1. <br /> Media Reports to Medical Facts: Vitamin D and Dementia<br />Ashlie Seifert<br />North Dakota State University<br />Media Reports to Medical Facts: Vitamin D and Dementia<br />Introduction<br />Today’s media is notorious for exploiting individual reports into dramatic, life-changing stories for popular demand by today’s society. But what happens when these reports are actual health stories regarding medical issues that affect many of the viewers personally with regard to their own health and the health of their loved ones? In such cases, it is vital that news reports and articles throughout the media not only have the medical facts straight but also produce a clear, audience-oriented message for both viewers and readers alike. In order to stop this problem at its root, it is essential to not only compare media reports of these individual health issues but also to evaluate these reports in terms of the medical studies from which they arise.<br />One recent study has found the link between low levels of vitamin D and the development of dementia among older adults. Dementia is a topic of much discussion throughout society as research has been discovered to find genetic links within the condition. Because of this, many are looking at ways to prevent the development of dementia in later years. Research has found that various medications, early medical screenings, and even brain teasers such as crossword puzzles may all aid in this prevention. In this case, however, research also suggests that adequate intake of vitamin D can play a vital role in decreasing the likelihood of dementia development. Because dementia is topic of discussion within today’s society it comes to no surprise that many media stories have covered this new finding.<br />To further explore the reports of this study, I will compare both the news stories of this finding and the medical reports regarding this discovery. In this evaluation, I hope to not only reveal how these media reports portray the correct information to its consumers but to also provide the medical facts in a comprehensible form for you as a reader. I will begin with background information regarding both vitamin D and dementia, then I will analyze three medical reports found on this discovery, next I will examine three media reports concerning this subject, and lastly I will end with a conclusion and recommendations regarding this new finding. Overall I hope to show that though these media reports could use further details to explain the medical finding, they accurately display the information from the study without skewing or misinterpreting data for many of us as trusting viewers and readers.<br />Background Information<br />Vitamin D is a fat soluble vitamin that is used in a variety of ways by our bodies. Though several forms of this vitamin exist, there are two forms which we use as humans. These forms are known as vitamin D2 and D3 and are technically named ergocalciferol and cholecalciferol. Vitamin D2 is synthesized from plants while vitamin D3 is synthesized from the skin of humans when exposed to the sun. Because of this, healthy sources of vitamin D include fish, eggs, fortified milk, fortified cereals, and sun exposure. In our bodies, vitamin D works by helping maintain adequate levels of calcium and phosphorus throughout the body. In particular, it aids with absorption of calcium within the intestines and further reabsorption of calcium within the kidneys. This vitamin also helps the immune system as vitamin D receptors are found in several white blood cells to help cell growth and specialization. With these activities, vitamin D aids in the protection of strong bones, low blood pressure, and has even been found to protect against various autoimmune diseases (Mayo Clinic Staff, 2010).<br />Dementia is a condition in which loss of brain function occurs with certain diseases such as Alzheimer’s disease or stroke. In this condition changes in memory, thinking, judgment, and behavior can occur for individuals. Though many may believe that dementia comes with age, there is actually a difference between normal forgetfulness due to aging and dementia. With age mild cognitive impairment (MCI) may occur, leading to mild problems such as forgetting events or conversations, difficulty performing more than one task at a time, and difficulty solving problems. However, when dementia develops severe symptoms such as forgetting events in your own life history, having hallucinations, withdrawing from social contact, or having difficulty with daily tasks such as getting dressed may occur (MedlinePlus, 2010).<br />Medical Reports: What Are the Facts?<br />Within the various media reports mentioning the link between vitamin D and cognitive health the study by a man by the name of Dr. David J. Llewellyn was continually brought up as a major step in the finding of this link. However, after researching the internet through and through for this particular study I found that it was not accessible. With this said, I think it is important to note that though these media stories are citing a reputable medical study as basis for their reports they should also allow access to this study in order for consumers to further explore its results. However, in this time I will review three medical studies regarding vitamin D’s ability to affect one’s cognition and health during the aging process in order to find the facts regarding this study.<br />Figure 134213801570990One study conducted in 2009 by William B. Grant, a man who works for the Sunlight, Nutrition, and Health Research Center in San Francisco, California, in 2009 with the title “Does Vitamin D Reduce the Risk of Dementia?” investigated this topic. The article begins by explaining the upcoming research regarding vitamin D in the past two decades and notes that in addition to the beneficial roles of strengthening bones, reducing cancer risk, inhibiting bacterial and viral infections, and increasing heart health there has also been a new finding that vitamin D reduces the risk of dementia development in old age (Grant, 2010). In explaining the use of vitamin D by our bodies, Grant proposes that the vitamin may actually directly or indirectly affect the risk factors of dementia.<br />During the study’s introduction, the Grant explains how vitamin D is produced by the body when one is exposed to sunlight (also illustrated in Figure 1). The first step of this process occurs when ultraviolet-B rays from the sun photolyze, or break down molecules with light, the chemical 7-dehydrocholesterol, also known as provitamin D3, found in the epidermis of our skin. After this occurs, previtamin D3 undergoes a heat-induced isomerisation (chemical change into an isomer) that takes two to three days to complete. With this, cholecalciterol is formed for metabolization by the liver and at this time 25-dihydroxvitamin D3 is produced. This metabolite is further developed into the active form of vitamin D3 (technically known as 1,25-dihydroxyvitamin D3) for use by the body in maintaining calcium and phosphorus balance with the body (Grant, 2010). <br />However, Grant also points out that with age there are multiple risk factors that lead to vitamin D deficiencies. These risk factors include:<br /><ul><li>Less sun exposure
2. Fewer provitamin D3 “receptors” within the skin
3. Less vitamin D found in the diet
4. Trouble converting vitamin D3 to a useful form due to aging kidneys</li></ul>Because of these risk factors, it is vital that older adults keep in the mind the importance of vitamin D and its intake through sun exposure, the diet, and even with the help of supplements.<br />To further explain his hypothesis, Grant mentions the risk factors involved with dementia development in older adults in order to determine the benefits that vitamin D may have in its reduction. The factors considered for this study include neuronal protection, neuron growth factor, neuronal calcium regulation, inflammation, thrombosis (formation of blood clots), and transition metal ion concentrations-including copper, aluminum, and zinc found in the nervous system (Grant, 2001). He presents these factors within a table of his article and explains the effects of vitamin D for each according to observational studies conducted from 2004-2008. In conclusion, he finds that vitamin D metabolites actually counteract many of the mechanisms associated with dementia listed above. This table is summarized below in Figure 2.<br />Figure 2<br />Dementia Risk FactorVitamin D’s MechanismNeuron ProtectionCalcium regulation, interaction with reactive oxygen and nitrogen, enhances antioxidant pathways, facilitates detoxificationNeuron Growth Factor (NGF)Induces production of NGF-which is a protein that is important for nerve cell growth, maintenance, and survivalNeuron-Calcium RegulationProtects against excess calcium entry into the brainInflammatory factorsDecreases pro-inflammatory signals from cytokines (proteins of the immune system used in cellular communication)ThrombosisReduces risk of clot formationTransition metal concentrationsBy increasing calcium absorption, may decrease aluminum, copper, and zinc levels (which are found to be elevated in the brains of Alzheimer’s patients)<br />In order to evaluate these findings, guidelines were used from “Reading Medical Literature”, written by Robillard and Ullery, and during this time I will mentions various aspects of the study which validate its use medically and professionally (2010). Grant’s review was sponsored by the UV Foundation, Vitamin D Society, and the European Sunlight Association and included twenty five observational studies that investigated the use of vitamin D in protection of brain against risk factors of dementia. As the topic of this study grows seemingly popular in research, the findings and conclusion prove that though more investigation is needed a great link may have been found in preventing dementia. The epidemiological studies chosen for this research are presented to medical professionals in an organized, well-cited manner that adds aspects of reputability for the selected findings. Statistical analysis was provided for comparable groups from the selected studies and p-values and confidence intervals were reported to provide measures of central tendency within the data sets. Though the study mentions many of the positive effects that Vitamin D is capable for within the body, Grant also notes the nutrient’s adverse effects. These effects occur when vitamin D intake is greater than the tolerable upper limit (UL) established by the Institute of Medicine as 2000 IU per day or 50 µg per day (Grant, 2010). The main outcome of high vitamin D concentrations of the body is the development of hypercalcemia in which calcium begins to be withdrawn from the bones. <br />In conclusion, this study allows for thorough review of an upcoming finding that may change the lives of many. As a medical professional, this study may be used as evidence-based research in regard to recommendations and health matters given to patients. As I continue, I will support this study with two other reviews regarding the roles of vitamin D in one’s cognition. In doing so, I hope to provide more information regarding this topic for you as informed readers as well as provide a strong base for comparison to the various media reports that have mentioned this finding.<br />Figure 3A systematic review titled “Vitamin D and Neurocognitive Dysfunction: Preventing ‘D’ecline?” conducted by Jennifer S. Buell and Bess Dawson-Hughes also explores the use of vitamin D beyond aiding in mineral homeostasis. Much like Grant’s study, this review begins with the explanation of vitamin D’s absorption by the body while also explaining the definition of dementia. In linking the two together within the introduction, the authors of the study state that, “Vitamin D may help protect against cognitive deterioration and dementia, specifically, vascular dementia and Alzheimer’s disease, through vascular protection, preservation of neurons, and protection against risk factors for cognitive dysfunction” (Buell & Dawson-Hughes, 2008). With this introduction, it is easy to note that there is relevance between these two studies in their hypotheses regarding vitamin D’s mechanism in aiding against dementia risk factors.<br />Vascular Dementia4478655127635In addition to Grant’s study, Buell and Dawson-Hughes explain the means by which dementia may occur in older adults. In doing so, they define the difference between these two forms of cognitive dysfunction in order to explain vitamin D’s role for each. <br />Below, I will summarize this explanation as provided by the authors. <br />4486275819785Alzheimer’s DiseaseVascular Dementia-cognitive dysfunction occurring after hemorrhagic brain lesions in case of weakened blood vessels. Weakened vessels in the brain may be present due to high blood pressure, diabetes, or injury from a stroke. In this case, behavioral <br />cognitive dysfunction is impaired but memory impairment is less<br />profound than in Alzheimer’s (Buell & Dawson-Hughes,2008). <br />Alzheimer’s Disease-occurs with progressive deterioration of specific<br />Cognitive functions such as language, motor skills, perceptions, and memory. With this, both neuron and synaptic loss in the cerebral cortex, hippocampus, and amygdala of the brain actually cause its size to decrease leading to altered behavioral patterns, memory loss, and impaired activities of daily living (Buell & Dawson-Hughes, 2008).<br />Vitamin D’s roles in both forms of dementia were studied within this report. As Grant also proposed within his study, the authors in this report believe that vitamin D helps reduce the risks of dementia development. Buell and Dawson-Hughes therefore found many of the same findings within their review. In the case of vascular dementia, vitamin D aids against the development of blood clots within the brain and has also been found to help reduce blood pressure. With Alzheimer’s disease, vitamin D may actually help by protecting the structure and integrity of neurons through detoxification pathways, enhancing antioxidant pathways, and supporting neuron growth and development (Buell & Dawson-Hughes, 2008). Overall, the findings of this study further support those found in Grant’s research.<br />Lastly, a study titled “Vitamin D and Cognitive Performance in Adults: A Systematic Review” used five studies from 1979-December 2008 to explore vitamin D’s role in cognition (Annweiler, Allali, Bridenbaugh, Schott, Kressing, & Beauchet, 2009). Both case-control and cross-sectional studies were summarized within the review to provide evidence for this link. Unlike the first two studies mentioned, this review explains the use of mental exams in testing the role of vitamin d in cognitive performance. Tests used within the reviewed studies include:<br /><ul><li>Seashore Rhythm Test-Was originally used to identify musical talent but is now used to evaluate brain and nervous system functioning by testing visual, auditory, and tactual input; verbal communication, and ability to analyze information, form mental concepts, and make judgments (Friedrich, 2010).
5. Trail Making Test- Studies visual attention and task switching by using numbers and letters in which subjects must “connect-the-dots” in a timely manner (Long, 2008).
6. Short Blessed Test-Measures memory and concentration by having participants repeat words, count out loud, and identify time and date. This test is often used in identifying Alzheimer’s disease (Morris, 2010).
7. Clinical Dementia Rating-A numeric scale used to quantify the severity of dementia symptoms. The scale tests memory, orientation, judgment, problem solving, community affairs, hobbies, and personal care (Morris, 2010).
8. Mini Mental State Exam-A 30-point questionnaire used to measure arithmetic, orientation, and memory that is commonly used in healthcare settings (Rosenzweig, 2010).</li></ul>In their review, the authors were able to find a significant positive association between vitamin D concentration and high performance for some of these tests but not for others. Those tests with a positive association included the Short Blessed Test, Mini Mental State Examination, and the Clinical Dementia Rating while the Trail Making Test and Seashore Rhythm Test did not show significant association (Annweiler et. al., 2009). With these findings, the authors believe that mixed results may be due to the choice of cognitive tasks. In the case of both the Trail Making Test and Seashore Rhythm Test specific aspects of cognition are explored. However, with the Short Blessed Test, Clinical Dementia Rating, and the Mini Mental State Exam more holistic cognitive functioning is tested (Annweiler et. al., 2009).. Though inconclusive results may have been found with this review, insight is still provided in support of vitamin D’s role in cognition and additional input is given towards Grant’s review regarding the actual testing for the nutrient’s function.<br />Media Reports: Is This Link Well-Portrayed?<br />On July 13th, 2010 a news report given by Susan Hendricks regarding the link between vitamin D and dementia was aired on CNN. The short report explains a study published in the Archives of Internal Medicine in which 850 people age 65 and older in Italy were observed and found that those with lower levels of vitamin D were 60 percent more likely to experience “substantial mental decline” and 31 percent were more likely to experience new problems with their mental health as they got older (Hendricks, 2010). The report begins by discussing the supply of vitamin D for the body found in the dietary sources such as fish, in supplementary form, and mostly through sun exposure. It then mentions, however, that elderly people have been found to be deficient for the nutrient. As a whole, the report explains how the high prevalence of vitamin deficiency, especially in older adults, should be observed by health professionals in order to help preserve cognitive health.<br />This “Health Minute” news report just skimmed the surface of the upcoming medical topic. In a matter of a minute, the short report gave a simplified presentation which may lead many viewers wondering more about the study, and perhaps may drive many to go research the study themselves. However, as I mentioned earlier the study was not accessible through research. Though many of the basic facts are mentioned in order to provide enough information for consumers to understand the concept as a whole, supplying more facts regarding the medical study may allow for more informed individuals who may have loved ones with dementia or who may worry about their own development of cognitive dysfunction.<br />Health News Review (HNR) provides ratings for many media represented reports on various medical topics considering costs, availability, benefits, alternative sources, and other aspects critical in providing informative matter for health news (Schwitzer, 2010). Using this 10-point review system, I will analyze CNN’s report to discover if ample information is provided for consumers. <br />Availability of vitamin D is mentioned in the report by providing information regarding vitamin D’s three main sources in diet, supplements, and sun. On the other hand, costs are not mentioned within the report but could be provided by mentioning the inexpensive prices for those foods with vitamin D and even vitamin D supplements in order to supply the nutrient for our bodies. The report avoids “disease mongering” by not exaggerating vitamin D’s use in cognition in the story to make it seem as a life-changing discovery. Quality of evidence is provided with use of number of participants, their location, and percentages of those who had stable cognition, yet more information about the author of the study and a link to the study itself may provide further reliability. The report fails to mention harmful side effects that vitamin D may have when taken in doses over the upper tolerable limit. Alternatives of dementia treatments are also not mentioned for viewers to explore. Overall, this report meets five of the ten points established by HNR and is therefore a two star rating. With more information regarding the medical study, this report could have furthered its reputability.<br />An article directed towards older adults on the AARP website titled “Vitamin D Deficiency Linked to Dementia” also explores this subject (Simon, 2010). The article, which may have risen from the main news release regarding the subject, notes the research conducted by David Llewellyn from the University of Exeter in England of 3,325 adults age 65 and older. The findings of the study showed that the likelihood of performing poorly on tests of memory and attention were 42 percent higher in individuals who were vitamin D deficient and almost 400 percent higher in those that were severely deficient (Simon, 2010). Adding credibility to the article, the author also mentions that these findings are similar to a related medical report which was recently published in the Archives of Internal Medicine (most likely the study mentioned in the report above). A side box within the article provides facts about vitamin D including the recommended intake and its sources. The article concludes with recommendation from a health professional regarding the medical study in which he states that many should make sure to maintain adequate vitamin D levels as it has many functions for their health.<br />Though this article cites a different source for its basis, it still adequately supports CNN’s report on the subject. This time around, however, more information regarding the study and its interpretation is provided for readers. When considering Health News Review, one can note that costs and potential harms are unspoken of. However, it is important to also note that the author gives the additional information regarding the original source, available sources of vitamin D, availability of alternative medical sources for the subject, and benefits written in the report are provided from medical professionals. Because of this, this report receives a 7 out of 10 HNR rating and an overall 3-star rating. <br />A third media report from USA Today is titled “Study: Exercise, Tea, and Vitamin D to Ward off Dementia” and explores various findings to reduce the risks of cognitive decline in older adults (Marcus, 2010). The article explains three studies announced at the Alzheimer’s Association International Conference in Honolulu in early July. The same study was described as in AARP’s article and provides the statistics, number of participants of the study, and the founder of the study David Llewellyn. In addition to this, the author of the article includes commentary from Llewellyn himself regarding his medical study. Llewellyn states that, “Vitamin-D is neuro-protective in a number of ways, including the protection of the brain’s blood supply and the clearance of toxins” (Marcus, 2010). This information links both this media report and medical study to Grant’s study regarding vitamin D’s role in the brain. <br />USA Today’s article fails to mention availability, costs, and potential harms of vitamin D, as there are only a couple of brief paragraphs written on the subject overall. The author of the article does however thoroughly explain the source of its information, establish novelty and potential benefits of these findings, and succeeds in avoiding “disease mongering” of the subject. With this, a 6 out of 10 rating on the HNR analysis and a 3-star rating can be applied. <br />Though each of these articles could use much more information regarding the findings of vitamin D’s link to dementia, they each provide the basic facts regarding the medical studies of this link. CNN’s report allows for a short, understandable, relatable source for viewers to learn about a new medical discovery. With the addition of a link to the source itself, CNN’s reporters could allow viewers to further research the medical study in an easy, accessible way. AARP’s article on the other hand provides information for its readers on the medical study source while also citing the similar study mentioned in CNN’s report. The article also readily provides the basic facts regarding vitamin D to inform readers of its background. Lastly, USA Today’s article briefly explains vitamin D’s link to dementia while using Llewellyn’s study as its source. Explanation of the study itself is brief and further information regarding the subject may add credibility. However, these studies succeed in providing the informative basics regarding vitamin D and dementia to consumers without misconstruing the facts of the study. With the use of accessible medical sources, these media reports would help support the knowledge driven consumers of today’s society who are interested in the topic.<br />Conclusion<br />Trusting today’s media isn’t always easy, but further research and exploration into the hot topics of discussion may allow for the true facts behind all stories. Sometimes media stories succeed in providing clear facts concerning issues that may be important to many of us while other times this may not be the case. In the case of this particular finding, media stories may simplify medical stories to a condensed, comprehensible form for readers. In this time, I was able to explain the three medical studies regarding the link between vitamin D and dementia along with three media stories. In doing so, I provided a base network of facts regarding the individual topics of vitamin D and dementia themselves, evaluated the medical studies concerning the subject, and compared the popular media reports to the originating studies themselves. <br />For informative readers much like yourself it is important to compare media reports to the medical studies from which they arise to decipher fact from fiction. In order to further explore this topic I recommend looking at all the articles mentioned in this paper as well as an article within the New York Times, Web MD, and Natural News (which will all be cited within the references) to provide a more holistic view on the topic. In regards to whether vitamin D aids cognitive health, I recommend consulting your health professional to ensure your vitamin D intake is within the recommended range of 200-400 IU per day as established by the United States Department of Agriculture. <br />References<br />Annweiler, C., Allali, G., Beauchet O., Bridenbaugh, S., Schott, A., & Kressig, W. (2009).<br />Vitamin D and cognitive performance in adults: a systematic review. European Journal<br />Of Neurology, 16 (1), 1083-1089.<br />Buell, J., & Dawson-Hughes, B. (2008). Vitamin D and neurocognitive dysfunction: Preventing <br />‘d’ecline? Molecular Aspects of Medicine, 29 (2), 415-422.<br />Friedrich, S. (2010). Halstead-Reitan Battery. Retrieved from HYPERLINK "http://www.minddisorders.com/ <br />Flu-Inv/ Halstead-Reitan-Battery.html" http://www.minddisorders.com/ <br />Flu-Inv/ Halstead-Reitan-Battery.html.<br />Grant, W. (2009). Does vitamin D reduce the risk of dementia? Journal of Alzheimer’s<br />Disease, 17 (1), 151-159.<br />Hendricks, S. (CNN). (July 13, 2010). Vitamin D and dementia. [Health Minute]. Los Angles, C<br />CA: CNN Headline News.<br />Long, C. (2010). Neuropsychology and Behavioral Science. Retrieved from <br />http://neuro.psyc.memphis.edu/neuropsyc/np-test1.htm.<br />Marcus, M. (2010). Study: Exercise, Tea, and Vitamin D to Ward off Dementia. Retrieved from<br />http://www.usatoday.com/news/health/2010-07-12-alzheimerslifestyle12_ST_N.htm.<br />Morris, J. (2010). Short Blessed Test. Retrieved from: http://alzheimer.wustl.edu/.<br />Morris, J. (2010). Clinical Dementia Rating. Retrieved from: http://alzheimer.wustl.edu/.<br />Mayo Clinic Staff. (2010). Vitamin D. Retrieved from http://www.mayoclinic.com/ <br />health/vitamin-d/NS_patient-vitamind.<br />MedlinePlus. (2010). Dementia. Retrieved from http://www.nlm.nih.gov/medlineplus/ <br />Dementia.html.<br />Robillard, R., & Ullery, S. (2001). Writing, Speaking, and Communication Skills for Health<br />Professionals. Reading the medical literature: Reports on clinical intervention studies.<br />(3-34). New Haven: The Health Care.<br />Rosenzweig, A. (2010). Mini-Mental State Exam.Retrieved from http://www.minimental.com/.<br />Schwitzer, G. (2010). How We Rate Stories. Retrieved from http://www.healthnewsreview.org/ <br />how-we-rate-stories.php.<br />Simon, N. Vitamin D Deficiency and Dementia. Retrieved from http://www.aarp.org/health/ <br />conditions-treatments/info-07-2010/ vitamin_d_deficiency _linked_to_dementia.html.<br />For Additional Information Refer To:<br />Bakalar, N. Aging: Vitamin D Levels Tied to Dementia Risk. Retrieved from<br />http://www.nytimes.com/2009/02/24/health/research/24aging.html.<br />Baker, S. Lack of Vitamin D Linked to Alzheimer’s and Vascular Dementia. Retrieved from<br />http://www.naturalnews.com/026392_Vitamin_D_Alzheimers_disease.html.<br />Mann, D. Vitamin D and E May Affect Dementia Risk. Retrieved from HYPERLINK "http://www.webmd.com/ <br />" http://www.webmd.com/ <br />brain/news/20100712/vitamins-d-and-e-may-affect-dementia-risk.<br />