Vitamin D and Parkinsons

It has been theorised, based on several series of evidence, that chronic insufficiency of vitamin D, particularly in the elderly, is a significant factor in the pathogenesis of Parkinsons disease. In the brain, 1 hydroxylase converts 1, 25-dihydroxy vitamin D (circulating vit D) into the active form of the vitamin D, Calcitriol. As mentioned, the effects of Parkinsons are mainly seen within the substantia nigra, and it has also been found that Vitamin D receptors and 1 hydroxylase concentrations are also large in this area. It is thought that an insufficiency of circulatory vitamin D may lead to an abnormal function of the cells in the substantia nigra. Further to this, chronic insufficiency of circulatory vitamin D may lead to cellular damage and degeneration, and potential death of neurons, as noted in the pathology of PD. (It is also interesting to note that in a study of Parkinsons patients who were given high doses of vitamin D supplements daily (as addition to antiparkinsonian therapy) their symptoms improved dramatically over the next year with decreased parkinsonism.)

Is there a correlation between Vitamin D deficiency and the development of Parkinsons disease?

Parkinsons Disease
Parkinsons disease is a neurodegenerative disorder The main symptoms are related to movement: tremor, muscle stiffness, bradykinesia (where physical movements become slow) collectively called parkinsonism. Other, non-motor symptoms include depression, dysphagia (problems swallowing) and drowsiness Pathology of Parkinsons is characterised by the accumulation of protein into inclusions in neurons, and from insufficient production and activity of dopamine in the midbrain. This leads to neuronal loss, especially in the substantia nigra. Parkinsons is caused by a mutations in specific genes. Most cases of Parkinsons are idiopathic, however possible causes include exposure to toxins such as pesticides. In rare cases Parkinsons is thought to be hereditary.

Search Parameters
Used Google Scholar as a first source PubMed/Medline Ovid Wiley Online Library JAMA Network (Journal of the American Medical Association)

The first search phrase we used was Vitamin D and Parkinsons Disease After finding the original few papers, we noticed that many of them were referencing the study carried out by Dr. Evatt. We then altered our search, to find more papers relating to this and other similar studies.

Principle Sources of Data Used

High prevalence of hypovitaminosis D status in patients with early Parkinsons disease.
Trial results article from Arch Neurol, Vol 68, Number 3, March 2011

Serum Vitamin D and the risk of Parkinsons disease.

Trial results article from Arch Neurol, Vol 67,Number 7, July 2010

Vitamin D and Parkinsons disease- a hypothesis.

Article from Movement Disorders, Vol 22, Issue 4, pg 461-68, 2007

Serum Vitamin D and the risk of Parkinsons disease Finlands National Institute for Health and Welfare Study
Mini Finland Health Survey, which was conducted from 19781980, with a further PD test to be conducted at the end of 2007. 300, 173 unaffected 50-79 year olds took part. The serum Vitamin D levels were measured from the blood samples. taken for the survey, 29 years later. 50 out of people were diagnosed with PD

High prevalence of hypovitaminosis D status in patients with early Parkinsons disease.

In a study of over 150 Parkinsons patients, carried out by Dr. Evatt, almost 70% of those with a recent diagnosis had a vitamin D insufficiency (less than 30ng per ml), and about 20% had a vitamin D deficiency (less than 20ng per ml).

Meaning of vitamin D deficiency linking to onset of Parkinsons disease for the physician.
Vitamin D deficiency possibly preceding PD :
From recent studies it appears that chronic vitamin D insufficiency ( <30 ng/ml) is commonly present in the early stages of PD; physicians should be aware that chronically insufficient or deficient patients have a higher risk of the development of Parkinsons disease.
Screening for Parkinson's disease should take place, if chronic insufficiency is a sign of the early stages of PD.

Vitamin D deficiency in people already diagnosed with PD:

Patients with Parkinsons should have high levels of vitamin D supplementation.
Suggested up to 5000 units per day to help maintain normal serum levels of vitamin D of around 40-90 ng/ml.

1. Dr Evatt. High prevalence of hypovitaminosis D status in patients with early Parkinsons disease. 2. Dr Canell. Vitamin D Council. http://www.youtube.com/watch?v=sNIiNQ1AG9s&feature=related (accessed 9.11.12)

Meaning of vitamin D deficiency linking to onset of Parkinsons disease for the patient.
For a vitamin D deficient patient:
Vitamin D insufficient or deficient patients should ask their doctor about Parkinsons disease. These patients should look out for common motor symptom and neuropsychiatric symptoms associated with the disease PD.
Tremors. Slowness of Movement. Rigidity of muscles.

For patients with PD:

Patients with Parkinsons disease should take vitamin D supplements to reduce their likelihood of being deficient.

For patients with a family member diagnosed with PD

NB. Some atypical cases of PD are familial and are therefore past down generations (15% of all cases). Ask for vitamin D serum test to evaluate levels and probability of eventual onset of PD. Once and if tested; start vitamin D supplements to keep serum levels in a normal healthy range

1. S Lesage. Parkinson's disease: from monogenic forms to genetic susceptibility factors. 2009