Effect of Vitamin D Replacement on Cognition in Multiple Sclerosis Patients

Hala Darwish,Hani Tamim,Bassem Yamout,Ribal Haddad,Stephanie Ghassan,Sahar Osman,Samia Khoury

doi:10.1038/srep45926

Abstract

Multiple Sclerosis is associated with deficient serum 25 hydroxyvitamin D (25 (OH)D) level and cognitive impairment. The aim of this study is to evaluate cognitive performance in MS patients with deficient 25 (OH)D (<25 ng/ml) compared to patients with sufficient levels (>35 ng/ml), then to evaluate the change in cognitive performance after 3 months of vitamin D3 oral replacement. Eighty-eight MS patients with relapsing remitting and clinically isolated type of MS, older than 18 years treated with interferon beta were enrolled. Cognitive testing was performed at baseline and at 3 months using the Montreal Cognitive Assessment (MoCA), Stroop, Symbol Digit Modalities (SDMT) and Brief Visuospatial Memory Test (BVMT-R). Serum 25 (OH)D was measured at baseline and at the end of the study. Vitamin D3 replacement improved the MS patients’ cognitive performance after 3 months on the MoCA and BVMT-Delayed Recall (DR). Sufficient serum 25 (OH)D level predicted better cognitive performance on the BVMT-DR at baseline (β: 1.74, p: <0.008) and 3 months (β: 1.93, p: <0.01) after adjusting for all measured confounding variables. Vitamin D3 replacement could improve cognitive performance in MS patients and make a significant difference in the patient’s quality of life.

Highlights

Multiple Sclerosis (MS) is a chronic inflammatory disease of the central nervous system that is linked to environmental factors such as smoking and vitamin D level
After supplementation with high dose vitamin D3 for three months, 25 (OH)D level increased to 49.0 ± 14.6 ng/ml (p < 0.001 compared to baseline) in the deficient group, it remained lower than the sufficient group that received usual care 64.2 ± 18.7 ng/ml (p < 0.001)
We show that a relatively short course of oral supplementation with vitamin D3 in MS patients deficient in serum 25 (OH)D, improved memory as measured by the BVMT Delayed Recall and Montreal Cognitive Assessment (MoCA)

Summary

Introduction

Multiple Sclerosis (MS) is a chronic inflammatory disease of the central nervous system that is linked to environmental factors such as smoking and vitamin D level. Low serum 25 hydroxyvitamin D (25 (OH) D) is associated with increased risk of MS1,2 and increased disease activity in patients with MS3,4. Cognitive impairment is a common symptom of MS that impacts quality of life, and affects up to 65% of patients[10,11,12]. The impairment affects a wide range of cognitive functions including verbal and non-verbal memory, and information processing speed[12]. Studies in humans provide support for a role of the vitamin D in cognitive functioning, and recent studies have linked low serum 25 (OH)D levels to cognitive dysfunction in adults[13,14,15]. This study aim was to measure cognitive performance in patients with serum 25 (OH)D deficiency (3 5 ng/ml), evaluate the change in cognitive performance in 25 (OH)D deficient subjects after supplementation with oral vitamin D3 (Cholecalciferol, Euro-D 10000, Montreal, Quebec, Canada)

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Conclusion