Evaluating Research on Dementia and Vitamin E

This assignment evaluates research studies investigating the relationship between vitamin E and dementia risk. It involves a critical appraisal of individual studies based on methodological rigor, considering factors like study design, participant recruitment, bias mitigation, and confounding factors. The assignment also summarizes quantitative findings through meta-analysis and qualitative insights from multiple studies.

To critically review the role of
vitamins in prevention of
dementia

ACKNOWLEDGEMENT
I am so grateful to all those persons who have given me support, guidance as well as much
needed motivation so as to complete the current research study. Firstly, I owe my thanks to mentor
who gave me chance to undertake this dissertation. Furthermore, I am thankful to my team
members, family and friends who helped me in all possible accords. This led to successful
completion of dissertation and achievement of relevant results.

ABSTRACT
Background: Dementia is a mental disorder that reduces the ability of brain functioning. The
patient suffering form same finds it difficult to communicate with others as well as recognizing
family members. He further faces issues of memory loss or mental decline. In this regard,
vitamins play a key role to reduce the chances of dementia. It is further known that vitamin
deficiency has led to an increase in dementia patients. The low levels of them especially vitamin
D has been acting as a potential risk factor.
Aim: This dissertation is based on role of vitamins in prevention of dementia.
Search Strategy: The search strategy followed the use of different electronic databases such as
Science Direct, British Nursing Index, PUB MED, CINHAL PLUS, PubMed, Emerald insight
and Google scholar. There has been use of key search terms like Vitamin and Dementia.
Key Findings: it has been found out that vitamin C, D, B6, B12 and B9 play a key role to keep
mind healthy and active. They further aid to reduce risk of brain degeneration that is likely to
result in dementia.
Recommendations: It can be recommended that the individual who are vulnerable to developing
dementia are required to take adequate amount of vitamin to minimize dementia problems easily.
By changing the lifestyle and quitting certain habits, it can be easy to prevent from dementia
diseases.

TABLE OF CONTENTS
introduction......................................................................................................................................1
Rational...................................................................................................................................1
Overview of dissertation.........................................................................................................2
Aim and Objectives................................................................................................................3
Research question...................................................................................................................4
CHAPTER 1: BACKGROUND REVIEW.....................................................................................5
Chapter 3: Methodology................................................................................................................11
3.1 Analysis and justification for Systematic Review (SR).................................................11
3.3 SR Protocol.....................................................................................................................11
3.3.1 Literature Search Strategy......................................................................................11
3.3.2 Search terms............................................................................................................11
3.3.3 Inclusion & exclusion criteria.................................................................................12
3.3.4 Sources....................................................................................................................13
3.3.5 Database decisions..................................................................................................13
3.4 Quality assessment strategy............................................................................................14
3.4.1 Boolean operators...................................................................................................14
3.4.2 Prisma flow chart....................................................................................................15
Identification........................................................................................................................15
Eligibility...............................................................................................................................15
Included................................................................................................................................15
Screening..............................................................................................................................15
3.4.3 Critical appraisal tools –CASP...............................................................................16
3.5 Positivism philosophy....................................................................................................16
3.6 Validity and Reliability..................................................................................................16
3.7 Ethical issues..................................................................................................................17
3.8 Data extraction strategy..................................................................................................17
chapter 3: Findings and results......................................................................................................18
3.1 Data extraction................................................................................................................18
3.2 Synthesis of the extracted evidence................................................................................22
3.3.1 Thematic analysis...................................................................................................26

Chapter 4: DISCUSSION..............................................................................................................30
4.1 Integration of the results of your findings with existing research and theory................30
4.2 Critical analysis of knowledge and clinical practice gap and discussion.......................31
4.3 Consideration to effectively communicate review findings...........................................31
chapter 5: implication for practice and reflection..........................................................................34
5.1 How will you utilize the results of the SR to move practice forward............................34
5.2 Recommendations for future research............................................................................34
5.3 Reflection on the whole SR process and your own learning..........................................35
CONCLUSION..............................................................................................................................38
references.......................................................................................................................................41
Appendix 1.....................................................................................................................................43
CASP Analysis.....................................................................................................................43

INTRODUCTION
Dementia is a kind of metal disorder which results to decline in mental ability due to
brain disease or injury, personality changes, etc. While suffering from dementia, patients feel
difficulty in understanding or using language, complexity in recognizing family, etc. Doctors
examine dementia with the help of Mini Mental State Exam. Patients can reduce memory loss or
mental decline by keeping their mind active and body fit (Dementia due to metabolic causes.
2016). There are various causes of dementia which includes Alzheimer's disease, vascular
disease, lewy body disease, traumatic head injury, alcohol abuse, brain abscess, etc. Good
personal health habits and proper medical care plays an important role in preventing dementia
(Prince and et.al., 2013). It is further known that vitamin deficiency has led to an increase in
dementia patients. The low levels of them especially vitamin D has been acting as a potential risk
factor.
The present research is based on systematic review of the vital role played by vitamins in
prevention of dementia. Systematic literature review refers to the research study which is formed
by systematically collecting information from multiple studies. It includes proper planning and
mapping with respect to the research, its scope, concepts, various sources of collecting relevant
data, evaluation of obtained information and proper record of complete research (What is a
systematic review, 2016).
Rational
What is the issue?
The presence of dementia in patients is itself an issue. This is as dementia is not just
"forgetfulness. The patient further exhibits communication, emotional, and behavior problems.
The caregivers also face an issue when the love ones start facing these issues. Moreover, the
doctors have further found it difficult to prevent dementia in patients who are suffering from it.
Thus, it is important for the doctors and health care organizations to resolve this issue for
providing proper treatment to the patients and to reduce death percentage of it (Beard, 2011).
Why it is an issue?
Moreover, the dementia patients are acting as a huge source of burden on health care
professes. This in as the patients require proper care due to their overall inability in making
decisions (Blundo, Marin and Ricci, 2011).
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Why it is an issue now?
Due to the changes in living style, people have ignored balanced diet, regular physical
and mental exercises which results in deficiency of vitamins and proteins. Along with this,
people have started preferring instant packed fast food, , , etc. which results in improper
development of individuals and this inappropriate and ineffective development leads to cause
vitamin deficiency dementia (Jung, 2015).
Research will shed light on?
The current investigation will determine the issues related to the cause of dementia, its
symptoms, treatments and proper medication. Along with it, this research will focus on the
various areas for preventing vitamin deficiency dementia, various factors for reducing mental
loss, different tools and techniques for diagnosing this disease and other factors for preventing
patients from vitamin deficiency (DeLuca and et.al, 2013). The proposed study will develop new
strategies for preventing people from vitamin deficiency and suggest them to follow healthy
measures for preventing from dementia.
Overview of dissertation
Dementia is a form of mental disorder which causes due to various mental and physical
diseases. Generally it occurs when the brain neurons die and connection between them are
discontinued. Various conditions which can cause dementia are creutzfeldt-Jakob disease,
immunodeficiency syndrome, multiple sclerosis, degenerative diseases and many other
conditions (O'Leary, Allman-Farinelli and Samman, 2012). Along with it, sometimes dementia
also causes due to the depression, infection, metabolic changes and adverse reactions to drugs. In
a survey it is found that in developed nations, about 15% of old age people (above or equal to 65
years) are reported as suffering from dementia. It is also identified that 40% to 45% of people
suffers from dementia due to Alzheimer's disease. 20% due to vascular diseases and 20% due to
Lewy body disease (Dementia, 2013).
On the other hand, vitamin B12 and Vitamin D plays an important role for preventing
from vitamin based dementia. Vitamin B12 helps in keeping body's nerves and blood cells
healthy which results to make DNA. Hydrochloric acid plays a vital role in separating vitamin
B12 from the proteins (Gu, 2014). After this, vitamin B12 combines with the proteins formed by
the stomach and then absorbed by the body. People can maintain the level of B12 by eating
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variety of foods such as beef liver, fish, meat, milk, eggs, cereals, dairy products, etc. Lack in
vitamin B12 result in causing various diseases such as heart disease and dementia. It is important
to take proper diet which contains proper quantity of vitamins specially vitamin B for preventing
from dementia (Vitamin B12, 2011).
Vitamin D refers to fat soluble vitamin which is presented in very few food items. It is
essential for making bones strong. In addition, it also prevents from cold, and depression. The
best source of vitamin D is sun and if someone's body is facing trouble in absorbing it then they
are going to suffer from various problems one of them is dementia (Littlejohns and et.al, 2014).
Deficiency of either vitamin B12 or D results in causing dementia. It is important for
people to take proper diet from early age for preventing themselves from this disease. Lack of
vitamin B results to cause nutritional disorder which leads to suffer patient from loss of brain
functions, loss of memory, etc. This nutritional deficiency results to cause vitaminB1 and
vitamin B12 deficiency with respect to the dementia (Hurd, 2013). Doctors must focus on these
disorders and needs so to control them by understanding the symptoms. On the other hand, there
is a threshold level of circulating vitamin D, below this it increases the risk of dementia. The best
source for maintaining the level of vitamin D is sun and from its people can prevent from
dementia (Mercola, 2014).
It has further been found that deficiency of Vitamin D is a modifiable risk factor that is
linked with dementia. This is as Vitamin D has a major role to play in overall brain functioning
of human beings. At molecular level it has been found that brain has an ability to undertake
synthesis of vitamin D in its active form being 1, 25-dihydroxyvitamin D (Westwood, 2014).
This synthesis takes place in many kind of cell types as well as regions that are predominantly
present in hypothalamus and the large neurons of substantia nigra. Other than that there exist
many genes that are regulated by Vitamin D. This allows to synthesize products in response to
signals as well as stimuli. It is further clear that there exists a presence of Low vitamin D
concentrations all over the world in all ages (Jung, 2015). The need is thus to assess the link that
exists between vitamin D concentration and dementia by undertaking explicit examination of
evidence. This has thus generated the need to conduct comprehensive systematic literature
review so as to better understand the association between the two.
Aim and Objectives
Aim
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The aim is to critically review the role of vitamins in prevention of dementia.
Objectives:
The objectives of this research are as follows:
 To identify different vitamins which play an important role in dementia.
 To understand the link between dementia and vitamins.
 To identify the importance of vitamins for preventing dementia.
 To recommend appropriate suggestions for preventing dementia.
Research question
There has been a usage of PICO framework so as to formulate the given research
question. It is a technique that is used to frame as well as answer the research question. It is
further helpful in developing literature search strategies. PICO is basically an acronym that
stands for
• P : Patient, problem or population (Dementia patients)
• I : Intervention (Vitamins)
• C : Comparison, control or comparator (none)
• O : Outcomes (prevention of dementia)
1. Do vitamins play a vital role in prevention of dementia?
2. What is the major role of vitamins for preventing dementia?
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CHAPTER 1: BACKGROUND REVIEW
In order to take the dissertation in the right direction, the need is to search the papers in a
proper manner so as to undertake a best possible systematic review. Hence the need is to ensure
that there is a proper adoption of systematic search strategy. Hence the current section will
provide an explanation about how the literature can be sourced in proper manner (Campbell,
Seymour and Primrose, 2014). The section will focus on providing a detailed account about how
the papers have been selected. Emphasis will be given on what type of databases has been used
for search. This is further followed by understanding the key search terms.
In order to take the dissertation in the right direction, the need is to search the papers in a
proper manner so as to undertake a best possible systematic review. Hence the need is to ensure
that there is a proper adoption of systematic search strategy (O'Leary, Allman-Farinelli and
Samman, 2012). Hence the current section will provide an explanation about how the literature
can be sourced in proper manner. The section will focus on providing a detailed account about
how the papers have been selected. Emphasis will be given on what type of databases has been
used for search. This is further followed by understanding the key search terms (Greenhalgh and
Peacock, 2015).
Different vitamins which play an important role in dementia
Baskys, and Cheng, 2012 have stated that “Major activities associated with central and
peripheral nervous system are the result of various vitamin functions that controls the brain
activity” (Baskys, and Cheng, 2012). According to Balion, Griffith and Raina, 2012 “Vitamin B
plays a vital role in managing different brain functions throughout the life. Deficiency in Vitamin
B12 can leads to serious neurological disorders such as Dementia and Alzheimer’s disease”
(Balion, Griffith and Raina, 2012). Vitamin B includes thiamine, riboflavin niacin and biotin that
produces special effects on brain which are necessary to maintain neurological and psychological
balance in an individual. Deficiency of B complex vitamin is not common in youngsters and
teenagers but older citizens are more prone to vitamin B deficiency as a result of neurological
disturbances (Majounie and et.al., 2012). On contrary Blasko, 2015 has concluded that “The
main structural and functional roles of brain are governed by Vitamin D which is also
responsible for aging in individuals with time” (Blasko, 2015). It has also been reported that
vitamin D improves the neurologic conditions of patients suffering from dementia and
Alzheimer’s disease. It helps in boosting the brain activities at a higher rate hence, promoting
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brain chemicals to protect nerve cells effectively. Bottiglieri, 2013 has stated that “Increase in
deficiency of Vitamin D also increases the risk of dementia exponentially” (Bottiglieri, 2013). In
contrast Combs, 2012 has concluded that “Vitamin B complex and B12 helps in completing
various biochemical reactions in nervous system which otherwise remains incomplete due to the
deficiency of vitamin B complexes.” (Combs, 2012). Certain co-enzymes are very necessary to
carry out various chemical and biological reaction in brain. Vitamin B12 acts as an essential co-
enzymes by converting methylmelonyl CoA into succinyl CoA. If methylmelonyl CoA do not
covert succinyl CoA into its byproducts it will lead to destabilize the myelin sheaths which
further causes dementia.
According to Douaud, Refsum and Smith, 2013 “Vitamin D is responsible for exhibiting
the functional changes that regulates various antioxidative mechanism, calcium metabolism and
enhanced nerve conduction” (Douaud, Refsum and Smith, 2013). Similarly Eyles, Burne and
McGrath, 2013 have stated “ Vitamin D plays a beneficial role in developing brain in children as
well as in adults” (Eyles, Burne and McGrath, 2013). Low level of vitamin D in body also
increases the risk of diabetes mellitus, dental degeneration, depression, and various periodontal
disorders in individuals. Peripheral neuropathy is also the result of vitamin B12 deficiency. It
disconnects the transmission of nerve signals which are responsible for carrying signals from
spinal cord to different body parts. The medical manifestations due to deficient levels of vitamin
B12 includes memory loss, Parkinson's disease and abnormal levels of neurotransmitters in brain
(Baskys and Cheng, 2012).
Link between dementia and vitamins:
Vitamins play a significant role in growth and development in aging adults. A direct link
has been found between roles of vitamins and dementia. Ford and Brandt, 2014 has stated that “
Individuals who are diagnosed with deficient levels of vitamin D are at greater risk of suffering
from dementia in future by 53%” (Ford and Brandt, 2014). Similarly Gitlin, Mann and Arthur,
2013 have said that “Vitamin D has been essential for all the neuroprotective functions which are
required for brain development. Excessive decrease in level of this vitamin increases the chances
of dementia by 125% in individuals” (Gitlin, Mann and Arthur, 2013). Vitamin D is important
in basic metabolism process such as mineral absorption, muscle movements and bone growth.
Improper or deficient levels of vitamin D partially increases the degenerative power of brain
which ultimately results in dementia. Magnesium is the most important source of vitamin D. the
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minimal intake of vitamin D ranges from 60-75 ng/ml which is also responsible for treating
cancer and cardiovascular diseases. The other two forms of vitamin D such as D2 and D3 are
also biologically significant for growth and development but D3 has found to be of more clinical
significance as compared to D2 (Bottiglieri, 2013).
In contrast to the above statement Heo and Lee, 2013 have stated that “Vitamin B
complexes are mainly responsible for all the neurological functions taking place in central
nervous system. Inadequate margins of thiamine, biotin and riboflavin increases the shrinking
capacity of brain which further leads to neurodegenrative disabilities” (Heo and Lee, 2013).
Likewise Jernerén and Smith, 2015 have said that “increased levels of vascular complications
and cognitive abnormalities are the result of lack of vitamin B12 in daily diet of an individual.”
(Jernerén and Smith, 2015). If the brain increases the releases of homocystein it will
automatically decrease the quantity of vitamin B complex which is necessary for brain
development and metabolism. In such cases the individuals gradually start to develop vascular
complications which further affects the transmission of nerve signals across the brain (Baskys,
and Cheng, 2012). Vitamin B12 contains primary micro nutrient which is necessary for the
development of brain in infants, children and elderly persons. Different conditions have been
reported which can result in lack of vitamin B. If the deficiency is caused due to improper dietary
habits it can be overcome by incorporating vitamin B supplements in daily diet. A greater
percentage of link between vitamin D and dementia is noticed by researchers in recent times.
Kovach, 2013 has stated that “sunlight exposure is the best source of increasing vitamin D
content in body, however, including fish cod liver oil, orange juices, and cereals also increase the
quantity of vitamin D in body of an individual” (Kovach, 2013). On contrary Littlejohns, Henley
and Lopez, 2014 have said that “ The risk of dementia increases with decrease in vitamin B
complex, hence, it is necessary to elevate the intake of banana, pulses, legumes and whole grains
to balance the vitamin B level in individuals body” (Littlejohns, Henley and Lopez, 2014).
Cobalamin or B12 levels in body can also be enhanced in body by incorporating milk products,
potatoes, beans eggs and sea foods.
Importance of vitamins for preventing dementia
Different types of vitamins present in body plays a significant role in curing and
preventing individuals suffering from dementia. According to Mohajeri, Troesch and Weber,
2015 “dementia is a neural degenerative disorder whose cure appropriate and full cure has not
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been developed yet. However it has been suggested that all the water and fat soluble vitamins
present in our body plays a vital role in preventing and slowing down the process of dementia to
a greater extent” (Mohajeri, Troesch and Weber, 2015).
Balion, Griffith and Raina, 2012 have concluded that “Vitamin C has the ability to
enhance the production of different neurotransmitters in brain which are responsible for
transmitting signals across the brains” (Balion, Griffith and Raina, 2012). It also increases the
capacity to focus, concentrate and remember. Vitamin C is also responsible for controlling
various metabolic activities such as mood swings, increased or decreased levels of sleep and
behavioral patterns. It further also decreases the risk associated with brain degeneration and
cognitive dysfunction (Balion, Griffith and Raina, 2012). The best source of vitamin C is citrus
fruits, pineapple, strawberries, cauliflower, sweet potatoes and tomatoes (Baskys and Cheng,
2012). Vitamin D also known as sunshine vitamin can be directly obtained from sunlight. If the
level of vitamin D is maintained in body throughout lifetime it can reduce chances of dementia,
Alzheimer's disease and other neuropathy disorders by 67%. Pludowski, Holick and Soni, 2013
have stated that “increased index of ultraviolet radiations can produce sufficient amount of
vitamin D which can slow down the activity of patients suffering from dementia” (Pludowski,
Holick and Soni, 2013). Increased oxidative stress is one of the major consequences of deficient
levels of vitamin D in body. It ultimately increases the degenerative capacity of brain which
leads to risk of dementia by 45%.
According to Rooney, 2014 “vitamin B12 or Cobalamin is regarded as the key brain
chemicals responsible for enhancing the production of neurotransmitters such as dopamine,
serotonin and Gamma amino butyric acid” (Rooney, 2014). Lack or inadequate amount of
GABA release from brain leads to over exertion, anxiety and over stimulation in individuals.
Hence, it is very necessary to maintain a proper balance of thiamine, biotin niacin and riboflavin
in body. Elderly people are at a greater risk of suffering from dementia because the release of
neurotransmitters decreases with aging. Solomon, Mangialasche and Skoog, 2014 have
concluded that “ if the daily intake of vitamin B supplements is increased to three fourth level of
present diet the metal retention power neurological stimulation will increase effectively”
(Solomon, Mangialasche and Skoog, 2014). It is advisable to increase the intake of vitamin B
complex if a person is going through lot of stress and depression. Iron of folic acid ingredients
are the best source of vitamin B. The rich source of folic acid is spinach, green leafy vegetables,
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legumes, pulses and eggs. Fish, meat, and dairy products are also good sources of Cobalamin
(Bottiglieri, 2013).
Suggestions for preventing dementia:
According to Stabler, 2013 “a well-balanced and maintained diet reduces the risk of
dementia and other neurological disorders by 28%” (Stabler, 2013). Incorporating food with low
fatty acid content helps in keeping blood pressure and cholesterol level low. Similarly Tangney,
2012 included that “intake of leafy greens cruciferous vegetables like broccoli and cauliflower,
beans and legumes can increase the folic acid intake which is necessary for pregnant women. It
decreases the risk of dementia in older age people to a larger extent” (Tangney, 2012). It has
been reported that daily mental exercise tends to increase and strengthen the mental capacity of
brain which delays the onset of dementia in patients. Wu, Barnes and Mehling, 2015 have stated
that “Exercise is the best way to keep brain and heart healthy. Brain uses more that 20% of
oxygen supplied by heart to function throughout the day. Hence, it is very necessary to exercise
so that brain and heart do not experience fatigue in short period of time” (Wu, Barnes and
Mehling, 2015). It helps in building connections between nerve cells which are responsible for
nerve impulse conduction. Hence, it is very important to exercise daily to prevent dementia in
future. Jernerén and Smith, 2015 have stated that “sleep patterns plays a vital role in keeping a
brain healthy and growing. Disturbed sleep pattern has danger consequences on protein
metabolism which further affects the production of amino acids in DNA” (Jernerén and Smith,
2015). Individual with insomnia or sleeping disorder is likely to develop dementia in later stages
of life therefor it is required to get a proper amount of sleep on daily basis. Excessive intake of
alcohol beverages and tobacco also results in dementia in Middle Ages (Balion, Griffith and
Raina, 2012). Smoking promotes the degeneration of nerve cells in brain which causes insanity.
It also fastens the onset of neurological disorders by seven years in men (Baskys, and Cheng,
2012).
Similarly Mohajeri, Troesch and Weber, 2015 have stated that “Smoking of tobacco on
daily basis has serious life threatening effects on brain. It decreases the power to remember, to
concentrate and to learn gradually” (Mohajeri, Troesch and Weber, 2015). Hence, the quantity of
alcohol and tobacco should be limited to certain level so that a person do not increase the
chances of suffering from dementia in future. Incorporating iron tablets and folic acid
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supplements in daily diet enhances the cognitive functioning power of brain thus by reducing the
release of homocystein in brain (Bottiglieri, 2013).
Biological function of brain and function of vitamins:
The biochemical rationale and functions of brain in patients with dementia Alzheimer's disease
and cognitive disorders differ from the biological function of a normal brain. The inactivation of
methylmalonyl-CoA could substitute malonyl-CoA in fatty acid synthesis, which will further
lead to accumulation of abnormal fatty acids in brain. The deficiency of vitamin B-12 also
decreases the level of red blood cells in body which results in anaemia (Haris, 2015). It is also
responsible for destroying the autoimmune cells of parietal and frontal lobe of brain in patients
suffering from dementia. Increased level of homocysteine in neural cell decreased the power of
retention, concentration and leaning abilities. It also caused degeneration of brain cells which
lead to reduce the overall functioning of brain in Alzheimer's and dementia patients. However
studies revealed that mild cognitive impairment in individuals did not cause any abnormality in
autonomic functioning of brain in cognitive impairment. Increase in level of vitamin D and folic
acid tend to increase the activity of brain to a greater extent (Mercola, 2016). Decreased level of
fatty acid was not found to have any effect on the functioning of brain in patients suffering from
various neurological disorders. Cognitive and motor neuron impairment can be noticed in
patients with deficiency of various minerals apart from vitamin B complex, Vitamin D folates
and fatty acids. Neurological dysfunction is noticed in brain because vitamin deficiency inhibits
proper transmission of nerve signals from one neuron to another in a systematic way (Gu and
et.al., 2014).
Human brain accounts for 2 percent of body weight and requires 25 percent of glucose, 15
percent of blood supply and number of vitamins to keep it in optimal function (Haris, 2015). It
has been observed in different studies that deficiency of certain vitamins affect the cognitive
functioning in individuals and elevates the risk of mental disorders. Among these, Dementia is
the most common mental condition which is caused by the lower concentration of essential
vitamins. Vitamin B has been found to impact the brain signaling in humans. It has been studied
that neurons are responsible for processing information by setting up communication in body
with the help of neurotransmitters. B Vitamins such as vitamin B6, B12, riboflavin and folate
play very important role in the production of neurotransmitters. This helps in smooth brain
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functioning which is very cardinal to prevent the risk of dementia (Breeze and et.al., 2014).
Besides this, Vitamin E also play important role in protecting brain tissues from damage. It has
been observed that acute deficiency of this vitamin negatively impact cognitive functioning as it
leads to dementia symptoms such as memory loss and impaired balance. Several studies reveal
that proper supplement of Vitamin E is helpful in prevention of Alzheimer's which a progressive
stage of dementia is. Another vitamin which is very essential in prevention of mental disorders is
antioxidant nutrient called vitamin C (Mercola, 2016). Studies indicate that Vitamin C is
responsible for removal of toxins in brain. It has been observed that accumulation of toxins in
brain can lead to development of mental disorders such as dementia, Alzheimer's and Parkinson's
by damaging neurons.
Vitamins B and Dementia
Healthy skin as well as muscles. In order to downcast the progression or growing rate of
dementia vitamins are considered as beneficial. Researchers within Oxford University has been
acknowledged that basically there are three form of vitamins that are consider as safe in treating
the dementia disease among the individual. The three types of vitamins inlcude Vitamin B16,
B12 and folic acid these are capable enough to equalize the blood levels of amino acid that are
often termed as homocysteine. Therefore, it can be said that the increasing risk of dementia has
been associated with the increasing level of homoccysteine.
At the Oxford University Smith and his colleagues with 168 volunteers has conducted
clinical two year proceeding that measure the effect of Vitamin B on the MCI. The participants
diagnosed with MCI were provided with vitamin pill that generally consists of high medication
of folic acid. Placebo substitution pill or it may be vitamin B6 and B12. These vitamin pills are
also considered as “TrioBe Plus” that include high quantity of vitamin B12 that is more than 300
times of the recommended quantity, high amounts of folate that will be 4 times more than the
daily advised and it also contain B6 vitamin that is 15 times more than the advised level. In the
beginning and end of two year clinical trial they also study the rate of brain shrinkage with the
help of using brain scans. Through conducting the study it was observed that by taking the
vitamin pills the rate of brain shrinkage was around 0.76% in a year on the other hand, by taking
the substitute pills the rate of brain shrinkage was 1.08%. Therefore, it can be said that taking
substitute pills are consider as the major reason of increasing brain atrophy.
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Furthermore, through conducting the trial it can also be stated that individual that possess
low rate of brain atrophy generally score higher in the tests. The trial has also result in enabling
further research that ensure establishing big scale trials that support in determining the
effectiveness of using vitamin B complex that result in lowering or decreasing the evolution of
different neurodegenerative diseases.
Vitamin C and Dementia
The antioxidants serum-concentration, beta-carotene and vitamin C are in low quantity
among the dementia patients than the other patients that does not shows the symptoms of
Alzheimer's Disease (AD), that also propose that all these antioxidant protect the patients and
individual from the dementia.
From the previous study it was studied that in taking vitamin C does not lower the danger
of dementia and Alzheimer's Disease but from the University of Ulm, Epidemiologist Professor
Gabriele Nagel and Neurologist Professor Christine von Arnim, has declared that through this iot
might influences the way under which the disease Alzheimer develop. It is consider as
neurodegenerative diseases. With the help of amyloid-beta-plaques, deterioration of fibrillae and
a reduction of synapses these are consider as key origin that ensure brain changes.
The common ground for developing the AD can be originate from the oxidative stress
that generally limit the usage of oxygen within the body. There are different foods that are
considered as major source of gaining Vitamin C that include oranges, strawberries, kiwi,
Spinanch, cauliflower, brussels sprouts that assist in battling the evidence of dementia.
While conducting the study professionals or expertise has measured that pateints that suffers of
AD possess low serum-levels of beta-carotene, vitamin C, vitamin E, lycopene and coenzyme
Q10 in their blood. However, Nagel state that they need to be awake regarding assessing the
potential risk that influences the development of AD among the individual. It has also determine
that a compare to the healthy individual patient with AD possess vitamin C and beta-carotene
level in their blood serum. There are different factors that need to be considered by the experts
such as consumption of alcohol level, body mass index, usage of tobacco etc.
In addition to this, it has also stated that the processing of food as well as storage of food
also contribute in assessing the patient’s personal life. In order to convinced their finding it is
necessary to focus on more research through using different surveys. Gabriele Nagel also state
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that large scale studies with more contestant assure the outcome that vitamin C and beta-carotene
generally forbid the development of AD among the individual.
Vitamin D and Dementia
The study conducted by international team for the long six year has confirmed that there
is relationship between the low vitamin D and dementia. From report published in the science
daily “The participant that features the deficient of vitamin D will develop the AD and
dementia”.
Adult participants within the study those are moderately lacking in the vitamin D
generally possess higher risk of developing dementia diseases and around 125 percent are those
that badly lack the vitamins.
Likewise outcome that were taped for AD also that individual with moderately deficient
of vitamins are around 69 percent that develop dementia while it jump off to 122 percent if
individual seriously lack the vitamins.
Therefore author has concluded that lack in vitamin D that increased the cases of dementia and
Alzheimer diseases. That further initiate the debate regarding assessing the role of vitamin D in
nonskeletal conditions.
From the finding it can suggest that there is certain level that assist current level of
vitamin D that increases the risk associated with dementia. The current beginning of vitamin D
level found to be around 50 nmol/L, or 20 ng/ml. From the previous research it is suggested
that20 ng/ml is dangerous as well as low. While it come to vitamin D it must be accordant with
the range.
In the present through measuring the healthy population it result in acquiring abundance
of natural sun disclosure that further suggests that general health appears between 50 and 70
ng/ml, or 125-175 nmol/L that is quite distant from the previous study.
Vitamin E and Dementia
Many researcher and investigator has research regarding the Vitamin E in order to
understand their role and function in variety of pathophysiological contexts. In the huge
published work has been assessed on the antioxidant properties of vitamin E that is basically
famed as lipophilic antioxidant that defend the membranes from the free radicals. However,
recently investigation revealed that there is biological roles that is mistranslated with the
antioxidant holding. Therefore, vitamin E may also define as regulator of signal transduction,
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gene expression, and redox sensor. With the introduction of free radical theory related with the
brain ageing has revived the researcher interest within the vitamin. Thus the resultant work
claims that vitamin E must be utilized as therapeutic approach that prevent and reduces the brain
damages. Therefore, through this article it has also consider that natural dietary factor that is
vitamin E plays an essential factor in preventing the brain ageing, cognition as well as
Alzheimer's dementia.
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CHAPTER 3: METHODOLOGY
3.1 Analysis and justification for Systematic Review (SR)
The current study focuses on role of vitamins in prevention of dementia and for attaining
this, author has used systematic review of relevant studies. In the SR, researcher needs to collect
and look at multiple studies (Campbell, Seymour and Primrose, 2014). Therefore, for the current
study author has selected different types of articles, such as systematic review, qualitative, case
control and cohort studies on related subjects. For resolving research issue author has included
studies relevant to dementia and different types of vitamins which play important role in this
diseases. Systematic review has applied for the current study because it is usually quicker and
most cost effective for researcher (Wind and et.al., 2013). Including this, it is more reliable and
accurate than individual studies so, author has applied systematic review for the same. Therefore,
systematic review is one of the important way to analyse the role of vitamin in dementia.
3.3 SR Protocol
Systematic review protocol can be defined as a roadmap for the whole review which
specifies the objectives, methods and outcomes of primary interest of SR. These protocols help
in promoting transparency of methods (Prince and et.al., 2013). Major protocols include
literature search strategy, search terms, inclusion and exclusion criteria, sources, database, data
extraction process, etc. A brief discussion of all these SR protocols are described as under:
3.3.1 Literature Search Strategy
There has been a utilization of a well-defined, systematic as well as ordered process of
search so as to ensure that there is a proper establishment of overall credibility of the literature
review. This may aid in ensuring towards an explicit as well as focussed search. Hence the next
task after finalizing the research topic and question is to identify the diverse kinds of search
strategies that can be used to select the articles (Greenhalgh and Peacock, 2015). Hence the
upcoming sections have made an attempt to focus on the varied kinds of strategies that can be
utilized for carrying out overall research.
3.3.2 Search terms
In order to ensure towards carrying out a proper search the need is to make use of proper
keywords. These terms consists of all possible synonyms that are likely to be utilized in relation
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to the given research topic (Shalowitz Garrett-Mayer and Wendler, 2012). For the given study on
vitamin and dementia there has been a usage of following search terms;
Table 1: Search Terms
TERM 1 Vitamin, Vitamin D, Vitamin B12, ,25-
dihydroxyvitamin D
TERM 2 Dementia, memory
3.3.3 Inclusion & exclusion criteria
Main emphasis has also been given on inclusion and exclusion criteria that assist in
selecting the articles. These criteria are effective for getting most appropriate and relevant
articles for current study (Wind, 2013). Major considerations of inclusion and exclusion criteria
are as follows:
 Inclusion criteria: According to this criteria author has comprised or considered all
those articles which were written in English and professional language. Along with
this, study has selected only those articles which have published after the year 2000.
Researcher has emphasized on the key word search at the time of selecting articles so,
study has included only those articles which were relevant to vitamins and dementia.
Consequently, inclusion criteria has helped in getting suitable articles for determining
appropriate solution of the research question.
 Exclusion criteria: According to this criteria author has not comprised or reviewed
those articles which were not based on research subject. At the time of selection of
articles, researcher has excluded all those articles which have not used English
language and published before the year 2000. All those research articles which have
not included search terms in their title have also excluded from the research.
Researcher has used exclusion criteria for reducing involvement in unnecessary and
unrelated evidence.
Inclusion criteria: Exclusion criteria:
Written in English Not used English language
Published after the year 2000. Published before the year 2000
Includes keywords like vitamins and No search terms in title
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dementia
3.3.4 Sources
The study has refereed to making use of online databases so as to ensure that the most apt
as well as right kind of information is selected. The section will provide subject indices for the
journal articles (Pittas and et.al., 2011). These sources are helpful in getting reliable information
about dementia and vitamins. Along with this, all these sources have their own digital records of
different articles from all over the world which can be used by researcher at any place and any
time (Pittas and et.al., 2011).
Major database which are used by researcher include British Nursing Index, PUB MED,
CINHAL PLUS, Science Direct, Google Scholar, Emerald insight, BioMed Central and
Cochrane library, etc.
3.3.5 Database decisions
As per the above discussion researcher has used different database for selecting different
articles for systematic literature review. Description about these database are as follows:
Table 2: Databases used
Databases selected Description
PubMed PubMed has got the presence of more than 25
million literatures. The database further
provide links to full text and abstracts as well.
CINHAL CINHAL database is the one that provides
access to broad content that includes articles
from the field of nursing, general health and
medicine etc (Campbell, Seymour and
Primrose, 2014).
Science Direct The given database gives full text on the
articles that are scientific in nature. This
happens as there is an availability of around
11000 journals on the online database. There is
further a presence of around 20000 books.
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Google scholar This is a
Google Scholar is a freely accessible online
search engine that provides full text on
scholarly literature (Wind, 2013).
Emerald insight It is a global publisher that manages a portfolio
of 300 journals, books as well as cases on
varied topics.
BioMed Central This is a UK based publisher which is also
referred as BMC, It further contains 256
journal articles that have been peer reviewed
and are also openly accessible. The articles are
majorly on medicine and topics of scientific
nature (Shalowitz, Garrett-Mayer and Wendler,
2012).
Cochrane library The given database has been provided by
Cochrane Collaboration where there is an
existence of journal articles on medicine and
health care specialties.
British Nursing Index It is a UK nursing and midwifery database
which covering over 400 UK journals and
other English language titles.
3.4 Quality assessment strategy
3.4.1 Boolean operators
At the time of searching articles related to the current subject researcher has used
different Boolean operators and simple words such as AND, OR, NOT and ANDNOT, etc.
These operators have used by author for combining and excluding keywords in search. Use of
these operators helped in getting more focused and productive results. Boolean operated saved
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time and effort by eliminating inappropriate hits because these operators scanned relevant
articles.
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3.4.2 Prisma flow chart
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Records identified through
database searching on dementia
Scr
ee
nin
g
Inc
lud
ed
Elig
ibil
ity
Ide
nti
fic
ati
on
Additional records identified
through other sources
(n = 10000)
Records after duplicates removed
(n = 100000)
Records screened
(n = 700)
Records excluded
(n = 530)
Full-text articles assessed
for eligibility
(n = 40)
Full-text articles excluded,
with reasons
(n = 20)
Studies included in
qualitative synthesis
(n = 10)
Studies included in
quantitative synthesis
(meta-analysis)
(n = 7 )

3.4.3 Critical appraisal tools –CASP
Critical Appraisal Skills Programme (CASP) is a useful tool to assess the data in
published research on the basis of internal validity, reporting standards, conclusion and
generalizability, etc. it is central part of systematic review and helped in selecting research
articles for getting appropriate conclusion for the current investigation. CASP checklist includes
different questions for each and every articles which help in assessing findings of different
studies, such as SR, Cohort, Case control and qualitative, etc. CASP analysis for the current
investigation is included in Appendix 1.
3.5 Positivism philosophy
Research philosophy can be defined as a paradigm which helps in conducting
investigation in subjective and objective aspect. There are two types of research philosophies
positivism and intrepretivism. For the current investigation author has selected positivism
because it based on objective of the research rather than subject aspect of the subject. Therefore,
it helps in attaining objective of the investigation in effective manner. Including this, positivism
research philosophy also supports systematic review of literature and provides an opportunity to
conduct in-depth research on subject. Overall, it has played an important role in attaining aim
and objective in very appropriate way.
3.6 Validity and Reliability
It is one of the important consideration which helps in getting valid findings for the
current investigation. Researcher has used inclusion and exclusion criteria for selecting articles
for the current study which helps in increasing validity of the collected facts and figures. As per
the above discussion author has used critical appraisal method for review which helped in
determining the quality of validity of every articles. It helped in improving validity of the
collected data. Author needs to focus on reliability of the data also because it helped in
determining that whether study has included sufficient and error free data or not. Along with
this, available data is appropriate for fulfilling purpose and context of the research. For
maintaining reliability author has used the most authentic data bases which provided valid and
authentic articles for systematic review. Therefore, author has maintained appropriate reliability
and validity of information for the current research.
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3.7 Ethical issues
Consideration of ethical issues is one of the major requirement for completing
investigation in ethical manner. The current investigation is a systematic review so, plagiarism
and manipulation of the data are considered as major ethical issues (Harris and et.al., 2013). So,
for resolving these issues researcher has used appropriate referencing and citation process which
have helped in maintaining research ethics for whole investigation.
3.8 Data extraction strategy
Data extraction strategy can be defined as a process of retrieving data about dementia and
vitamins out of unstructured data sources. It helps in conducting further data processing for
resolving issue. Author has used inclusion and exclusion criteria for extracting different
research articles for SR. Along with this, author has also decided different key words for
searching appropriate articles for the current study. Therefore, data extraction helps in excluding
invalid and inappropriate evidence.
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CHAPTER 3: FINDINGS AND RESULTS
3.1 Data extraction
Tabular presentation and supporting commentary is as follows:
Paper Journal Type of
study
Purpose Key findings
Morris, M. S., 2012,
The Role of B
Vitamins in
Preventing and
Treating Cognitive
Impairment and
Decline. Advances
in Nutrition, An
International
Review Journal.
An
Internation
al Review
Journal.
Qualitativ
e
Objective: To
identify role
of B vitamins
in prevention
of Dementia.
Lower levels of Vitamin B
12 is responsible for
triggering dementia among
individuals.
Haan, M.N., Miller,
J.W., Aiello, A.E.,
Whitmer, R.A.,
Jagust, W.J.,
Mungas, D.M.,
Allen, L.H. and
Green, R., 2007.
Homocysteine, B
vitamins, and the
incidence of
dementia and
cognitive
impairment: results
from the
American
Journal of
Clinical
Nutrition
Cohort
study
To identify the
association
between
Homocysteine
, B vitamins,
and the
incidence of
dementia.
Homocysteine has been
found out to be an
independent risk factor foe
dementia.
The risk can be reduced on
a significant level if there is
a provision of Higher
plasma vitamin B-12
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Sacramento Area
Latino Study on
Aging. The
American journal of
clinical nutrition,
85(2), pp.511-517.
http://
ajcn.nutrition.org/
content/
85/2/511.short
Maxwell, C.J.,
Hicks, M.S.,
Hogan, D.B.,
Basran, J. and
Ebly, E.M., 2005.
Supplemental use of
antioxidant vitamins
and subsequent risk
of cognitive decline
and dementia.
Dementia and
Geriatrics Cognitive
Disorders. 20.
pp.45-51.
http://
www.karger.com/
dem
Dement
Geriatr
Cogn
Disord
Case
control.
To examine
the association
between the
supplemental
use of anti
oxidants
vitamins and
subsequent
risk of
significant
cognitive
decline.
The results of this article
have been unclear. It is not
clear whether the
supplemental use of
antioxidant vitamin will
actually decrease the risk of
neurological impairment. or
not.
Vitamin B12 and
Cognitive Function:
Ontario
Health
Technolog
Case
control.
To study the
clinical utility
of vitamin
No strong evidence has
been concluded regarding
the increased homocysteine
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An Evidence-Based
Analysis. 2013.
13(23). pp.1-45.
http://
www.hqontario.ca/
evidence/
publications-and-
ohtac-
recommendations/
ontario-health-
technology-
assessment-series
y
Assessmen
t Series
B12 testing in
patients with
increased
chances of
dementia or
cognitive
decline.
level sand the onset of
dementia in geriatrics.
Further it has been
concluded that
incorporation of vitamin
B12 and folates ij diet can
slow down the rate of brain
impairment .
Agnew-Blais. J. C.
and et.al., 2014.
Folate, Vitamin B-
6, and Vitamin B-12
Intake and
Mild Cognitive
Impairment and
Probable
Dementia in the
Women's Health
Initiative
Memory Study.
115(2). pp.231-241.
http://
www.dx.doi.org/
Journal of
the
academy of
nutrition
and
dietetics.
. Case
control.
To determine
whether
standard
folate, vitamin
B-6, and/or
vitamin B-12
intake, alone
or in
combination,
are linked
with cases of
dementia
among elderly
women.
The study concluded that
the decrease in amount of
folate and vitamin B-6 can
increase the risk of
dementia and neurological
disorders in future.
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10.1016/
j.jand.2014.07.006
Clarke, R., 2008. B-
vitamins and
prevention of
dementia.
Proceedings of the
Nutrition Society,
67(01), pp.75-81.
http://
journals.cambridge.
org/action/
displayAbstract?
fromPage=online&a
id=1681116&fileId
=s00296651080060
46
Case
control
There has been an Elevated
plasma homocysteine (Hcy)
concentration which is
linked with increased
presence of cognitive
impairment and dementia.
However, there is a lack of
clarity as to whether low
vitamin B12 or folate status
is responsible for the said
decline.
Helmer, C.,
Peuchant, E.,
Letenneur, L.,
Bourdel-
Marchasson, I.,
Larrieu, S.,
Dartigues, J.F.,
Dubourg, L.,
Thomas, M.J. and
Barberger-Gateau,
P., 2003.
Association
Case
control
These results suggest that
subjects with low plasma
vitamin E concentrations
are at a higher risk of
developing a dementia in
subsequent years.
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between antioxidant
nutritional
indicators and the
incidence of
dementia: results
from the PAQUID
prospective cohort
study. European
journal of clinical
nutrition, 57(12),
pp.1555-1561.
http://
www.nature.com/
ejcn/journal/v57/
n12/abs/
1601724a.html
3.2 Synthesis of the extracted evidence
The main objective of the above research article is to identify non genetic factors other
than age which can lead to the development of Dementia among individuals. The study involves
seventy-seven cross sectional studies on more than 34000 subjects and 33 prospective studies on
more than 12000 subjects. The research have shown relevant association between homocysteine
and B vitamins and dementia. The article proposes biological mechanism that can be held
accountable for such associations. This entails atrophy of cerebral cortex. However, the causal
pathway is still needed to be explored (Littlejohns and et.al, 2012). According to the article
elevated homocysteine is found to be the strong causal agent of dementia in future among world
population. In addition to this it is also common among majority of population. Besides this, the
study also shows that lower concentrations of B vitamins are common among vulnerable
segments of world population. Thus, it can be concluded from the article that low concentrations
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of B vitamins (B12 and B6) as well as elevated concentrations of homocysteine in blood are the
major risk factors for Alzheimer's and Dementia in individuals. Therefore, it can be inferred that
dementia can be prevented by improving the concentration of B vitamins such as B12 and B6.
The study is very useful in attaining the objective of the present research to identify the role of
vitamins in the prevention of Dementia and Alzheimer's which the prognosis of the cognitive
decline is.
According to the research article by Morris, 2012, low levels of B vitamins are very well
linked with cognitive function in individuals (Morris, 2012). The historic underpinnings of the
study is linked with deficiency of Vitamin B12 that causes autoimmune destruction of neurons
that was said to trigger dementia among people. However, the article throws light on the current
status of knowledge on the role of B Vitamins in prevention of Dementia. For studying the effect
of low concentrations of B vitamins o the cognitive function in humans through various
randomized control trials. These trials involve both folate and Vitamin B12 to check the impact
on subjects brain functionality. Thus, from the article it can be concluded that low Vitamin B 12
level is strongly linked to slow information processing and memory impairment. The study is
very useful in achieving the aims and objectives of the present study which focuses on
identifying the importance of vitamins in prevention of Dementia.
The current research article is based on link between increased levels of homocysteine
and incidence of dementia. Researchers have chosen this topic because high concentration of
homocysteine level tends to increase the risk of dementia and cognitive impairment especially in
older individuals. Research has evaluated a direct association between homocysteine and
dementia. Increased level of homocysteine also caused cognitive impairment without dementia in
many cases. Haan and et.al, 2007 have also stated that “lowering the elevated levels of amino
acid homocysteine by incorporating vitamin B supplements can gradually decreases the chances
of dementia and cognitive impairment in individuals” (Haan and et.al, 2007). It has also been
reported that elevated baseline homocysteine increases the risk of neurological disorders by
136%. They further evaluated the study by using proportional hazard methods to estimate the
risk of dementia and CIND associated with homocysteine. Haan and et.al, 2007 have concluded
that “folic acid levels measured in blood components were not linked to amino acid
homocysteine levels of cognitive impairment” (Haan and et.al, 2007).
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On other hand Hooshmand, 2013 stated that “the relation of homocysteine vitamin B12
and folic acid has a direct effect on structural , functional and performance level of brain in
elderly individuals” (Hooshmand, 2013). The article also included that the cognitive decline
caused due to elevated levels of homocysteine also had a severe impact on social and
occupational functioning of person suffering from cognitive impairment of cerebral
degeneration. It has been found that increasing the intake of vitamin B complex in diet can
reduce the complex degeneration of brain by delaying the onset of dementia in patients.
Hooshmand, 2013 has also concluded that “age related factors and family history of dementia is
also responsible for increased risk of mental disorder in patients. It includes high blood pressure,
negative basal metabolic rate and increased cholesterol level in elder citizens” (Hooshmand,
2013).
On contrary to the above article yet another researcher have selected the topic based on
relation between vitamin D and dementia. The study measured the requirement of increased level
of vitamin D to reduce the risk of Alzheimer's disease and dementia. The researchers used Q
statistics and I2 methods to test the non-uniformity of Alzheimer's disease and dementia. Balion
and et.al, 2012 has stated that “individuals with decreased level of vitamin D in there body
develops greater chances of suffering from Alzheimer's disease and cognitive dysfunction”
(Balion and et.al, 2012). It also included that results of weighted mean difference in individual
with different vitamin D levels. A positive effect and decreased risk of dementia was observed in
individuals with elevated levels of vitamin D.
In another article researches based their study on relation between vitamin D, central
nervous system and its neurological functions associated with dementia. Littlejohns and et.al,
2012 has stated that “central nervous system of human was found to be a major target for various
vitamin D activities. All the complex of vitamin D present in the cerebrospinal fluid of brain
circulated throughout the brain” (Littlejohns and et.al, 2012). The decreased level of vitamin D
in CNS has a negative effect on the release and concentration of cerebrospinal fluids in blood
plasma. This decreased level of fluids in plasma increased the risk of dementia and cognitive
impairment in elderly individuals to a greater extent. The research was based on various
interventional, longitudinal and cross sectional studies. It concluded that vitamin D plays a vital
role in preventing and treating neurological disorders such as dementia, Alzheimer's disease and
cognitive disabilities (Haan and et.al, 2007).
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In another study, researchers examined the association between vitamin D deficiency,
cognitive impairment and dementia. The study was based on literature research and meta-
analysis to assess the link between cognitive dysfunctionality and lack of vitamin D in body.
Etgen and et.al, 2012 have said that “a longitudinal study which comprised of 7688 participants
were reported to exhibit cognitive disabilities due to decreased level of vitamin D content in the
body” (Etgen and et. al, 2012). Statistical data was interpreted through different studies such as
cross sectional and longitudinal studies. Meta-analysis on 5 cross sectional studies suggested
participants with incorporation of vitamin D supplements in their body had comparatively mild
cognitive impairment. Etgen and et.al, 2012 has concluded that “The chances of dementia and
Alzheimer's disease increases in the population with lower level of vitamin D” (Etgen and et.al,
2012).
On other hand another research article stated that epidemiological evidences between
vitamin D and cognition. Annweiler and et.al, 2012 have said that “the vitamin D deficiency has
a major impact on central nervous system during the advanced stage of dementia and cognitive
impairment” ( Annweiler and et.al, 2012). It also included that mild cognitive disability do not
disturbs the neurological functions of brain but increased impairment can affect the functional
autonomy of brain at a later stage. It is very important to determine the level of vitamin D that
causes impaired neurologic activity in older adults. The article was based on analytical study
conducted to determine the concentration of vitamin D serum requires to inhibit dementia and
cognitive damage to brain. Annweiler and et.al, 2012 have stated that “concentration level less
than 30 mg/mL increases the chances of dementia by 29%” ( Annweiler and et.al, 2012).
In another research the discussion was based on the involvement of vitamin B complex
fatty acids in prevention of Alzheimer's disease and dementia. A systematic study comprising
different perspective was carried on to evaluate the supplementation of vitamin B and and fatty
acids to reduce the risk of dementia and Alzheimer's disease in older adults. Dangour and et.al,
2010 have said that “presence of fatty acids, folic acid and vitamin B complex declined the
cognitive impairment and dementia in individuals” (Dangour and et.al, 2010). It also included
that the result drawn from the above research are not consistent in all the cases of neurological
disorders. Healthy diet habits and nutritional contents also plays a major role in reducing the risk
of cognitive impairment and dementia in future.
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On other hand the researchers found that vitamin B12 complex helps in maintaining red
blood cells and nerve cells healthy which are important to reduce signs and symptoms of
memory loss and cognitive impairment. Smith, 2010 has said that “Increasing the intake of
cereals, meat, poultry and sea food in diet can probably decrease the signs of Alzheimer's disease
in older individuals beyond the age group of 60 years” (Smith, 2010). It further helps in
increasing the retention power of brain and also elevates the ability to remember learn and
concentrate on a particular thing. It also included that present research and report on association
of vitamin B in preventing dementia has not been successfully completed. A more broad level of
research is required to be conducted to ensure that increased level of vitamin B complex helps in
treating and preventing dementia and Alzheimer's disease.
According to Clarke, 2008, dementia can be prevented by supplementation of B vitamins.
The article shows that increased levels of plasma homocysteine is the major risk factor of
cognitive impairment and dementia. The study indicates that homocysteine hypothesis of
dementia is used to explain that the development of the cognitive decline can be lowered by
supplementing the diet of individuals with folic acid and vitamin B12. The methodology
involves twelve randomized homocysteine lowering trials for prevention of Dementia (Clarke,
2008). Through these trials data was collected from 30000 respondents with cognitive function.
Some of these trials assess the influence on cognitive function by using only folic acid or
Vitamin B 12 while other trials are done by using combination of these two nutrients. Thus, from
the article it can be concluded that Vitamin B12 play very important role in lowering the risk of
dementia among individuals. This article is very useful in critical reviewing the role of vitamins
in the prevention of dementia.
Helmer and et.al., 2003, carried out research to analyze the link between antioxidant
vitamin A, E and malondialdehyde lipoperoxidation product plasma concentration with the
evidence of dementia. The study was carried out on 626 subjects. The blood sample was
collected to identify the risk factors of dementia among the participants. The study showed that
out of 626 subjects, 46 developed dementia during the course and were considered as cases for
the research. The findings of the study indicated that concentration of vitamin E was found low
among cases. In addition to this the same was noticed for Vitamin A concentrations. These
results suggested that those subjects with lower levels of Vitamin E are at greater risk of
developing dementia in the future as compared to Vitamin A. Therefore it can be concluded from
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the above article that higher levels of plasma vitamin E plays very cardinal role in the prevention
of dementia among population (Helmer and et.al., 2003).
3.3.1 Thematic analysis
Theme 1: dementia as a major issue
Dementia can be defined as a general term that is used to indicate the difficulties tghat is faced
by the person with respect to reasoning, judgment, and memory. The individuals suffering
from dementia has a problem of memory loss followed by difficulty in one of the given
areas. These can be relaterd to speaking/writing, Recognizing familiar surroundings as well
as undertaking planning activities.
Dementia is caused on account of several diseases that put a major impact on the brain. The most
common cause is Alzheimer disease which accounts to more than 60 to 80 percent of all
cases of dementia (Tom and et.al., 2015). Although dementia affects old people but it still
cannot be considered as a normal part of aging. The statistics have revealed that dementia
affects 47.5 million people all over the world. There is further a presence of 7.7 million new
cases of dementia that take place every year (Qaseem and et.al., 2008). Dementia has further
been regarded as one of the major causes of disabilities in old age that further increases
dependency of adults. It further has a presence of physical, psychological, social and
economical impact on the patient, caeregivers as well as family members.
Dementia as an issue is further a cause of colnxcern as people have a lack of awareness and
understanding towards it. This thus has got a tendency to cause stigmatization and barrier
with respect to diagnosis as well as providing the appropriate care. Mo0reover, the total
number of dementia patients has been projected to be 75.6 million in 2030. it ios going to
be almost triple by the year 2050 (Dementia, 2016).
The studies have further revealed that such as rising numbers of people with respect to dementia
in low- and middle-income countries. Moreover, there is a lack of proper cure that is
available for dementia. Further there is an absence of altering the progressive course. In this
regard, there is a presence of many new treatments that are being investigated for treating
dementia. But as of now the patients are in a need of proper support so that they can live a
proper life even after suffering from dementia.
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From systematic review of different articles, it has been found that for proper functioning
of brain throughout the life, Vitamins plays an important role. Vitamin B is most important
component for managing functioning of brain in human being during dementia. On the other
hand, vitamin D improves neurologic conditions of dementia patients. It helps in boost various
brain activities with higher rate. It is responsible or improving a number of various kinds of brain
disorders. From the critical analysis of literature study, the researcher has been determined that
the deficiency of vitamin has increased the risk of dementia in human being. Therefore, to reduce
such type of probability, vitamin B 12 is playing necessary role. It is working as a co-enzymes
with other food components which will help in reducing the risk of dementia in a person.
Vitamin B 12 has lower down the level of amino acid in the blood because the high level of
amino acid in the blood is increasing the more dementia issues in patients. Beside this, the
systematic study of various past researches, it has been determined that vitamin E slow down the
progression of dementia because it works as an antioxidant supplements of other vitamins. High
amount of vitamin E in blood leads to improve brain functioning in dementia patients. Hence,
from the findings of above discussion, it has been analysed that vitamins B, D, B12 and E are
playing an important role in growth and development of brain and its functioning. But deficiency
of any vitamin in body of human being can leads to dementia problem. In this context, vitamin D
has determined to be most needed components to improve dementia disorders. The reason of
giving it more importance in daily diet of a person is most of the brain tissues are activating from
vitamin D and that help in improvement in functioning of brain. It has boost the levels of
important brain chemicals and prevent it from number of brain disorders.
Theme 2: Link between dementia and vitamins.
A systematic literature review has been showed that the growth and development in
adults, children and teenagers, vitamins plays an essential role. During the studied of various
relevant previous researchers, the researcher has found a relationship between dementia and
vitamins. The deficiency of vitamin D in the blood has raised the signs dementia in human being.
In this context, if a patient is suffering from dementia and his vitamin D level is continuously
decreasing in blood then will affect the functionality of brain. On the other hand, for better
functioning of neurological activities, vitamin B is most essential component. The inadequate
amount of in daily food consumption leads to shrinking capacity of brain. It has affected the
various activities of mind and the result of this is raise the possibility of dementia diseases in a
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person. The same thing is happing with vitamin B12 that is needed for development of brain of
children, infant and elderly people. But in the present time, people are avoiding those food
products which are good for their health and full of vitamins. At the place of that, they are
attracting towards fast foods and other things. It has decrease the level of vitamins in body and
increase the risk of dementia. If the vitamins in body goes below a threshold level and it affect
brain activities. Therefore, from the above stated findings, it can be concluded that there is a
strong relationship between level of vitamins in body and dementia. To live a longer and
healthier life, the consumption of different vitamins is essential. It is minimizing the level of risk
of numerous mental disorder such as dementia. Along with this, it is also assisting in improving
the brain activities of dementia patients and make them able to live a normal life like other
people.
Theme 3: Importance of vitamins for preventing dementia.
For optimal brain functioning and its health, all types of vitamins are require. But there
are few which stand out and being essential for healthy brain. In this context, vitamin C is a
single vitamin supplement. The proper amount of it reduces the symptoms of dementia. It
protects the mind from degeneration and other strokes. Vitamin C is working as a antioxidant
element for the brain which prevent it from dementia in different stages of life. On the other
hand, vitamin D is also important for proper functioning of brain activities. It is good for mind
and keep it healthy for lifelong. The adequate amount of different supplement of vitamin D
throughout the life can ward off the brain from dementia issues. It has sharpen the memory and
change the moods swings probability in various situations. It has prevent the mind from different
level of depression and other kinds of stress. Similarly, the various forms of vitamins B is good
for health of brain and keep it healthy as well as prevent it from dementia diseases in near future.
B6, B12 and B9 are essential and important for improving the functioning of mind and minimize
the number of mental disorders such as dementia. These are reducing brain shrinkage and make
it active all the time. Beside this, vitamin E is also protecting the mind from different types of
dementia diseases. Hence, the above findings has denoted that various kinds of vitamins are
preventing brain from different forms of dementia. The main and important vitamins which are
good for mind and keep it healthy all the time are C, D, B6, B12 and B9.
Theme 4: Appropriate suggestions for preventing dementia.
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The increase risk of dementia due to deficiency of vitamins has decreased the growth and
development of brain for further stage. For this, it is important to adopt some strategies or ways
which can prevent the mind from dementia and remain always healthy. From the literature
review, the researcher has identified the different methods that has been represent in the form of
suggestions for preventing dementia. In this context, by increase the consumption of green
vegetables such as broccoli, cauliflower, beans and legumes, it has increase the amount of
vitamins in the body of human being. It leads to prevent the brain from different stages and types
of dementia. On the other hand, the mental exercise has increased the capability of mind and
keep it healthy for lifelong. Along with this, sleeping pattern is also help in preventing the brain
from dementia as well as other diseases. People have to include those food products which are
having full source of different kinds of vitamins. This help in improving brain functioning and
make it active all the time. In addition to this, by avoiding drinking too much alcohol and other
kinds of drugs, the possibility of signs of dementia can be easily reduced. By reducing overall
consumption of calories is also helping in keep the brain healthy and active all the time. Beside
this, by following nutrition plan during taking food also assist in reducing the changes of
dementia in elderly stage of life. By avoiding sugar and other artificial fructose, it can be easy to
minimize mental disorders with the time. Therefore, by taking nutrition diet, mental and physical
activities, proper sleeping and minimize the consumption of alcohol and other drugs helps in
preventing the brain from dementia and other mental disorders.
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CHAPTER 4: DISCUSSION
Strength and weakness of selected articles
Strength of Article written by Smith, 2006 lies in the fact that it has properly presented
the research question being Prevention of dementia: a role for B vitamins. The question itself has
made it clear about the contents that are likely to be included in the study. The study has further
carried out a review of around Seventy seven cross-sectional studies as well as 33 prospective
studies on the mentioned topic. It has further given emphasis on the date range being 2005 to
2016 there by ensuring towards a relevant as well as valid search. However, the study has failed
to present future research findings. Nor has it emphasized on creating a proper recommendation
section for the study.
In the same way study carried out by Haan and et.al., is a well presented one. The
abstract itself has made the contents clear on account of mentioning proper subheadings such as
background, objectives, design, results as well as conclusions. There has further been a clear
mention of objectives being studying the association between homocysteine and 4.5-y combined
incidences of dementia and cognitive impairment without dementia. The cohort selected are also
in a good year range being 60 to 101 thereby justing that dementia is a disease of old people.
Other than the study design has also used proportional hazards models so as to assess the risk of
homocysteine-associated dementia and its influence on RBC folate and plasma vitamin B-12.
The weakness of the study is the absence of any future research findings as well as
recommendation section. Moreover there is also an absence of a proper research question that
could have further made the objective clear.
Study by Maxwell and et.al., 2005 has presented a well-defined title being Supplemental
use of antioxidant vitamins and subsequent risk of cognitive decline and dementia which covers
all the key words as well as their association with each other. However the study lacks in terms
of presenting a well-defined aim, objective as well as a research question thereby causing an
unclear understanding. The study has further clarified the findings as well as future research area
being requirement of randomized controlled trials.
Study by Ontario-health-technology-assessment-series has presented a well-defined
objective, background, methods, results as well as conclusion section. There have further been a
selection of eighteen studies that have been divided into 7 systematic reviews and 11
observational studies so as to assess the association between B12 and the onset of dementia.
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However the section has shown an absence towards making use of CASP tool. Morever the year
range could have been from 2005 rather 2002 to ensure towards validity and reliability factor.
Study has chosen article of Agnew-Blais. J. C. and et.al, 2014 which has published in a
well-known journals of the academy of nutrition and dietetics. It has a clearly defined objectives
which helps in selecting appropriate cases for resolving research issue. Along with this, it has
clearly conclusion that decrease in amount of folate and vitamin B-6 can increase the risk of
dementia and neurological disorders in future. But, findings of this study is not appropriate for
rare exposers because this findings is based on some specific incidents.
Study of Clarke, 2008 does not have appropriate objectives and research question. So, it
is difficult to understand the focus and purpose of this study. But its title helps in conducting
investigation in effective manner. Including this, findings of the current investigation helped in
determining link between dementia and vitamin. However, there is a lack of clarity as to whether
low vitamin B12 or folate status is responsible for the said decline.
Helmer and et.al, 2003 has conducted research study on Association between antioxidant
nutritional indicators and the incidence of dementia. But it did not based on a specific and clear
defined an objective. However results suggest that subjects with low plasma vitamin E
concentrations are at a higher risk of developing a dementia in subsequent years. Therefore,
findings helps in real work practices.
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4.1 Integration of the results of your findings with existing research and theory
The data and information collected through the existing findings can be linked to current
findings in many ways. The existing article stated that the increased level of homocysteine was
responsible dementia and memory loss in an individual. The current approach of research also
included that increased level of amino acid homocysteine increased the chances of neurological
disorders exponentially. The existing research also reported that elevated level of homocysteine
were also responsible for causing CIND (Cognitive Impairment not demented). The findings of
existing research was based on proportional hazard method which estimated the risk of dementia
and cognitive disorders in individuals with increased levels of homocysteine.
The existing research article also assessed the role of vitamin D in treating and preventing
dementia and Alzheimer's disease. The current research included that increased level of vitamin
D promoted better brain activity which reduced the risk of individual suffering from memory
loss and cognitive incapabilities. The existing research incorporated various methods such as Q
statistics and 12 methodology to evaluate the non-uniformity between Alzheimer's disease and
dementia. The study was evaluated on the basis of weighed mean difference which were
produced at various levels of vitamin D. Different analytical study on various participants
concluded that vitamin D plays an important role in treating memory loss and dementia.
The current research was based on increasing the level of vitamin D in daily intake. It stated that
individuals with low or deficient level of vitamin D in their daily intake were prone to
neurological disorders to a greater extent. The existing research conducted various studies such
as cross-sectional, longitudinal and integrated study pattern to determine the level of vitamin D
in individuals. It was helpful in evaluating and determining the amount of vitamin D required to
treat people suffering from dementia, Alzheimer's disease and cognitive impairment.
From the thematic research it can be analysed that vitamins play very vital role in optimal
brain functioning. The study indicates that among the group of vitamins there few important
vitamins that really stands out in maintaining proper cognitive functioning of brain. Among these
vitamins of B group such as B12, B6 and B9 are found to ameliorate the functioning of brain and
reducing the risk of mental disorders such as dementia and Alzheimer's. The systematic review
of different articles helps in drawing relevant inferences on the importance of B vitamins which
are the most vital components for managing proper functioning of brain in individuals who suffer
from dementia. The current research was conducted on the case control in which 46 cases out of
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626 subjects were found to be suffered from dementia. It has been observed from the study that
vitamin E played very significant role in lowering the risk of dementia among cases.
4.2 Critical analysis of knowledge and clinical practice gap and discussion
Critical analysis of various studies has showed that there is a huge knowledge and clinical
practice gaps among healthcare practitioners and other care workers who are delivering the care
services related to deficiency of vitamins and its impact on brain activeness that causes dementia
diseases in human being. The existing education, training level and knowledge of healthcare
workers are not sufficient to understand the role of vitamins in preventing dementia. It has not
enhanced the quality of life and wellbeing of patients. In such situations, the healthcare
practitioners who are specialized in dementia has to attain different types of trainings and
educational programs so that their existing knowledge can be improved. But, most of the
educational institutes have not delivered any kind of training and education of reasons of
occurrence of dementia in different stages of life. So, they have followed the instructions of their
senior care practitioners and delivered the medical services according to it.
4.3 Consideration to effectively communicate review findings
Findings of the literature review has very less values if these are not communicating to
various healthcare practitioners as well as other care staff members of many institutes of
dementia in right manner. For the researcher, it has important to communicate all the findings of
entire study in appropriate form and regarding this, there are some considerations have required
to take. There are several reasons for communicating the findings of literature review like this
information will help those people who are facing deficiency of vitamins and its consequences
on health. Another intention of behind distribution of collected findings is increase the awareness
in the people about dementia and methods to reduce its impact on health. Therefore, by sharing
all important information regarding the current study, healthcare workers, dementia patients and
other people can adopt the different ways to keep their brain happy, healthy and active.
First method of communicating the findings of the investigation in appropriate manner in
front of the learners and other researchers is presentation. With the help of it, the investigator can
included those information which are more important for audience to know, understand and
adopt to reduce the risks of mental disorders situations in different life stages. In addition to this,
various facts and figures has also included in the presentation work as an evidence so that the
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audience can understand the findings of the study in appropriate manner. Beside this, it must be
involve the benefits of different vitamins for all age of people as well as those who are facing
dementia diseases in different stage of life. Therefore, with the help of presentation work, the
researcher can able to communicate the essential findings in front of the dementia institutes,
healthcare professionals and other care workers, all age of people and patients who are suffering
deficiency of vitamins and its negative impact on health.
Another method of sharing important findings of research, scholar can represent it in
national and international conferences. With this help of this, it has minimized the geographical
barriers for the researcher and able communicate most essential information in front of more than
one nation. The subject matter contains during conferences are major vitamins deficiency which
create the signs of dementia and other mental disorder problems for the people as well as ways to
minimize the progression of it at earlier stage of diseases. Hence, by doing this, findings of the
research can be easily communicate to the target audience and create the awareness about
consume different supplements of vitamins for lower down the risk of dementia in various stages
of life. Along with this, listeners can know about numerous ways to keep the brain active and
healthy for long time.
Rather than above stated ways, the investigator can prepare some posters which shows
the relationship between different vitamins and dementia. These can be posted near dementia
care centers and other hospitals, medical colleges etc. It will help in spreading essential findings
and information about roles of various types of vitamins in increase the functionality of brain. It
will help in resolving the misunderstanding of people related to vitamins. Another method for
communicating the findings of current research is publishing the research paper in healthcare
journals at international and national level. By doing this, the scholar can provide assistance in
conducting the future research on vitamins and their roles in preventing from dementia. Along
with this, by sharing the information with the help of creating the blogs or websites on internet,
the researcher can easily communicate the essential findings in front of the audience. This
information can be access by various people like healthcare practitioners, dementia patients
about importance of various types of vitamins and their roles in preventing dementia. Therefore,
with the help of above stated methods of communication, the researcher can communicate its
research findings in front of the audience in effective manner.
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CHAPTER 5: IMPLICATION FOR PRACTICE AND REFLECTION
5.1 How will you utilize the results of the SR to move practice forward
As per the findings of the research, it has important to utilize those outcomes of
systematic review of various literatures into the practices. For the healthcare practitioners and
other care workers who are delivering the care services to dementia patients should develop a
care plan in which they should first check the level of mental disorder problem. Along with this,
they should determine the level of different vitamins in body of the patients. So by doing this, the
finding of the present study will help in implement them into practices. On the other hand,
healthcare practitioners should considered the deficiency of vitamins as a most important term
and include it into daily practices. With the help of this, it will easy to prescribe the treatments to
the patients.
Other care workers who are suggesting the diet chart or food should give emphasize on
including those food stuff which are having plenty of vitamins. It will help them to explain the
benefits of that food products to improve brain functions and keep it healthy for long time. On
the other side, the healthcare practitioners should prescribed the vitamin treatments for pregnant
women so that the mental disorder issues like dementia in unborn child can be reduced.
Similarly, healthcare workers should include those food items which are having high level of
different types of vitamins for dementia patients. It will help in improvement in their health,
make their brain active and healthy. In addition to this, for elderly people, healthcare
practitioners have to develop a care plan so that the chances of arising of dementia in them can
be minimized. By identifying the primary signs of mental disorder in elderly age people and then
recommended them a proper balanced diet as well as treatment, it can be easy to stop the growth
of dementia to its next step. Therefore, by following the above stated ways, the results of
systematic review can help in to implement the findings in practice.
5.2 Recommendations for future research
The present research is relating to role of vitamins in prevention of dementia. During the
study, the researcher has developed some conclusions related to the investigation. At that time of
conducting the study, the researcher has faced various issues and problems such as ethical
consideration etc. Along with this, he has adopted many ways and techniques to resolve it.
Therefore, it has recommended for future research in same area study is the scholar should use
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those participants who are facing deficiency of vitamin and its consequences on health for
collecting more information.
The findings of the following research has helped the other researchers to carry out new
work in this direction. To accomplish it, recommendations for future research can conduct an
investigation on link between vitamin D deficiency and dementia. The reason of suggesting this
subject for research is vitamin D has helped in improved different mental disorders. It has
responsible for nerve growth in human brain. The optimal level of vitamin D in body has boosted
level of brain chemicals in right amount that protect brain from diseases or injuries. If the level
of vitamin D in blood is blow than threshold level then it will increase risk of dementia. On the
other hand, another recommended area for future research is different ways which improves
brain functionality and minimize the risk of dementia. It will assist the new researchers to carry
out the investigation for determining new methods and ideas that keep the mind active and
improve its functionality. Rather than this, role of vitamin B in preventing the human being from
dementia can be conducted. It has improved the brain functions and reduce brain shrinkage.
Similarly, future research can be carried out for importance of various types of vitamins in
minimizing the Alzheimer’s diseases at different stages of life.
5.3 Reflection on the whole SR process and your own learning
The given systematic review on dementia and Vitamin D has been carried out by
adhering with a systematic process for the same. In this regard, firstly there was a development
of research protocol that entailed for discussing about the background, objectives, inclusion
criteria, search methods. This helped me to ensure that an important study on the topic of
dementia and Vitamins is not missed. The protocol further served as a road map to provide a
framework about essential processes that are required to be carried out for conducting a
systematic review.
The next step followed by me was of Specifying the review question which was done by
making use of PICO framework. The framework thus aided me in developing specific,
scientifically relevant and systematic questions. I further ensured that the research question made
by me is fairly concise one so as to address the aim of the study in best possible manner.
Then came the most important part of the study which as of searching for literature
studies on the topic of dementia and Vitamin. It happened out to be a very time consuming as
well as difficult process. There came a need to test and re-test the review search strategy in order
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to capture all the studies that were relevant. To make the process a fruitful one, I thus made use
of electronic databases so as to search topics on varied disciplines. I further found out that public
health literature on the topic of dementia and vitamin was highly dispersed. Hence, I undertook
the process of manual searching of public health journals and journals related to the topic. This
further provided me with a list of additional citations that can be included in the topic. I further
made use of technique related to internet search so as to ensure that none of the important study
of the topic has been missed. I further made use of grey literature that is a set of papers, reports
as well as other documents that are not distributed or indexed by commercial publishers. In this
regard, most of the documents on the topic of dementia and vitamins were difficult to obtain as
well as locate. As the Grey literature is usually not subject to peer review, hence I ensured to
scrutinize them in the best possible manner. In all, I made sure to carry out a careful selection of
Articles by making use of appropriate and multiple databases. This aided you make sure that I
had a proper access as well as collection of relevant studies. I further found out that there is not a
presence of any single systematic search technique that can be used for carrying out the review.
It varied as per nature of the research question and the topic area that is selected. While carrying
out the review I thus aimed to keep a search log so as to record the detail as to how the searching
process was carried out by me. For example, I ensured to note down the names of journals,
websites and databases that were explicitly searched by me. I also prepared a list of search terms
on a separate paper along with specifying the combinations that could be applied on the
databases. I further made sure that there is a presence of enough details of the information so as
to make the search process more explicit and transparent.
Other than that the most important section that I found while undertaking the systematic
review was of critical assessment of all the selected studies. Hence, I undertook an in-depth
analysis of the selected studies by making use of CASP tool. It aided me to find out if the
methods as well as results are valid or not. CASP tool further provided me a checklist of question
set for different kinds of study designs.
In terms of the above process of systematic review, I have enhanced my learning in
varied area. Firstly, the review helped me to understand as to what the exact concept of
systematic review is and how important it is in terms of being the best source of evidence. I also
developed learning about the importance of developing a proper protocol. It was learnt by me
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that the protocol plays an effective role in guiding the researchers in the process. It further aids in
enhancing the overall methodological transparency of the review.
I further found out the technique by which a high quality systematic review can be prepared.
These are inclusive of adhering with a proper search strategy as well as data extraction
technique. The review further increased my awareness about the importance of critically
appraising the text. I got to know about CASP tool and its importance. This tool can further be
applied by me in other studies. I also developed an understanding about varied kinds of research
studies such as qualitative, RCT, cohort studies etc. This was beneficial in terms of new learning
and having access to varied kinds of concepts. The review has further helped me to feel like an
expert in the area of dementia and vitamin D. I am now in a position to talk more about the
concepts on account of detailed and in-depth knowledge that I have gained from the published
literature. The review further gave me a chance to develop an expertise in the area of database
searching as well as, reviewing piles of papers. At first I found he same to be tedious but I was
able to learn the process by deviating some extra time. This further r taught me about the
importance of time management and proper planning. I further got a chance to not rush up in
terms of writing the results. Learning was also gained about how the quality of reviews can be
improved through transparency as well as ensuring greater breadth of studies. It was further done
by encouraging myself to engage critically in terms of quality of evidence.
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CONCLUSION
In a nutshell, the systematic review of the above research articles play very crucial role in
drawing relevant conclusion of the present study. It can be inferred from the above mentioned
articles that lower levels of B vitamins and higher concentration of homocysteine are the strong
non genetic risk factors responsible for the development of Dementia in vulnerable section of
world population. In addition to this supplement of Vitamin B vitamins can significantly reduce
the risk of Dementia. The articles elaborated homocysteine hypothesis to explain the association
between Vitamin B on the cognitive function among participants. The research was carried out
by involving trial methods. The trials assess the impact on cognitive function by using only
vitamin B12 or folic acid or both these elements. The study concludes that vitamin B12 play very
significant role in prevention of dementia. Apart from this another research article analyses
relationship between vitamin A, E and malondialdehyde lipoperoxidation concentration in
plasma and the incident of cognitive decline among subjects. It has been observed that lower
concentration of vitamin E is more responsible for the development of the mental condition as
compared to vitamin A among the participants. Therefore, these articles contribute significantly
in identifying different vitamins as well as understanding their importance in preventing
dementia. They are also helpful in comprehending the link between dementia and vitamins.
Besides this, the research articles lay the groundwork to form recommendations to minimize and
prevent the risk of dementia.
To identify different vitamins which play an important role in dementia
All the above research articles concluded that vitamins play a very significant role in
preventing and treating various neurological disorders such as dementia Alzheimer's disease and
cognitive impairment in brain. The study revealed that increase in amino acid homocysteine was
responsible for increased risk of dementia in older age citizens. It also included that increased
level of homocysteine had a severe impact on social and occupational life of an individual. In yet
another research article the study explored the importance of vitamin D complex which reduced
the chances of Alzheimer's disease and dementia. Individuals with deficient level of vitamin D
were at a greater risk of suffering from cognitive disabilities and abnormalities. Different
parameters were adopted to determine the level of vitamin required to prevent neurological
disorders in individuals of all ages. The study also focused on the role of vitamin B complex in
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the treatment of Alzheimer's disease, dementia and cognitive abnormalities. However there was
no evidence recorded which cured and prevented these disease at earlier or advanced stages of
life. Mild cognitive impairment did not resulted in dysfunction of brain anatomy hence vitamin B
was helpful in curing dementia to a smaller extent. The research articles assists in minimizing the
risk of dementia in old age people. Different vitamins like vitamin B complex and D complexes
have been identified which help in treating and preventing neurological disorders at early and
advanced levels. Diet rich in vitamin B included poultry meat, fish and eggs which helps in
decreasing cognitive impairment. Incorporation of vitamin D supplements also tends to increase
the metal retention power, concentration, sleep patterns and learning abilities.
Dementia is a mental disorder which affect the mental ability of brain. There are many
reasons that increase the chances of this diseases in human being in different stage of life. It has
examine that deficiency of vitamins in body is one of the major factor of occurrence of dementia
which is called vitamin deficiency dementia. At present, it is an issue now because the life style
of the people are changing with the time. Along with this, by consuming unbalanced diet leads to
deficiency of vitamins level in blood and it has directly affected the brain functioning. Therefore,
the purpose of the following study is understand the role of vitamins in prevention of dementia.
Finding of the literature review has concluded that for proper functioning of brain and
keep it healthy for life long, it has important to intake right amount of vitamins on daily basis. In
this context, some of important vitamins have been identified that decreased the chances of
mental disorders such as dementia. These are vitamins B, D, B12 and E and these help in proper
growth and development of brain functioning. The findings shows that vitamin D has most
important component for body. Proper consumption of different supplements of it on regular
basis has activated the brain tissues. Along with this, it has boosted the level of chemicals
reactions in mind that keep it healthy for long time.
To understand the link between dementia and vitamins
On the other hand, the findings of systematic literature review shows that there is some
link between dementia and vitamins. Vitamin B help in fight against dementia diseases because
it has supported several enzymes and cholinergic neurons. It has slowed down the progression of
many kinds of mental disorders in the people. Literature review has showed that the numerous
supplements of vitamin B has delivered significant benefits to dementia patients. On the opposite
side, various substitute of vitamin E has not only slow down the progression of dementia but also
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protected human being primary signs of developing this diseases in any stage of life. The high
level of vitamin E in blood has improved the functioning of brain. Similarly, vitamin D has also
keep the brain active and healthy. It has profound effects on the mind during all stages of life.
The deficiency of it in body has raised the probability of dementia. On the other hand, B12
vitamin has more required like other vitamins for healthy brain. It has improved the functioning
of mind and reduced the chances of shrinkage of different areas of brain. Therefore, there is a
strong link between dementia and vitamins B, E, B12 and D. Adequate intake of these in various
forms helped in preventing from dementia and other mental disorders.
To identify the importance of vitamins for preventing dementia.
From the findings, it can be summarized that for optimal functioning and good health of
brain, vitamins are more important because it prevent dementia diseases in all stages of life. In
this regards, vitamin C, D, B6, B12 and B9 are best for keep the the mind healthy and active.
Vitamin C has minimized the instant mood swing issues, make the brain more concentrate,
increased intelligence, reduced risk of brain degeneration etc. So, these all benefits of vitamin C
has kept the mind healthy and active in all kinds of situation and minimize the risk of dementia
in all stages of life cycle. On the other side, vitamin D has also useful in preventing the body of
human being from various diseases such as dementia. It is good for proper development of brain
at many stages of life. By taking adequate amount of it in adult age, it can be easy to minimize
dementia problems easily. Similarly, vitamin B has played an important role in reduced mental
disorders diseases with the time. It has prevented the brain from depression, aging and other
issues. The sub vitamins B6, B12 and B9 has worked together that helped in protected dementia
disease and improved brain functioning at different life stages.
To recommend appropriate suggestions for preventing dementia:
The findings of the analysis has showed that with the help of various methods and
activities, person can easily prevent himself from dementia issues. It has recommended that by
changing the lifestyle and quitting certain habits, it can be easy to prevent from dementia
diseases. On the other hand, taking regular physical and mental exercise, the risk of such kind of
problem can be lower down throughout the life. By doing exercise 3 to 5 times in a week for
more than 30 minutes is beneficial for different body parts. Similarly, by intake proper amount of
those foods which are complete source of vitamins, the level of different vitamins in blood can
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be raised. It helps in improve the functioning of brain and keep it healthy as well as active all the
time. In addition to this, it has also suggested that quitting the habit of consumption of alcohol in
teenage, adult and elderly age, the risk of developing dementia can be lower down.
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REFERENCES
Books and journals
Balion, C., Griffith, L.E. and Raina, P., 2012. Vitamin D, cognition, and dementia A systematic
review and meta-analysis. Neurology. 79(13). pp.1397-1405.
Baskys, A. and Cheng, J.X., 2012. Pharmacological prevention and treatment of vascular
dementia: approaches and perspectives. Experimental gerontology. 47(11). pp.887-891.
Beard, R.L., 2011. Art therapies and dementia care: A systematic review.Dementia,
Blasko, I., 2015. Interaction of ω-3 fatty acids with B vitamins in slowing the progression of
brain atrophy: identifying the elderly at risk. The American journal of clinical nutrition.
102(1). pp.7-8.
Blundo, C., Marin, D. and Ricci, M., 2011. Vitamin B12 deficiency associated with symptoms of
frontotemporal dementia. Neurological Sciences. 32(1). pp.101-105.
Bottiglieri, T., 2013. Folate, vitamin B 12, and S-adenosylmethionine. Psychiatric Clinics of
North America. 36(1). pp.1-13.
Combs, G.C., 2012. The vitamins. Academic press.
DeLuca, G.C. and et.al., 2013. Review: the role of vitamin D in nervous system health and
disease. Neuropathology and applied neurobiology. 39(5). pp.458-484.
Douaud, G., Refsum, H. and Smith, A.D., 2013. Preventing Alzheimer’s disease-related gray
matter atrophy by B-vitamin treatment. Proceedings of the National Academy of Sciences.
110(23). pp.9523-9528.
Eyles, D.W., Burne, T.H. and McGrath, J.J., 2013. Vitamin D, effects on brain development,
adult brain function and the links between low levels of vitamin D and neuropsychiatric
disease. Frontiers in neuroendocrinology. 34(1). pp.47-64.
Ford, J.M. and Brandt, N.J., 2014. Role of Nutraceuticals in Dementia Care. Journal of
gerontological nursing. 40(4). pp.12-17.
Gitlin, L.N., Mann, W.C. and Arthur, P.B., 2013. A non-pharmacologic approach to address
challenging behaviors of Veterans with dementia: description of the tailored activity
program-VA randomized trial. BMC geriatrics. 13(1). p.12-15.
Heo, J.H. and Lee, K.M., 2013. The possible role of antioxidant vitamin C in Alzheimer’s
disease treatment and prevention. American journal of Alzheimer's disease and other
dementias. 28(2). pp.120-125.
Jernerén, F. and Smith, A.D., 2015. Brain atrophy in cognitively impaired elderly: the
importance of long-chain ω-3 fatty acids and B vitamin status in a randomized controlled
trial. The American journal of clinical nutritio. 102(1). pp.215-221.
Jung, C.G., 2015. Psychology of Dementia Praecox. Princeton University Press.
Kovach, C.R., 2013. End-Stage Dementia Care: A Basic Guide. Taylor & Francis.
49 | P a g e

Littlejohns, T.J. and et.al., 2014. Vitamin D and the risk of dementia and Alzheimer
disease. Neurology. 83(10). pp.920-928.
Littlejohns, T.J., Henley, W.E. and Lopez, O.L., 2014. Vitamin D and the risk of dementia and
Alzheimer disease. Neurology. 83(10). pp.920-928.
Mohajeri, M.H., Troesch, B. and Weber, P., 2015. Inadequate supply of vitamins and DHA in the
elderly: Implications for brain aging and Alzheimer-type dementia. Nutrition. 31(2).
pp.261-275.
O'Leary, F., Allman-Farinelli, M. and Samman, S., 2012. Vitamin B 12 status, cognitive decline
and dementia: a systematic review of prospective cohort studies. British Journal
of Nutrition. 108(11). pp.1948-1961.
Pludowski, P., Holick, M.F. and Soni, M., 2013. Vitamin D effects on musculoskeletal health,
immunity, autoimmunity, cardiovascular disease, cancer, fertility, pregnancy, dementia
and mortality—a review of recent evidence. Autoimmunity reviews. 12(10). pp.976-989.
Rooney, R.F., 2014. Preventing dementia: how lifestyle in midlife affects risk. Current opinion
in psychiatry. 27(2). pp.149-157.
Solomon, A., Mangialasche, F. and Skoog, I., 2014. Advances in the prevention of Alzheimer's
disease and dementia. Journal of internal medicine. 275(3). pp.229-250.
Stabler, S.P., 2013. Vitamin B12 deficiency. New England Journal of Medicine, 368(2), pp.149-
160.
Tangney, C.C., 2012. Is there a link between vitamin B12 deficiency and cognitive decline in the
elderly?. Aging Health. 8(5). pp.441-443.
Wu, E., Barnes, D.E. and Mehling, W.E., 2015. Preventing Loss of Independence through
Exercise (PLIÉ): qualitative analysis of a clinical trial in older adults with dementia.
Aging.
Campbell, S.E., Seymour, D.G. and Primrose, W.R., 2014. A systematic literature review and its
factors affecting meta-analysis. Springer International Publishing.
Greenhalgh, T. and Peacock, R., 2015. Effectiveness and efficiency of search methods in
systematic reviews. Springer.
Harris, R.P. and et.al.,2013. Current methods of systematic review. Cengage Learning.
Pai, M., Zwerling, A. and Menzies, D., 2012. Systematic review and its methods. Springer
International Publishing.
Pittas, A.G. and et.al., 2011. Systematic review: vitamin D and cardiometabolic outcomes.
Cengage
Prince, M. and et.al., 2013. The global prevalence of dementia: a systematic review and
metaanalysis. Alzheimer's & Dementia. 9(1). pp.63-75.
Westwood, S., 2014. Dementia, women and sexuality: How the intersection of ageing,
gender and sexuality magnify dementia concerns among lesbian and bisexual women.
Dementia. 12(4). pp.560-565.
50 | P a g e

Gu, Y. and et.al., 2014. Dietary total antioxidant capacity and risk of dementia and mild
cognitive impairments. Alzheimer's & dementia: The Journal of the Alzheimer's
Association. 10(4). pp.P748.
Hurd, M.D. And et.al., 2013. Monetary costs of dementia in the United States. New
England Journal of Medicine. 368(14). pp.1326-1334.
Jung, C.G., 2015. Psychology of Dementia Praecox. Princeton University Press.
Majounie, E. and et.al., 2012. Frequency of the C9orf72 hexanucleotide repeat expansion
in patients with amyotrophic lateral sclerosis and front temporal dementia: a cross-
sectional study. The Lancet.
Breeze, E. and et.al., 2014. Cohort studies have a role to play in dementia research.
Alzheimer's & Dementia: The Journal of the Alzheimer's Association. 10(4). p.P189.
Shalowitz, D.I., Garrett-Mayer, E. and Wendler, D., 2012. The accuracy of systematic review.
McGraw-Hill Education.
Wind, J. and et.al., 2013. Systematic review of enhanced recovery programmes in colonic
surgery. Springer International Publishing.
Qaseem A., and et.al., 2008. Current pharmacologic treatment of dementia: a clinical practice
guideline from the American College of Physicians and the American Academy of Family
Physicians. Ann Intern Med. 148:370
1. Tom, S.E., and et.al., 2015. Characterization of dementia and Alzheimer's disease in an
older population: updated incidence and life expectancy with and without dementia. Am J
Public Health. 105:408.
Online
Dementia due to metabolic causes. 2016. [Online]. Available Through:
<https://www.nlm.nih.gov/medlineplus/ency/article/000683.htm>. [Accessed on
6th February 2016]
Dementia. 2013. [Online]. Available Through: <http://www.prevention.com/health/dementia>.
[Accessed on 6th February 2016]
Mercola, 2014. Link between vitamin D deficiency and dementia confirmed. [Online]. Available
Through: <http://articles.mercola.com/sites/articles/archive/2014/11/06/vitamin-
d-deficiency-dementia.aspx>. [Accessed on 6th February 2016]
Vitamin B12. 2011. [Online]. Available Through:
<https://ods.od.nih.gov/factsheets/VitaminB12-Consumer/>. [Accessed on 6th
February 2016].
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Haris, n., 2015. The best vitamins to increase brain function. [online] available through :
<http://www.livestrong.com/article/289107-the-best-vitamins-to-increase-brain-function/>.
[accessed on 17th february 2016].
Mercola, 2016. Nine ways to make yourself smarter. [online] available through :
<http://articles.mercola.com/sites/articles/archive/2012/05/17/good-brain-health-tips.aspx>.
[accessed on 17th february 2016].
(Dementia, 2016). http://www.who.int/mediacentre/factsheets/fs362/en/
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APPENDIX 1
CASP Analysis
Qualitative study:
Smith, A. D., 2006. Prevention of dementia: a role for B vitamins. Nutr Health. 18(3). Pp. 225-
226.
1. Was there a clear statement of the aims of
the research?
Yes it has stated a clear aim for the current
research.
2. Is a qualitative methodology appropriate? Yes it has used an appropriate methodology
of qualitative.
3. Was the research design appropriate to
address the aims of the research?
Abstract of the research has not included
information about the research design but
findings has reflected that author has used
appropriate design of research.
4. Was the recruitment strategy appropriate to
the aims of the research?
It has not collected information from
participants so, there is not information about
recruitment strategy.
5. Was the data collected in a way that
addressed the research issue?
Collected data have addressed research issue
in effective manner.
6. Has the relationship between researcher and
participants been adequately considered?
Yes
7. Have ethical issues been taken into
consideration?
All ethical issues have appropriate
considered.
8. Was the data analysis sufficiently rigorous? Yes
9. Is there a clear statement of findings? Yes
10. How valuable is the research? It is very valuable for forwards practice.
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11. Was there a clear statement of the aims of
the research?
Yes, clearly stated
12. Is a qualitative methodology appropriate? Appropriate methodology has used
13. Was the research design appropriate to
address the aims of the research?
Selected design of research has addressed the
aim of research.
Cohort study:
Haan, M.N., Miller, J.W., Aiello, A.E., Whitmer, R.A., Jagust, W.J., Mungas, D.M., Allen,
L.H. and Green, R., 2007. Homocysteine, B vitamins, and the incidence of dementia and
cognitive impairment: results from the Sacramento Area Latino Study on Aging. The
American journal of clinical nutrition, 85(2), pp.511-517.
1. Did the study address a clearly focused
issue?
Yes, study addressed a clearly focused issue of
dementia in Mexican American aged 60-101y.
2. Was the cohort recruited in an acceptable
way?
Information about the recruitment strategy has
not provided.
3. Was the exposure accurately measured to
minimize bias?
Yes, exposure accurately measured to
minimize bias because study has used
objective measurements and helped in getting
valid conclusion.
4. Was the outcome accurately measured to
minimize bias?
Yes, outcome accurately measured to
minimize bias.
5. (a) Have the authors identified all
important confounding factors?
Yes author identified all-important
confounding factors associated with a greater
risk of dementia.
(b) Have they take account of the Yes, author applied proportional hazards
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confounding factors in the design models for analysis of different confounding
factors.
And/or analysis?
6. (a) Was the follow up of subjects complete
enough?
Yes
(b) Was the follow up of subjects long
enough?
No,
7. What are the results of this study? Homocysteine is an independent risk factor for
both dementia and CIND. Higher plasma
vitamin B-12 may reduce the risk of
homocysteine-associated dementia or CIND.
hazard ratio (HR): 2.39; 95% CI: 1.11, 5.16.
8. How precise are the results? Results has précised in accurate manner and
included suitable statists in appropriate way.
9. Do you believe the results? Yes.
10. Can the results be applied to the local
population?
Yes, it can be applied to the local population
who have greater risk of dementia or CIND.
11. Do the results of this study fit with other
available evidence?
Yes.
12. What are the implications of this study
for practice?
No information has given about implication of
this study for practice.
Case control:
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Maxwell, C.J., Hicks, M.S., Hogan, D.B., Basran, J. and Ebly, E.M., 2005. Dementia and
Geriatrics Cognitive Disorders. Dement Geriatr Cogn Disord. 20. pp.45-51.
1. Did the study address a clearly focused
issue?
Yes the study clearly focused on the
supplemental use of antioxidant to decrease
the risk of dementia.
2. Did the authors use an appropriate method
to answer their question?
No definite strategy or plan have been
discussed in the research article to carry out
the study.
3. Were the cases recruited in an acceptable
way?
Yes
4. Were the controls selected in an acceptable
way?
Yes
5. Was the exposure accurately measured to
minimize bias?
Yes
6. (a) What confounding factors have authors
accounted for
Authors have included all the confounding
factors associated with the case study.
6 (b) Have the authors taken account of the
potential confounding factors in the design
and/or in their analysis?
Yes, author have taken into account the
potential confounding factors in the analysis.
7. What are the results of this study? The results of this article have been unclear. It
is not clear whether the supplemental use of
antioxidant vitamin will actually decrease the
risk of neurological impairment. or not.
8. How precise are the results? Results are unclear and inappropriate.
9. Do you believe the results? Yes No Yes
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10. Can the results be applied to the local
population?
No
11. Do the results of this study fit with other
available evidence?
No
Systematic review and Observational studies.
Vitamin B12 and Cognitive Function:
An Evidence-Based Analysis
Health Quality Ontario
1. Was there a clear statement of the aims of
the research?
Yes there was a clear statement of aims and
objectives mentioned in the research.
2. Is a qualitative methodology appropriate? Yes it is appropriate.
3. Was the research design appropriate to
address the aims of the research?
Yes the research was completed using an
appropriate design and model.
4. Was the recruitment strategy appropriate to
the aims of the research?
Yes
5. Was the data collected in a way that
addressed the research issue?
Yes
6. Has the relationship between researcher and
participants been adequately considered?
Yes the relationship between researcher and
participants have been adequately considered.
7. Have ethical issues been taken into
consideration?
Yes
8. Was the data analysis sufficiently rigorous? No
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9. Is there a clear statement of findings? Yes
10. How valuable is the research? It is valuable for future research and analysis
11. Was there a clear statement of the aims of
the research?
Yes
12. Is a qualitative methodology appropriate? Yes
13. Was the research design appropriate to
address the aims of the research?
Yes it was appropriate.
Cohort study:
Agnew-Blais. J. C. and et.al., 2014. Folate, Vitamin B-6, and Vitamin B-12 Intake and
Mild Cognitive Impairment and Probable
Dementia in the Woman's Health Initiative
Memory Study. Journal of the academy of nutrition and dietetics. 115(2). pp.231-241
1. Did the study address a clearly focused
issue?
Yes the study clearly focused issue
2. Was the cohort recruited in an acceptable
way?
Yes it is appropriate.
3. Was the exposure accurately measured to
minimize bias?
No information is given on this.
4. Was the outcome accurately measured to
minimize bias?
Yes, the outcomes of the study were accurately
measured to minimize bias
5. (a) Have the authors identified all
important confounding factors?
The author has failed to focus on the
confounding factors
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(b) Have they take account of the
confounding factors in the design And/or
analysis?
confounding factors have not been taken into
account in the design And/or analysis?
6. (a) Was the follow up of subjects complete
enough?
Over a mean follow-up of 5.0 years, was done
for the subjects
(b) Was the follow up of subjects long
enough?
Yes the follow up was long enough
7. What are the results of this study? The study has concluded towards the need for
taking proper Folate intake to impart a
protective effect on cognition in later life
8. How precise are the results? The precision of results cannot be judged.
9. Do you believe the results? Yes, I believe the results
10. Can the results be applied to the local
population?
Yes, results can be applied to the local
population
11. Do the results of this study fit with other
available evidence?
Yes, results of this study fit with other
available evidence
12. What are the implications of this study
for practice?
No information is given on this.
Case control:
Clarke, R., 2008. B-vitamins and prevention of dementia. Proceedings of the Nutrition Society,
67(01), pp.75-81.
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1. Did the study address a clearly focused
issue?
Yes, study has addressed a clear issue of
dementia.
2. Did the authors use an appropriate method
to answer their question?
Yes, this case control study has an appropriate
way to answer the question.
3. Were the cases recruited in an acceptable
way?
Yes, all selected cases recruited in appropriate
way.
4. Were the controls selected in an acceptable
way?
Yes, geographically the controls selected
which are acceptable.
5. Was the exposure accurately measured to
minimise bias?
Exposures was accurately measured to
minimize bias.
6. (a) What confounding factors have authors
accounted for
Author has included all important factors in
study.
6 (b) Have the authors taken account of the
potential confounding factors in the design
and/or in their analysis?
No, researcher has not taken account of the
potential confounding factors in the design
and/or in their analysis?
7. What are the results of this study? There has been an Elevated plasma
homocysteine (Hcy) concentration which is
linked with increased presence of cognitive
impairment and dementia. However, there is a
lack of clarity as to whether low vitamin B12
or folate status is responsible for the said
decline.
8. How precise are the results? In appropriate manner.
9. Do you believe the results? Yes No Yes
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