years or older with vitamin D deficiency

are four times more likely of having cognitive impairments than people with adequate intake.

Also, those with Alzheimer’s disease (AD), the sixth leading cause of death in the United States,

have fewer vitamin D receptors in the brain (Alzheimer’s Association, 2015). These vitamin D

receptors that are in the brain, according to scientists, possess neuro-protective effects by

possibly inhibiting the formation of tangles and plaques that characterizes AD (Vitamin D

Council, n.d.). With that being said, providing proper nutritional knowledge about vitamin D’s

benefits and the possible consequences of vitamin D deficiency in relation to dementia is critical

in maintaining the older adult population’s nutritional status, improving their quality of life, and

preserve their brain function.

Specific Aims

Goals:

To alleviate knowledge-deficits related to vitamin D deficiency, our goals are: 1) to

educate the older adult population on the importance of adequate vitamin d intake and the

Page 5: GROUP ASSIGNMENT PROJECT Cheuk Chung (Article research, Part …janetchow.weebly.com/uploads/5/2/0/5/52050405/ntrs_417b... · 2018. 8. 31. · Eric Pau (Article research, part II,

NTRS 417B GROUP ASSIGNMENT PROJECT 5

consequences of vitamin D deficiency, and 2) to promote awareness about the prevalence of

vitamin D deficiency in elderly population and its effects on cognitive function.

Expected Outcome(s):

The expected outcomes, in correspondence to the goals, would be: 1) increased intake of

vitamin D and reduced incidence of vitamin D deficiency, as well as possible consequences with

impaired cognitive function, and 2) increased public awareness of vitamin D deficiency and its

impact on mental health.

Impact(s) on the area of interest:

In terms of impacts, public awareness of vitamin D’s benefits, as well as consequences of

its deficiency, would increase. In fact, several research studies have shown that vitamin D has the

potential to protect against cognitive decline. In addition, people with adequate vitamin D intake

have lower risks of cardiovascular disease and hypertension, all of which affect the brain. Hence,

incorporating vitamin D into one’s lifestyle helps improve the diet and physical activity of older

adults, as eating good sources of vitamin D is a step towards a better diet and performing outdoor

physical activity certainly extends the time of sunlight exposure. Therefore, understanding the

importance of vitamin D intake and its link to cognitive function can help the general public age

healthfully, as well as reduce the rate of vitamin D deficiency.

Specific Objectives:

1. Providing educational resources about the importance of vitamin D and prevention of

vitamin D deficiency such as handouts and videos at community centers and senior

centers.

2. Incorporating food sources of vitamin D into the senior meals and snacks at the

community centers/senior centers as a way to promote vitamin D intake.

Page 6: GROUP ASSIGNMENT PROJECT Cheuk Chung (Article research, Part …janetchow.weebly.com/uploads/5/2/0/5/52050405/ntrs_417b... · 2018. 8. 31. · Eric Pau (Article research, part II,

NTRS 417B GROUP ASSIGNMENT PROJECT 6

3. Community health fairs are held every other month in senior centers, community

hospitals, and parks to increase public awareness of vitamin D deficiency and its

possible consequences.

4. Health education classes about vitamin D deficiency and its complication, vitamin D

rich foods, and also about potential danger of excessive intake vitamin D (toxicity).

5. Create community events with posters and talks regarding vitamin D deficiency and

its possible relation to dementia and other cognitive dysfunctions.

6. Encourage older adults to engage in outdoor exercises, such as tai chi or walking as a

way to increase vitamin D intake through sun exposure

Search Criteria

Criteria for selecting articles were:

o Choosing articles that are related to vitamin D deficiency and cognitive impairment in

the older adult population.

o Using keywords such as: “dementia and vitamin D in older adults”, “vitamin D and

brain health”, “vitamin D and cognition”, “vitamin D and dementia”, “vitamin D and

older adults”, “vitamin D and brain health in older adults” “vitamin D deficiency in

older adults”, and “vitamin D and cognitive dysfunction”.

o Used health and science based database for the article research that included

“ScienceDirect”, “Google Scholar”, “Medline”, “Pubmed”

o Defined the older adult population as aged 65 and older.

o Chose articles that had both men and women.

o The articles had to be within 5 years.

o The articles had to be original research articles

Page 7: GROUP ASSIGNMENT PROJECT Cheuk Chung (Article research, Part …janetchow.weebly.com/uploads/5/2/0/5/52050405/ntrs_417b... · 2018. 8. 31. · Eric Pau (Article research, part II,

NTRS 417B GROUP ASSIGNMENT PROJECT 7

Exclusion criteria were as follows:

o Non-English language

o Children and teens

o Small sample size of < 100 people

o Animal studies

o Review articles

Critical appraisal plan:

The first step of selecting the articles was to assess the abstracts of each article and

then examine the articles as a whole. Afterwards, the inclusion criteria was followed, where

only the articles that related to the vitamin D deficiency and the risk of cognitive

impairments in the older adult population was chosen. Articles that did not follow the

inclusion criteria were discarded. Results and discussions of each article were used for the

literature review. Further analysis and comparisons of the research articles are also reported

in the literature review.

Literature Review

All of the original research articles support vitamin D deficiency’s associations in

increasing the risk of cognitive impairment disorders such as dementia and AD. The majority of

the original research articles used the same methods to reach their conclusion, where they used

neurological instruments to measure cognitive function and blood samples to measure serum

levels of vitamin D. There were some differences between European studies and U.S. studies in

assessing vitamin D deficiency. European studies defined vitamin D deficiency as < 50 nmol/L,

50-75 nmol/L as insufficient, and ≥ 50 as sufficient; while U.S. studies defined vitamin D

Page 8: GROUP ASSIGNMENT PROJECT Cheuk Chung (Article research, Part …janetchow.weebly.com/uploads/5/2/0/5/52050405/ntrs_417b... · 2018. 8. 31. · Eric Pau (Article research, part II,

NTRS 417B GROUP ASSIGNMENT PROJECT 8

deficiency as < 25 nmol/L as severely deficient, ≥ 25 nmol/L as deficient, and ≥ 50 as sufficient.

There are strengths and weaknesses to each study.

In the European studies, Lang et al. (2010), Annweiler et al. (2012), Afzal et al. (2014),

Toffanello et al. (2014), Seamans et al. (2010), and Breitling et al. (2011) researched on the

association between plasma vitamin D status and changes in cognitive level in Caucasians of

European origin ages 65 years and older, with conclusions about tight bondages between low

serum vitamin D levels and cognitive impairment at some level. In addition, one interesting finding

was revealed by Seamans et al. (2010) that although low serum 25-hydroxy vitamin D level was

associated with reduction in capacity for spatial working memory. The study, however, failed to

prove vitamin D deficiency’s causation to cognitive decline. Seamans concluded the study with

suggestion that extensive randomized controlled intervention studies are needed.

Among these researches, cognitive function was measured by COGTEL (Cognitive

Telephone Screening Instrument), MMSE (Mini-Mental Status Exam), Trail-Making Tests

(visuospatial scanning, sequential processing, motor speed, attention, and executive function), and

clinical diagnosis. Lang et al. (2010) and Afzal et al. (2014) used prospective cohort study,

Annweiler et al. (2012) used cross-sectional study while Toffanello et al. (2014) and Breitling et

al. (2011) used observational cohort study. Subjects with previous history of stroke, initial MMSE

score less than 10, abnormal gait, recent mental illness, delirium, or severe depression were filtered

out. Potential confounders such as obesity, age, gender, education, alcohol intake, and smoking

habits were identified and adjusted.

There were strengths as well as limitations to the European studies. The common strengths

between these studies included using a large sample size and using multiple cognitive functioning

instruments to cover multiple cognitive domains, as indicated in studies of Lang et al. (2010),

Page 9: GROUP ASSIGNMENT PROJECT Cheuk Chung (Article research, Part …janetchow.weebly.com/uploads/5/2/0/5/52050405/ntrs_417b... · 2018. 8. 31. · Eric Pau (Article research, part II,

NTRS 417B GROUP ASSIGNMENT PROJECT 9

Annweiler et al. (2012), Afzal et al. (2014), and Breitling et al. (2011). As for limitations, Lang et

al. (2010), Annweiler et al. (2012), and Afzal et al. (2014) used clinician’s diagnosis without the

utilization of imaging studies, Toffanello et al. (2014), used only one cognitive tool to measure

cognitive function, and Breitling et al. (2011) lacked baseline assessment of cognitive functioning,

which does not allow for adjustments in reverse causality. Finally, all of the subjects that were

selected were Caucasians from a confined geographic area.

In the U.S. studies, Littlejohns et al. (2014), Littlejohns et. al. (2013), and Llewellyn et al.

(2010) reached on the same conclusion that low vitamin D levels are associated with the increased

risk of cognitive impairments. All of these studies are using the prospective cohort study method.

According to these studies, there is a strong connection between vitamin D and the brain. For

instance, vitamin D receptors are expressed in areas throughout the brain. These areas include

those involved with memory, such as the hippocampus and dentate gyrus (Littlejohns et al., 2014).

There are also vitamin D receptors in brain-related cells, such as neurons and glial cells (Llewellyn

et al., 2010). Additionally, there are enzymes that synthesize the active form of vitamin D that is

produced in several cerebral regions and the active form regulates neurotrophin expression

involved in nerve growth and function of neural cells. The genes encoding the enzymes that are

involved in the metabolism of vitamin D are also expressed in the brain (Llewellyn et al., 2010).

Vitamin D also stimulates macrophages to help increase the clearance of amyloid plagues

associated with AD (Littlejohns et al., 2014).

As for another U.S. cohort study conducted by Wang et. al. (2012), data suggested that risk

alleles in association with late-onset AD have a relationship with lower vitamin D receptor (VDR)

activity, which could be a possible genetic link between VDR and late-onset AD risk. Like the

other U.S. studies that are previously mentioned, this study also suggests that vitamin D

Page 10: GROUP ASSIGNMENT PROJECT Cheuk Chung (Article research, Part …janetchow.weebly.com/uploads/5/2/0/5/52050405/ntrs_417b... · 2018. 8. 31. · Eric Pau (Article research, part II,

NTRS 417B GROUP ASSIGNMENT PROJECT 10

insufficiency increases the risk of developing AD. Though this study suggests a possible link

between vitamin D and late-onset AD risk, people with other conditions such as multiple sclerosis

(MS) and Type I diabetes mellitus (T1DM) could influence gene activity. As a result, direct

relationships between VDR and late-onset AD risk are unclear.

Strengths of the U.S. studies consisted of using large sample sizes, using an ethnically

diverse older adult population, using multiple cognitive tools, and as well as biological assays to

measure cognitive function and compare gene activity. The limitations of the US studies consisted

of excluding the Hispanic and Asian population, biased results, possible missing data, and

excluding those with cardiovascular disease, stroke, and cases of vascular dementia. The findings

of the U.S. studies were consistent with the European studies.

Nutritional insufficiency is a threat to the well-being of any given population, and it is

usually a preventable cause of multiple diseases, illnesses, or complications of dietary deficiency.

Since being too young or too old is a risk factor of nutritional deficiency, the elderly population is

especially susceptible to deficiencies such as vitamin D deficiency. Lifestyle (inadequate diet, not

enough sunlight/UVB exposure) or physiologic effects of aging can influence the needs of vitamin

D in elderlies. Thus, through the research articles and public awareness of adequate vitamin D, the

aging population will know how to maintain good health with good nutrition in order to age

healthfully.

Description of Population of Interest

In this research project, population of interest is elderly people of both genders with a mean

age of 65 years and above. This group of population is chosen for the project, because first of all,

elderly population is growing in western countries, especially in the U.S. Secondly, like any other

nutrients, vitamins, and minerals, vitamin D deficiency is more prone in elderly people. This may

Page 11: GROUP ASSIGNMENT PROJECT Cheuk Chung (Article research, Part …janetchow.weebly.com/uploads/5/2/0/5/52050405/ntrs_417b... · 2018. 8. 31. · Eric Pau (Article research, part II,

NTRS 417B GROUP ASSIGNMENT PROJECT 11

be due to either inadequate dietary intake or insufficient sunlight exposure. However, aging itself

can contribute to increase needs of vitamin D in older people. Factors of aging that effect vitamin

D synthesis are reduced synthesis of 7-dehydrocholesterol in the skin and decreases activity of

renal 1-hydroxylase enzyme. Lang et al. (2010) states that about 40 to 100 percent of older people

in European countries and the United States are vitamin D deficient. Thirdly, elderly population

have higher incidence of cognitive dysfunctions such as Alzheimer’s disease, vascular dementia,

and other types of dementia.

Moreover, cognitive impairments are common in aging population, and sometimes older

people dismiss their memory loss, which is one of the common symptoms of cognitive disorders,

as something trivial or something usual for their age. There are a number on studies done to learn

if there is association between vitamin D deficiency and occurrence of cognitive decline. Vitamin

D is believed to play an important role in calcium homeostasis, neurotrophic factor expression,

neurogenesis, and beta amyloid clearance. Thus, vitamin D may have neuro-protective effect or

have some role in preventing neurodegeneration.

In addition, if a strong association does exist between vitamin D and cognitive dysfunction

as suggested by the studies and researches done this particular aspect, there will be promising

options for prevention and treatment neurodegenerative diseases like Alzheimer’s disease. Not

only the elderly population but also the society as a whole will benefit if debilitating

neurodegenerative disorders can be prevented and treated. With more studies, researches, and

randomized control trials, vitamin D’s role in possible prevention or treatment of cognitive

impairment should be establish, and the minimum level of vitamin D in plasma which is required

to have neuro-protective effect. This is also important as vitamin D, like other fat-soluble vitamin,

have potential to have toxic effect when overdosed. Recommended daily allowances are 600 IU

Page 12: GROUP ASSIGNMENT PROJECT Cheuk Chung (Article research, Part …janetchow.weebly.com/uploads/5/2/0/5/52050405/ntrs_417b... · 2018. 8. 31. · Eric Pau (Article research, part II,

NTRS 417B GROUP ASSIGNMENT PROJECT 12

(15 μg) of vitamin D for ages 1 to 70, and 800 IU (20 μg) of vitamin D for those older than 70

years of age. Higher dosage of vitamin D supplementations need to be avoided to prevent

complications of vitamin D toxicity such as hypercalcemia, calcinosis, hyperphosphatemia,

hypertension, and renal dysfunction.

Summary/Overview of Proposed Work

Vitamin D deficiency is a condition that affects the majority of the older adult

population. As the aforementioned reports suggest, adequate amounts of vitamin D are obtained

through the body’s synthesis of the vitamin from sufficient sunlight exposure and adequate

dietary intake. As people age, their ability of obtaining the vitamin decreases. Hence, with the

diminished ability to obtain the vitamin, older adults have higher chances of developing

cognitive dysfunction as suggested by the studies. Since the majority of the population are

unaware of vitamin D’s benefits and the negative consequences of its deficiency, it is imperative

to provide proper nutritional education and promote nutritional well-being in an attempt to

reduce the incidence of deficiency. With proper nutritional knowledge and improved well-being,

older adults could improve their quality of life and age healthfully.

Page 13: GROUP ASSIGNMENT PROJECT Cheuk Chung (Article research, Part …janetchow.weebly.com/uploads/5/2/0/5/52050405/ntrs_417b... · 2018. 8. 31. · Eric Pau (Article research, part II,

NTRS 417B GROUP ASSIGNMENT PROJECT 13

References

Afzal, S., Bojesen, S., & Nordestgaard, B. (2014). Reduced 25-hydroxyvitamin D and risk of

Alzheimer’s disease and vascular dementia. The Journal of the Alzheimer's Association,

10(3), 296-302. Retrieved January 18, 2015, from PubMed.

Annweiler, C., Gall, D. L., Sarre, M., Remondiere, S., & Beauchet, O. (2010). Vitamin D

deficiency and moderate-to-severe dementia: Cross-sectional association in geriatric

inpatients. Alzheimers & Dementia, 59(1), 169-171. doi:10.1016/j.jalz.2010.05.1556

Annweiler, C., Gall, D. L., Sarre, M., Remondiere, S., & Beauchet, O. (2010). Vitamin D

deficiency and moderate-to-severe dementia: Cross-sectional association in geriatric

inpatients. Alzheimers & Dementia, 59(1), 169-171. doi:10.1016/j.jalz.2010.05.1556

Annweiler, C., Fantino, B., Schott, A., Krolak-Salmon, P., Allali, G., & Beauchet, O. (2012).

Vitamin D insufficiency and mild cognitive impairment: Cross-sectional association.

European Journal of Neurology, 19, 1023-1029. Retrieved January 18, 2015, from

PubMed.

Breitling, L. P., Perna, L., Müller, H., Raum, E., Kliegel, M., & Brenner, H. (2012). Vitamin D

and cognitive functioning in the elderly population in Germany. Experimental

Gerontology, 47, 122-127.

CA de Jager (2014) Vitamin D and Cognition: Are There Any Cautions against Intervention

Trials for Older Adults?. Vitamin Miner 3:e128. Doi: 10.4172/vms.1000e128

Elsevier. (2013). Vitamin D and incident Alzheimer's disease in the Cardiovascular Health

Cognition Study. Alzheimer's and Dementia, 9(4), 880. doi:10.1016/j.jalz.2013.08.227

Page 14: GROUP ASSIGNMENT PROJECT Cheuk Chung (Article research, Part …janetchow.weebly.com/uploads/5/2/0/5/52050405/ntrs_417b... · 2018. 8. 31. · Eric Pau (Article research, part II,

NTRS 417B GROUP ASSIGNMENT PROJECT 14

Gropper, S., & Smith, J. (2013). Fat Soluble Vitamin. In Advanced nutrition and human

metabolism (Sixth ed., p. 398,399). Belmont, California: Wadsworth.

LittleJohns, T., Soni, M., Annweiler, C., Chaves, P., Fried, L., Kesternbaum, B., . . . Lang, I.

(2013). Vitamin d and incident Alzheimer’s disease in the cardiovascular health cognition

study. doi:10.1016/j.jalz.2013.08.227

Littlejohns, T. J., Henley, W. E., Lang, I. A., Annweiler, C., Beaucher, O., Chaves, P., . . .

Llewellyn, D. J. (2014). Vitamin D and the risk of dementia and Alzheimer disease.

American Academy of Neurology, 83, 920-928.

Llewellyn, D., Lang, I., Langa, K., Muniz-Terrera, G., Phillips, C., Cherubini, A., ... Melzer,

D. (2010). Vitamin D and Risk of Cognitive Decline in Elderly Persons. ARCH

INTERN MED, 170(13), 1135-1141. Retrieved January 18, 2015, from PubMed.

Llewellyn, D. J., Lang, I. A., Langa, K. M., & Melzer, D. (2010). Vitamin D and cognitive

impairment in the elderly US population. Journal of Gerontology: Medical Sciences, 1-7.

National Center on Elder Abuse/ Administration of Aging. (2015). America's growing elderly

population. Retrieved from http://www.ncea.aoa.gov/Library/Data/

Seamans, K. M., Hill, T. R., Scully, L., Meunier, N., Andrillo-Sanchez, M., Polito, A., . . .

Cashman, K. D. (2010). Vitamin D status and measures of cognitive function in healthy

older European adults. European Journal of Clinical Nutrition.

doi:10.1038/ejcn.2010.117

Toffanello, E. D., Coin, A., Perissinotto, E., Zambon, S., Sarti, S., Veronese, N., . . . Sergi, G.

(2014). Vitamin D deficiency predicts cognitive decline in older men and women.

American Academy of Neurology, 83, 2292-2298.

Page 15: GROUP ASSIGNMENT PROJECT Cheuk Chung (Article research, Part …janetchow.weebly.com/uploads/5/2/0/5/52050405/ntrs_417b... · 2018. 8. 31. · Eric Pau (Article research, part II,

NTRS 417B GROUP ASSIGNMENT PROJECT 15

Vitamin D and cognitive impairment | Vitamin D Council. (n.d.). Retrieved from

https://www.vitamindcouncil.org/health-conditions/cognitive-impairment/

Vitamin D receptor and Alzheimer's disease: a genetic and functional study. (2012).

Neurobiology of Aging, 33(8), 1844e1-1844e9. doi:10.1016/j.neurobiolaging.2011.12.038

Wang, L., Hara, K., Van Baaren, J. M., Price, J. C., Beecham, G. W., Gallins, P. J., . . .

Whitehead, P. L. (2012). Vitamin D receptor and Alzheimer's disease: a genetic and

functional study. Neurobiology of Aging, 33, 1844.e1-1844.e9.

doi:10.1016/j.neurobiolaging.2011.12.038

Page 16: GROUP ASSIGNMENT PROJECT Cheuk Chung (Article research, Part …janetchow.weebly.com/uploads/5/2/0/5/52050405/ntrs_417b... · 2018. 8. 31. · Eric Pau (Article research, part II,

NTRS 417B GROUP ASSIGNMENT PROJECT 16

VII. Appendices

National Center on Elder Abuse/ Administration of Aging (2015) shows America’s growing

older adult population

US study data by Llewellyn et al. (2010), p. 5 illustrating odds of cognitive impairment by low

vitamin D levels. There is 95% confidence level.

Page 17: GROUP ASSIGNMENT PROJECT Cheuk Chung (Article research, Part …janetchow.weebly.com/uploads/5/2/0/5/52050405/ntrs_417b... · 2018. 8. 31. · Eric Pau (Article research, part II,

NTRS 417B GROUP ASSIGNMENT PROJECT 17

Table 1. Lang et al. (2010), p.1135

Baseline Characteristics of 858 InCHIANTI27 Participants by Serum 25(OH) D

Concentration

Table 4. Lang et al. (2010) p.1135

Random-Effects Models Illustrating Change in MMSE-Measured Cognitive Function by

Serum 25(OH) D Level

Page 18: GROUP ASSIGNMENT PROJECT Cheuk Chung (Article research, Part …janetchow.weebly.com/uploads/5/2/0/5/52050405/ntrs_417b... · 2018. 8. 31. · Eric Pau (Article research, part II,

NTRS 417B GROUP ASSIGNMENT PROJECT 18

Table 1. Breitling et al. (2012) p.124

Major characteristics and analysis variables in the elderly German study population

Table 2. Seamans et al. (2010) p.1175

SWM test scores in the entire group of 55- to 87-year-old ZENITH subjects stratified by

tertile of serum 25(OH) D concentration

Page 19: GROUP ASSIGNMENT PROJECT Cheuk Chung (Article research, Part …janetchow.weebly.com/uploads/5/2/0/5/52050405/ntrs_417b... · 2018. 8. 31. · Eric Pau (Article research, part II,

NTRS 417B GROUP ASSIGNMENT PROJECT 19

Fig. 2. Wang et al. (2012). p.1844.e5.

Expression analysis of Cdx-2 and VDR in brain regions and analysis of VDR promoter

activity in Neuro2A cells.

Page 20: GROUP ASSIGNMENT PROJECT Cheuk Chung (Article research, Part …janetchow.weebly.com/uploads/5/2/0/5/52050405/ntrs_417b... · 2018. 8. 31. · Eric Pau (Article research, part II,

NTRS 417B GROUP ASSIGNMENT PROJECT 20

Fig. 3. Wang et al. (2012). P.1844.e6.

Analysis of APP promoter activity regulated by VDR and 1, 25-(OH) 2 D3