Improving Functionality in Older People

The decline in brain function with aging is costly. The maintenance of optimal brain health
is a priority among the elderly. Complex modifiable factors impact brain function such as
education level, ongoing use of cognitive skills such as mentoring and social interaction. In
most instances, substantial time and effort will be required to improve brain function in the
elderly. There is an urgent need for an option that will yield rapid results. Investigator(s)
believe intensive Vitamin D replacement presents such a solution.

Emerging scientific information supports an important role for Vitamin D in brain health.
Much of this data is based on the association that higher Vitamin D values are linked to
better brain function. However, an association does not prove a cause and effect. To prove
that Vitamin D values play a causal role in cognition carefully controlled studies are
needed. Currently, there are very few controlled interventional studies in the elderly
demonstrating that Vitamin D levels can improve brain function. The 25(OH) Vitamin D is the
best indicator of Vitamin D status. The normal range for 25(OH) Vitamin D is usually between
30 and 100 ng/ml. Preliminary data indicates that 25(OH) Vitamin D values of greater than 40
ng/ml are needed to improve brain function. Prior Vitamin D studies have used varying
replacement protocols and types of Vitamin D such that stable 25(OH) Vitamin D values in the
high normal range have rarely been achieved.

Brain Impairment usually occurs gradually in dementia, giving the patient and the provider an
option to slow or halt progression of cognitive deterioration. Disruption in the white matter
(reflecting the nerve fibers that conduct electric impulses) of the brain as well as
reduction in brain volumes are linked to dementia and increasing chances of disability. These
white matter abnormalities and reduction in brain volumes are commonly present in the elderly
and are closely linked to Vitamin D deficiency. Animal studies using Vitamin D support a
benefit to cognition. There is a paucity of carefully controlled clinical trials involving
humans using appropriate Vitamin D replacement protocols. However, a few preliminary studies
do support a benefit to cognition in humans over a study period ranging from 1-15 months. The
present proposal addresses this relative deficiency by conducting a double blind controlled
study in the Vitamin D insufficient community dwelling elderly.

The hypothesis is that daily 5000 IU Vitamin D3 will regress or at least prevent progression
of white matter abnormalities or shrinking of brain volumes. There are specific anatomical
defects in the brain linked to Vitamin D deficiency. These deficits include impaired visual
memory and executive (higher brain functions). Investigator(s) will assess brain function by
tracking changes in a battery of computerized tests that have been proven reliable in
assessing brain function. These changes in computerized testing of brain skills will be
matched to changes in brain imaging over the course of the 1 year study. Brain imaging will
be done using a 3-Tesla Magnetic Resonance Imaging scan (MRI).

Once the institutional review board approves this study, free living participants (> 65 yrs.)
without prior brain disease or dysfunction will be recruited. The participants with Vitamin D
insufficiency (25(OH) Vitamin D < 30 ng/ml) will be randomized into two groups. Both
participant groups will be treated for 1 year with daily Vitamin D3 supplements. The standard
of care group will get 800 IU daily whereas the active group will get 5000 IU daily.
Cognitive tests, chemistry profile will be done at baseline and every 4 months for 1 year.
The basic chemistry profile (blood work) includes kidney function and calcium levels which
also provide safety monitoring. Based on published information, Vitamin D3 doses planned in
this study are far below the doses required for toxicity. The brain MRI will be done at
baseline, 4 and 12 months.

Additional strengths of this study include a multidisciplinary team with published expertise
and experience in Vitamin D replacement, brain and memory function.

Inclusion Criteria:

- Community dwelling subject (adults) aged between 65 and 89 years of age

- Subject should be ambulatory and living at home

- Subject should be capable of self-care

- Subject should be able to drive an automobile independently and without assistance

- Subject should agree to home visitation by CRI coordinators to assess pill counts or
willing to come to TTUHSC for such a visit

- 25(OH) Vitamin D value < 30 ng/ml

Exclusion Criteria:

- Participant unable or unwilling to have follow up for the duration of the study

- Subject that cannot take a daily supplement

- Subject unable to have MRI imaging

- Subject on peritoneal or hemodialysis

- Subject unwilling to have multiple blood draws

- Subject with Sarcoidosis or diseases associated with hypercalcemia

- Subject currently taking supplements containing Vitamin D

- Subject with prior cerebrovascular disease or memory problems

- Subject with prior myocardial infarction or atrial fibrillation or on anticoagulants

- Subject on medications for memory or cognitive issues or mental ill-health

- Subject with life expectancy less than 2 years

- Subject receiving assistance for self-care

- Subject cannot pass motor screening test for valid assessment of cognition

- Subject on medications for Diabetes

- Subject on medication for hypertension