Evaluation of Vitamin D and Clock Drawing Test Performance in Low Educated Elderly Patients

Year 2015, , 6 - 17, 08.09.2015

Erkan Cüre , Ayşegül Türkyılmaz Medine Cüre Serkan Kırbaş Aynur Kırbaş Süleyman Yüce Ahmet Tüfekci

https://doi.org/10.17826/cutf.97783

Abstract

We aimed to investigate whether CDT and 25-hydroxyvitamin D (25OHD) level are predictors for sun exposure and walking duration, and aimed to investigate whether CDT is reliable in low educated (LE) elderly. Material and Methods: A total of 185 LE patients without dementia above the age of 65 who had applied to internal medicine clinic were included in the study. The patients’ demographic data, sun exposure, walking duration, a history of coronary artery disease (CAD) and the number of falls were recorded. Clock drawing was measured using Manos scoring system. Results: The study population included 127 (68.6%) males with a mean age of 73 ± 6 years and 58 (31.4%) females with a mean age of 70 ± 5 years. According to Manos scoring system a total of 90 (48.6%) subjects had a CDT score of 0, 70 (37.9%) subjects had a CDT score of 1-9 and 25 (13.5%) subjects had a CDT score of 10. The mean vitamin D level of the patients was 18.4 ± 7.3 ng/mL. Vitamin D levels and CDT scores were predictive for sun exposure, duration of walking, number of falls and CAD. Conclusion: CDT scores of LE subjects were unreliable to demonstrate cognitive functions. This study has shown that vitamin D levels to be more potent predictor than CDT scores to demonstrate sun exposure, walking duration, numbers of falls and the incidence of CAD in LE subjects.

Keywords

Vitamin D; clock drawing test; low education level, sun exposure; physical activity

Düşük Eğitim Düzeyli Yaşlı Hastalarda D Vitamin ve Saat Çizme Testinin Değerlendirilmesi

Abstract

Amaç: Saat çizme testi (SÇT) kognitif fonksiyonları değerlendirmede kullanılan kısa, pratik ve güvenli bir testtir. Biz SÇT ile 25-hidroksivitamin D seviyesinin güneşe maruziyet ve yürüme süresi için prediktif olup olmadığını ve SÇT’nin düşük eğitim düzeyli (DE) yaşlılarda güvenilir olup olmadığını araştırmayı amaçladık.
Materyal ve Metod: İç hastalıkları kliniğine başvuran 65 yaş üzeri demansı olmayan 185 DE hasta bu çalışmaya dahil edildi. Hastaların demografik verileri, güneş maruziyetleri, yürüme süreleri, koroner kalp hastalığı (KKH) öyküsü ve düşme sayısı kaydedildi. SÇT, Manos skorlama sistemi kullanılarak ölçüldü. 
Bulgular: Çalışma populasyonu yaş ortalaması 73 ± 6 yıl olan 127 (%68.6) erkek ve yaş ortalaması 70 ± 5 yıl olan 58 (%31.4) kadın hastayı içeriyordu. Manos skorlama sistemine göre, 90 (%48.6) kişinin CDT skoru 0, 70 (%37.9) kişinin CDT skoru 1-9 arası ve 25 (%13.5) kişinin CDT skoru 10 idi. Hastaların ortalama D vitamin düzeyi 18.4 ± 7.3 ng/mL idi. D vitamin seviyesi ve SÇT skorları güneş maruziyeti, yürüme süresi ve düşme sayısı ve KKH için tahmin edici değerdeydi.
Sonuç: DE kişilerin SÇT skorları bilinç fonksiyonlarını göstermede güvenilir değildir. Bu çalışma gösterdi ki DE bireylerde D vitamin seviyeleri güneş maruziyeti, yürüme süresi, düşme sayısı ve KKH sıklığını göstermede SÇT skorundan daha güçlüdür.

Keywords

D vitamin, saat çizme testi, düşük eğitim düzeyi, güneş maruziyeti, fiziksel aktivite

References

• Matallana D, de Santacruz C, Cano C, Reyes P, Samper-Ternent R, Markides KS, et al. The relationship between education level and mini-mental state examination domains among older Mexican Americans. J Geriatr Psychiatry Neurol 2011;24:9-18.
• Maki Y, Yamaguchi T, Yamaguchi H. Symptoms of Early Dementia-11 Questionnaire (SED-11Q): A Brief Informant-Operated Screening for Dementia. Dement Geriatr Cogn Dis Extra. 2013;3:131-42.
• Shoyama M, Nishioka T, Okumura M, Kose A, Tsuji T, Ukai S, et al. Brain activity during the Clock- Drawing Test: multichannel near-infrared spectroscopy study. Appl Neuropsychol. 2011;18:243-51.
• Roman GC, Royall DR. Executive control function: a rational basis for the diagnosis of vascular dementia. Alzheimer Dis Assoc Disord. 1999;13:69-80.
• Cangöz B, Karakoç E, Selekler K. Saat çizme testinin 50 yaş ve üzeri Türk yetişkin ve yaşlı örneklemi üzerindeki norm belirleme ve geçerlik-güvenirlik çalışmaları. Turkish J Geriatr. 2006;9:136-42 (in Turkish).
• Pinto E, Peters R. Literature review of the Clock Drawing Test as a tool for cognitive screening. Dement Geriatr Cogn Disord. 2009;27:201-13.
• Manos PJ. The utility of the ten-point clock test as a screen for cognitive impairment in general hospital patients. Gen Hosp Psychiatry. 1997;19:439–44.
• Fuzikawa C, Lima-Costa MF, Uchoa E, Barreto SM, Shulman K. Bambui Health and Ageing Study. A population based study on the intra and inter-rater reliability of the clock drawing test in Brazil: the Bambui Health and Ageing Study. Int J Geriatr Psychiatry. 2003;18:450-6.
• Fuzikawa C, Lima-Costa MF, Uchoa E, Shulman K. Correlation and agreement between the Mini-mental State Examination and the Clock Drawing Test in older adults with low levels of schooling: the Bambuí Health Aging Study (BHAS). Int Psychogeriatr. 2007;19:657-67.
• Soni M, Kos K, Lang IA, Jones K, Melzer D, Llewellyn DJ. Vitamin D and cognitive function. Scand J Clin Lab Invest Suppl. 2012;243:79-82.
• Annweiler C, Fantino B, Schott AM, Krolak-Salmon P, Allali G, Beauchet O. Vitamin D insufficiency and mild cognitive impairment: cross-sectional association. Eur J Neurol. 2012;19:1023-9.
• Skalska A, Gałas A, Grodzicki T. 25-hydroxyvitamin D and physical and cognitive performance in older people with chronic conditions. Pol Arch Med Wewn. 2012;122:162-9.
• Slinin Y, Paudel ML, Taylor BC, Fink HA, Ishani A, Canales MT, et al. Osteoporotic Fractures in Men (MrOS) Study Research Group. 25-Hydroxyvitamin D levels and cognitive performance and decline in elderly men. Neurology. 2010;74:33-41.
• Dhesi JK, Jackson SH, Bearne LM, Moniz C, Hurley MV, Swift CG, et al. Vitamin D supplementation improves neuromuscular function in older people who fall. Age Ageing. 2004;33:589-95.
• Annweiler C, Rolland Y, Schott AM, Blain H, Vellas B, Herrmann FR, et al. Higher vitamin D dietary intake is associated with lower risk of alzheimer's disease: a 7-year follow-up. J Gerontol A Biol Sci Med Sci. 2012;67:1205-11.
• Oudshoorn C, Mattace-Raso FU, van der Velde N, Colin EM, van der Cammen TJ. Higher serum vitamin D3 levels are associated with better cognitive test performance in patients with Alzheimer's disease. Dement Geriatr Cogn Disord. 2008;25:539-43.
• Aydin ZD, Ersoy IH, Baştürk A, Kutlucan A, Göksu SS, Güngör G, et al. Predictors of clock drawing test (CDT) performance in elderly patients attending an internal medicine outpatient clinic: a pilot study on sun exposure and physical activity. Arch Gerontol Geriatr. 2011;52:226-31.
• Mainland BJ, Amodeo S, Shulman KI. Multiple clock drawing scoring systems: simpler is better. Int J Geriatr Psychiatry. 2014;29:127-36.
• Cecato JF, Fiorese B, Montiel JM, Bartholomeu D, Martinelli JE. Clock drawing test in elderly individuals with different education levels: correlation with clinical dementia rating. Am J Alzheimers Dis Other Demen. 2012;27:620-4.
• Kim H, Chey J. Effects of education, literacy, and dementia on the Clock Drawing Test performance. J Int Neuropsychol Soc 2010; 16:1138-46.
• Chan CC, Yung CY, Pan PC. Screening of dementia in Chinese elderly adults by the clock drawing test and the time and change test. Hong Kong Med J. 2005;11:13-9.
• Ainslie NK, Murden RA. Effect of education on the clock-drawing dementia screen in non-demented elderly persons. J Am Geriatr Soc. 1993;41:249-52.
• von Gunten A, Ostos-Wiechetek M, Brull J, Vaudaux-Pisquem I, Cattin S, Duc R. Clock-drawing test performance in the normal elderly and its dependence on age and education. Eur Neurol. 2008;60:73-8.
• Lourenço RA, Ribeiro-Filho ST, Moreira Ide F, Paradela EM, Miranda AS. The Clock Drawing Test: performance among elderly with low educational level. Rev Bras Psiquiatr. 2008;30:309-15.
• Thacher TD, Clarke BL. Vitamin D insufficiency. Mayo Clin Proc. 2011;86:50-60.
• Llewellyn DJ, Lang IA, Langa KM, Muniz-Terrera G, Phillips CL, Cherubini A, et al. Vitamin D and risk of cognitive decline in elderly persons. Arch Intern Med. 2010;170:1135-41.
• Eyles DW, Burne TH, McGrath JJ. Vitamin D, effects on brain development, adult brain function and the links between low levels of vitamin D and neuropsychiatric disease. Front Neuroendocrinol. 2013;34:47-64.
• Kirbas A, Kirbas S, Anlar O, Turkyilmaz AK, Cure MC, Efe H. Investigation of the relationship between vitamin D and bone mineral density in newly diagnosed multiple sclerosis. Acta Neurol Belg. 2013;113:43-7.
• Keeney JT, Förster S, Sultana R, Brewer LD, Latimer CS, Cai J, et al. Dietary vitamin D deficiency in rats from middle to old age leads to elevated tyrosine nitration and proteomics changes in levels of key proteins in brain: Implications for low vitamin D- dependent age-related cognitive decline. Free Radic Biol Med. 2013;65:324-34.
• Przybelski RJ, Binkley NC. Is vitamin D important for preserving cognition? A positive correlation of serum 25-hydroxyvitamin D concentration with cognitive function. Arch Biochem Biophys. 2007;460:202-5.
• Ozkan B, Doneray H, Karacan M, Vançelik S, Yildirim ZK, Ozkan A, et al. Prevalence of vitamin D deficiency rickets in the eastern part of Turkey. Eur J Pediatr 2009; 168: 95-100. Erratum in: Eur J Pediatr. 2009;168:101.
• Cumhur Cure M, Cure E, Yuce S, Yazici T, Karakoyun K, Efe H. Mean Platelet Volume and Vitamin D Level. Ann Lab Med. 2014; in press (March 2014).
• Song HR, Kweon SS, Choi JS, Rhee JA, Lee YH, Nam HS, et al. High Prevalence of Vitamin D Deficiency in Adults Aged 50 Years and Older in Gwangju, Korea: the Dong-gu Study. J Korean Med Sci. 2014;29:149-52.
• Hovsepian S, Amini M, Aminorroaya A, Amini P, Iraj B. Prevalence of Vitamin D Deficiency among Adult Population of Isfahan City, Iran J Health Popul Nutr. 2011;29:149-55.
• Dhanwal DK, Sahoo S, Gautam VK, Saha R. Hip fracture patients in India have vitamin D deficiency and secondary hyperparathyroidism. Osteoporos Int. 2013;24:553-7.
• Peterson A, Mattek N, Clemons A, Bowman GL, Buracchio T, Kaye J, Quinn J. Serum vitamin D concentrations are associated with falling and cognitive function in older adults. J Nutr Health Aging. 2012;16:898-901.
• Suzuki T, Kwon J, Kim H, Shimada H, Yoshida Y, Iwasa H, et al. Low serum 25-hydroxyvitamin D levels associated with falls among Japanese community- dwelling elderly. J Bone Miner Res. 2008;23:1309-17.
• Al-Othman A, Al-Musharaf S, Al-Daghri NM, Krishnaswamy S, Yusuf DS, Alkharfy KM, et al. Effect of physical activity and sun exposure on vitamin D status of Saudi children and adolescents. BMC Pediatr. 2012;12:92.
• Vercruyssen J, Jacquemyn Y, Ajaji M. Effect of sun exposure and 25-hydroxyvitamin D status among pregnant women in Antwerp, Belgium. Int J Gynaecol Obstet. 2012;116:76-7.
• Syal SK, Kapoor A, Bhatia E, Sinha A, Kumar S, Tewari S, et al. Vitamin D deficiency, coronary artery disease, and endothelial dysfunction: observations from a coronary angiographic study in Indian patients. J Invasive Cardiol. 2012;24:385-9.