Regular Research Articles| Volume 14, ISSUE 12, P1032-1040, December 2006

Vitamin D Deficiency Is Associated With Low Mood and Worse Cognitive Performance in Older Adults


      Vitamin D deficiency is common in older adults and has been implicated in psychiatric and neurologic disorders. This study examined the relationship among vitamin D status, cognitive performance, mood, and physical performance in older adults.


      A cross-sectional group of 80 participants, 40 with mild Alzheimer disease (AD) and 40 nondemented persons, were selected from a longitudinal study of memory and aging. Cognitive function was assessed using the Short Blessed Test (SBT), Mini-Mental State Exam (MMSE), Clinical Dementia Rating (CDR; a higher Sum of Boxes score indicates greater dementia severity), and a factor score from a neuropsychometric battery; mood was assessed using clinician's diagnosis and the depression symptoms inventory. The Physical Performance Test (PPT) was used to measure functional status. Serum 25-hydroxyvitamin D levels were measured for all participants.


      The mean vitamin D level in the total sample was 18.58 ng/mL (standard deviation: 7.59); 58% of the participants had abnormally low vitamin D levels defined as less than 20 ng/mL. After adjusting for age, race, gender, and season of vitamin D determination, vitamin D deficiency was associated with presence of an active mood disorder (odds ratio: 11.69, 95% confidence interval: 2.04–66.86; Wald χ2 = 7.66, df = 2, p = 0.022). Using the same covariates in a linear regression model, vitamin D deficiency was associated with worse performance on the SBT (F = 5.22, df = [2, 77], p = 0.044) and higher CDR Sum of Box scores (F = 3.20, df = [2, 77], p = 0.047) in the vitamin D-deficient group. There was no difference in performance on the MMSE, PPT, or factor scores between the vitamin D groups.


      In a cross-section of older adults, vitamin D deficiency was associated with low mood and with impairment on two of four measures of cognitive performance.

      Key Words

      To read this article in full you will need to make a payment

      Purchase one-time access:

      Academic & Personal: 24 hour online accessCorporate R&D Professionals: 24 hour online access
      One-time access price info
      • For academic or personal research use, select 'Academic and Personal'
      • For corporate R&D use, select 'Corporate R&D Professionals'


      Subscribe to The American Journal of Geriatric Psychiatry
      Already a print subscriber? Claim online access
      Already an online subscriber? Sign in
      Institutional Access: Sign in to ScienceDirect


        • Gloth FM
        • Gundberg CM
        • Hollis BW
        • et al.
        Vitamin D deficiency in homebound elderly persons.
        JAMA. 1995; 274: 1683-1686
        • Goldray D
        • Mizrahi-Sasson E
        • Merdler C
        • et al.
        Vitamin D deficiency in elderly patients in a general hospital.
        J Am Geriatr Soc. 1989; 37: 589-592
        • McKenna MJ
        Differences in vitamin D status between countries in young adults and the elderly.
        Am J Med. 1992; 93: 69-77
        • Malabanan A
        • Veronikis IE
        • Holick MF
        Redefining vitamin D insufficiency.
        Lancet. 1998; 351: 805-806
        • Sherman SS
        • Hollis BW
        • Tobin JD
        Vitamin D status and related parameters in a healthy population: the effects of age, sex, and season.
        J Clin Endocrinol Metab. 1990; 71: 405-413
        • Thomas MK
        • Lloyd-Jones DM
        • Thadhani RI
        • et al.
        Hypovitaminosis D in medical inpatients.
        N Engl J Med. 1998; 338: 83-777
        • Sato Y
        High prevalence of vitamin D deficiency and reduced bone mass in elderly women with Alzheimer's disease.
        Bone. 1998; 23: 555-557
        • Holick MF
        • Matsuoka LY
        • Wortsman J
        Age, vitamin D, and solar ultraviolet.
        Lancet. 1989; 4: 1104-1105
        • Parfitt AM
        • Chir B
        • Gallagher JC
        • et al.
        Vitamin D and bone health in the elderly.
        Am J Clin Nutr. 1982; 36: 1014-1031
        • Reichel H
        • Koeffler H
        • Norman AW
        The role of vitamin D endocrine system in health and disease.
        N Engl J Med. 1989; 320: 980-991
        • Holick MF
        Vitamin D the underappreciated D-lightful hormone that is important for skeletal and cellular health.
        Curr Opin Endocrinol Diabetes. 2002; 9: 87-98
        • Lips P
        Vitamin D deficiency and secondary hyperparathyriodism in the elderly: consequences for bone loss and fractures and therapeutic implications.
        Endocr Rev. 2001; 22: 477-501
        • Brown AJ
        • Dusso A
        • Slatopolsky E
        Vitamin D.
        Am J Physiol. 1999; 277: F157-175
        • Garcion E
        • Wion-Barbot N
        • Wion D
        New clues about vitamin D functions in the nervous system.
        Trends Endocrinol Metab. 2002; 13: 100-105
        • Eyles DW
        • Smith S
        • Kinobe R
        • et al.
        Distribution of the vitamin D receptor and 1alpha-hydroxylase in human brain.
        J Chem Neuroanat. 2005; 29: 21-30
        • Stumpf WE
        • Sar M
        • Clark SA
        • et al.
        Brain target sites for 1,25-dihydroxyvitamin D3.
        Science. 1982; 215: 1403-1405
        • Langub MC
        • Herman JP
        • Malluche HH
        • et al.
        Evidence of functional vitamin D receptors in rat hippocampus.
        Neuroscience. 2001; 104: 49-56
        • Neveu I
        • Naveilhan P
        • Jehan F
        • et al.
        1,25-dihydroxyvitamin D3 regulates the synthesis of nerve growth factor in primary cultures of glial cells.
        Brain Res Mol Brain Res. 1994; 24: 70-76
        • Cornet A
        • Baudet C
        • Neveu I
        • et al.
        1,25-dihydroxyvitamin D3 regulates the expression of VDR and NGF gene in Schwann cells in vitro.
        J Neurosci Res. 1998; 53: 742-746
        • Saporito MS
        • Brown ER
        • Hartpence KC
        • et al.
        Chronic 1,25-dihydroxyvitamin D3-mediated induction of nerve growth factor mRNA and protein in L929 fibroblasts and in adult rat brain.
        Brain Res. 1994; 633: 189-196
        • Brewer LD
        • Thibault V
        • Chen KC
        • et al.
        Vitamin D hormone confers neuroprotection in parallel with downregulation of L-type calcium channel expression in hippocampal neurons.
        J Neurosci. 2001; 21: 98-108
        • Landfield PW
        • Cadwallader-Neal L
        Long-term treatment with calcitriol (1,25 (OH) 2 vit D3) retards a biomarker of hippocampal aging in rates.
        Neurobiol Aging. 1998; 19: 469-477
        • Rosenthal NE
        • Sack DA
        • Carpenter CJ
        • et al.
        Antidepressant effects of light in seasonal affective disorder.
        Am J Psychiatry. 1985; 142: 163-170
        • Cole RJ
        • Kripke DF
        • Wisbey J
        • et al.
        Seasonal variation in human illumination exposure at two different latitudes.
        J Biol Rhythms. 1995; 10: 324-334
        • Spoont MR
        • Depue RA
        • Krauss SS
        Dimensional measurement of seasonal variation in mood and behavior.
        Psychiatry Res. 1991; 39: 269-284
        • Oren DA
        • Schulkin J
        • Rosenthal NE
        1,25 (OH)2 vitamin D3 levels in seasonal affective disorder: effects of light.
        Psychopharmacology. 1994; 116: 515-516
        • Schneider B
        • Weber B
        • Frensch A
        • et al.
        Vitamin D in schizophrenia, major depression and alcoholism.
        J Neural Transm. 2000; 107: 839-842
        • Kenny AM
        • Biskup B
        • Robbins B
        • et al.
        Effects of vitamin D supplementation on strength, physical function, and health perception in older, community-dwelling men.
        J Am Geriatr Soc. 2003; 51: 1762-1767
        • Gloth 3rd, FM
        • Alam W
        • Hollis B
        Vitamin D vs broad spectrum phototherapy in the treatment of seasonal affective disorder.
        J Nutr Health Aging. 1999; 3: 5-7
        • Lansdowne ATG
        • Provost SC
        Vitamin D3 enhances mood in healthy subjects during winter.
        Psychopharmacology. 1998; 135: 319-323
        • Pfeifer M
        • Begerow B
        • Minne HW
        • et al.
        Effects of a short-term vitamin D and calcium supplementation on body sway and secondary hyperparathyroidism in elderly women.
        J Bone Miner Res. 2000; 15: 1113-1118
        • Bischoff HA
        • Staehelin HB
        • Dick W
        • et al.
        Effects of vitamin D and calcium supplementation on falls: a randomized controlled trial.
        J Bone Miner Res. 2003; 18: 343-351
        • Mowe M
        • Haug E
        • Bohmer T
        Low serum calcidiol concentration in older adults with reduced muscular function.
        J Am Geriatr Soc. 1999; 47: 220-226
        • Stein MS
        • Wark JD
        • Scherer SC
        • et al.
        Falls relate to vitamin D and parathyroid hormone in an Australian nursing home and hostel.
        J Am Geriatr Soc. 1999; 47: 1195-1201
        • Folstein MF
        • Folstein SE
        • McHugh PR
        Mini-mental state: a practical method for grading the cognitive state of patients for the clinicians.
        J Psychiatr Res. 1975; 12: 189-198
        • Katzman R
        • Brown T
        • Fuld P
        • et al.
        Validation of a short orientation–memory–concentration test of cognitive impairment.
        Am J Psychiatry. 1983; 140: 734-739
        • Powlishta KK
        • Storandt M
        • Mandernach TA
        • et al.
        Absence of effect of depression on cognitive performance in early-stage Alzheimer disease.
        Arch Neurol. 2004; 61: 1265-1268
        • Rubin EH
        • Veiel LL
        • Kinscherf DA
        • et al.
        Clinically significant depressive symptoms and very mild to mild dementia of the Alzheimer type.
        Int J Geriatr Psychiatry. 2001; 16: 694-701
        • Burke WJ
        • Roccaforte WH
        • Wengel SP
        • et al.
        Disagreement in the reporting of depressive symptoms between patients with dementia of the Alzheimer type and their collateral sources.
        Am J Geriatr Psychiatry. 1998; 6: 308-319
        • Morris JC
        The Clinical Dementia Rating (CDR): current version and scoring rules.
        Neurology. 1993; 43: 2412-2414
        • Berg L
        • Miller JP
        • Baty J
        • et al.
        Mild senile dementia of the Alzheimer type. 4. Evaluation of intervention.
        Ann Neurol. 1992; 31: 242-249
        • Morris JC
        • McKeel D
        • Fulling K
        • et al.
        Validation of clinical diagnostic criteria for Alzheimer's disease.
        Ann Neurol. 1988; 24: 17-22
        • Burke WJ
        • Miller JP
        • Rubin EH
        • et al.
        Reliability of the Washington University clinical dementia rating.
        Arch Neurol. 1988; 45: 31-32
        • Storandt M
        • Hill RD
        Very mild senile dementia of the Alzheimer type. II. Psychometric test performance.
        Arch Neurol. 1989; 46: 383-386
        • Wechsler D
        • Stone CP
        Manual: Wechsler Memory Scale. Psychological Corporation, New York1973
        • Wechsler D
        Manual: Wechsler Adult Intelligence Scale. Psychological Corporation, New York1955
        • Goodglass H
        • Kaplan E
        Boston Naming Test Scoring Booklet. Lea & Febiger Psychological Corp, Philadelphia1983
        • Benton AL
        The Revised Visual Retention Test: Clinical and Experimental Applications. Psychological Corporation, New York1963
        • Armitage SG
        An analysis of certain psychological tests used in the evaluation of brain injury.
        Psychological Monographs. 1946; 60: 1-48
        • Thurstone LL
        • Thurstone LG
        Examiner Manual for the SRA Primary Mental Abilities Test. Science Research Associates, Chicago1949
        • Botwinick J
        • Storandt M
        Speed functions, vocabulary ability, and age.
        Percept Mot Skills. 1973; 36: 1123-1128
        • Rubin EH
        • Storandt M
        • Miller JP
        • et al.
        A prospective study of cognitive function and onset of dementia in cognitively healthy elders.
        Arch Neurol. 1998; 55: 395-401
        • Reuben DB
        • Siu AL
        An objective measure of physical function of elderly outpatients.
        J Am Geriatr Soc. 1990; 38: 1105-1112
        • Reuben DB
        • Siu AL
        • Kimpau S
        The predictive validity of self-report and performance-based measures of function and health.
        J Gerontol Med Sci. 1992; 47: M106-M110
        • Binder EF
        • Storandt M
        • Birge SJ
        The relation between psychometric test performance and physical performance in older adults.
        J Gerontol A Biol Sci Med Sci. 1999; 54A: M428-M432
        • Guralnik JM
        • Simonsick EM
        • Ferrucci L
        • et al.
        A short physical performance battery assessing lower extremity function: association with self-reported disability and prediction of mortality and nursing home admission.
        J Gerontol A Biol Sci Med Sci. 1994; 49: M85-M94
        • Rossiter-Fornoff JE
        • Wolf SL
        • Wolfson LI
        • et al.
        A cross-sectional validation study of the FICSIT common data base static balance measures. Frailty and Injuries: cooperative studies of intervention techniques.
        J Gerontol A Biol Sci Med Sci. 1995; 50: M291-M297
        • Peacock M
        • Hordon L
        Femoral fracture: the role of vitamin D.
        in: Kleerkoper M Krane SM Clinical Disorders of Bone and Mineral Metabolism. Mary Ann Liebert, New York1989: 265-271
        • Clemens TL
        Vitamin D nutrition and metabolism in aging and osteoporosis.
        in: Kleerkoper M Krane SM Clinical Disorders of Bone and Mineral Metabolism. Mary Ann Liebert, New York1989: 273-285
        • Eastman CI
        • Young MA
        • Fogg LF
        • et al.
        Bright light treatment of winter depression: a placebo-controlled trial.
        Arch Gen Psychiatry. 1998; 55: 883-889
        • Sumaya IC
        • Rienzi BM
        • Deegan JF
        • et al.
        Bright light treatment decreases depression in institutionalized older adults: a placebo-controlled crossover study.
        J Gerontol A Biol Sci Med Sci. 2001; 56: M356-M360
        • Clemens TL
        • Zhou X
        • Myles M
        • et al.
        Serum vitamin D2 and vitamin D3 metabolite concentrations and absorption of vitamin D2 in elderly subjects.
        J Clin Endocrinol Metab. 1986; 63: 656-660
        • Zerwekh JE
        The measurement of vitamin D: analytical aspects.
        Ann Clin Biochem. 2004; 41: 272-281
        • Morris JC
        • Heyman A
        • Mohs RC
        • et al.
        The Consortium to Establish a Registry for Alzheimer's Disease (CERAD). Part I. Clinical and neuropsychological assessment of Alzheimer's disease.
        Neurology. 1989; 39: 1159-1165
        • Fillenbaum GG
        • Heyman A
        • Wilkinson WE
        • et al.
        Comparison of two screening tests in Alzheimer's disease; the correlation and reliability of the Mini-Mental State Examination and the modified Blessed test.
        Arch Neurol. 1987; 44: 924-927
        • Lee DY
        • Youn JC
        • Choo IH
        • et al.
        Combination of clinical and neuropsychologic information as a better predictor of the progression to Alzheimer disease in questionable dementia individuals.
        Am J Geriatr Psychiatry. 2006; 14: 130-138