***TASK*** the task is to summarize an input biomedical literature in six sentences 
    ***INPUT*** the input is a biomedical literature 
    ***OUTPUT*** the output is the summary of an input biomedical literature in six sentences 
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    Input: Cognitive and affective complaints are common in patients with primary hyperparathyroidism ( PHPT ) , but few studies have used psychometric testing to document these symptoms and their response to parathyroidectomy . The current study sought to clarify the nature of cognitive and affective impairments in PHPT and changes postparathyroidectomy . One hundred eleven patients with PHPT underwent neuropsychological evaluation prior to parathyroidectomy with 68 returning for an early postsurgical evaluation . Changes in cognition were assessed using practice effect corrected reliable change indices . Biochemical and anesthesia variables were compared between groups who improved and declined . In a subset of patients , assessment revealed a significant pattern of cognitive slowing , reductions in psychomotor speed , memory impairment , and depression prior to parathyroidectomy . Postsurgical evaluations revealed a trend for improvements on timed tests and depression but a decline in memory . Older patients responded less well to surgical intervention , as did patients who experienced more dramatic changes in biochemical status following surgery . Cognitive changes early postparathyroidectomy are characterized by improved information processing speed and decline in verbal memory , with younger patients more likely to recover during this acute phase . The need for longer-term follow-up studies and increasing utilization of neuropsychological assessment s in this population are discussed BACKGROUND A role for vitamin D deficiency in Parkinson disease ( PD ) has recently been proposed . OBJECTIVE To compare the prevalence of vitamin D deficiency in a research data base cohort of patients with PD with the prevalence in age-matched healthy controls and patients with Alzheimer disease ( AD ) . DESIGN Survey study and blinded comparison of plasma 25-hydroxyvitamin D ( 25[OH]D ) concentrations of stored sample s in a clinical research data base at Emory University School of Medicine . SETTING Referral center ( PD and AD patients ) , primary care clinics , and community setting ( controls ) . PARTICIPANTS Participants were recruited into the study between May 1992 and March 2007 . Every fifth consecutively enrolled PD patient was selected from the clinical research data base . Unrelated AD ( n = 97 ) and control ( n = 99 ) participants were r and omly selected from the data base after matching for age , sex , race , APOE genotype , and geographic location . MAIN OUTCOME MEASURES Prevalence of suboptimal vitamin D and mean 25(OH)D concentrations . RESULTS Significantly more patients with PD ( 55 % ) had insufficient vitamin D than did controls ( 36 % ) or patients with AD ( 41 % ; P = .02 , chi(2)test ) . The mean ( SD ) 25(OH)D concentration in the PD cohort was significantly lower than in the AD and control cohorts ( 31.9 [ 13.6 ] ng/mL vs 34.8 [ 15.4 ] ng/mL and 37.0 [ 14.5 ] ng/mL , respectively ; P = .03 ) . CONCLUSIONS This report of 25(OH)D concentrations in a predominantly white PD cohort demonstrates a significantly higher prevalence of hypovitaminosis in PD vs both healthy controls and patients with AD . These data support a possible role of vitamin D insufficiency in PD . Further studies are needed to determine the factors contributing to these differences and eluci date the potential role of vitamin D in pathogenesis and clinical course of PD BACKGROUND Reductions in iodine and zinc deficiencies and improvements in hemoglobin were achieved from a micronutrient-fortified seasoning powder consumed in school lunches by children in northeast Thail and . OBJECTIVE The objective was to determine whether fortification with 4 micronutrients in a school lunch results in changes in children 's growth , morbidity , and cognitive function compared with no fortification . DESIGN In a r and omized controlled trial of 569 children aged 5.5 - 13.4 y from 10 schools , we compared the efficacy of a seasoning powder fortified with or without 5 mg Fe , 5 mg Zn , 50 mug I , and 270 mug vitamin A per serving consumed with a school lunch 5 d/wk . Here we report on results of the secondary functional outcomes . RESULTS The groups were comparable concerning compliance and loss to follow-up . The intervention had no statistically significant effect on anthropometric measures over 31 wk , but reduced the incidence of respiratory-related illnesses [ rate ratio ( RR ) : 0.83 ; 95 % CI : 0.73 , 0.94 ] , symptoms of runny nose ( RR : 0.80 ; 95 % CI : 0.70 , 0.92 ) , cough ( RR : 0.80 ; 95 % CI : 0.66 , 0.96 ) , and diarrhea ( RR : 0.38 ; 95 % CI : 0.16 , 0.90 ) . For the visual recall test , those in the fortified group recalled 0.5 more items ( 95 % CI : 0.1 , 0.9 ) than did the controls . There were no statistically significant differences between groups in the results of the digits forward and backward tests or in school grade s at the conclusion of the 2 semesters . CONCLUSION The beneficial effects on morbidity and visual recall over a short period , in addition to some biochemical improvements , highlight the potential of this micronutrient-fortified seasoning powder supplied in a school lunch . This trial was registered at clinical trials.gov as ACTRN12605000341628 BACKGROUND To our knowledge , no prospect i ve study has examined the association between vitamin D and cognitive decline or dementia . METHODS We determined whether low levels of serum 25-hydroxyvitamin D ( 25[OH]D ) were associated with an increased risk of substantial cognitive decline in the InCHIANTI population -based study conducted in Italy between 1998 and 2006 with follow-up assessment s every 3 years . A total of 858 adults 65 years or older completed interviews , cognitive assessment s , and medical examinations and provided blood sample s.  Cognitive decline was assessed using the  Mini-Mental State Examination ( MMSE )  , and substantial decline was defined as 3 or more points . The  Trail-Making Tests A and B were also used , and substantial decline was defined as the worst 10 % of the distribution of decline or as discontinued testing . RESULTS The multivariate adjusted relative risk ( 95 % confidence interval [ CI ] ) of substantial cognitive decline on the MMSE in participants who were severely serum 25(OH)D deficient ( levels < 25 nmol/L ) in comparison with those with sufficient levels of 25(OH)D ( > /=75 nmol/L ) was 1.60 ( 95 % CI , 1.19 - 2.00 ) . Multivariate adjusted r and om-effects models demonstrated that the scores of participants who were severely 25(OH)D deficient declined by an additional 0.3 MMSE points per year more than those with sufficient levels of 25(OH)D. The relative risk for substantial decline on Trail-Making Test B was 1.31 ( 95 % CI , 1.03 - 1.51 ) among those who were severely 25(OH)D deficient compared with those with sufficient levels of 25(OH)D. No significant association was observed for Trail-Making Test A. CONCLUSION Low levels of vitamin D were associated with substantial cognitive decline in the elderly population studied over a 6-year period , which raises important new possibilities for treatment and prevention OBJECTIVE To determine whether supplementation with vitamins and trace elements in modest amounts influences cognitive function in apparently healthy , elderly subjects . METHODS The study was design ed as a r and omized , double-blind , placebo-controlled trial . Ninety-six , apparently healthy , independent men and women older than 65 y of age were recruited and r and omized to receive a supplement of trace elements and vitamins or a placebo daily for 12 mo . Blood-nutrient levels were estimated at baseline and at the end of the study . The major outcome measure assessed was cognitive function consisting of immediate and long-term memory , abstract thinking , problem-solving ability , and attention . RESULTS Eighty-six subjects completed the 1-y trial . The supplemented group showed a significant improvement in all cognitive tests ( P < 0.001 to 0.05 ) except long-term memory recall ( P > 0.1 ) . Those whose blood-nutrient levels were below the reference st and ard showed lower responses on cognitive tests . There was no significant correlation between individual nutrient levels and performance on various cognitive function tests . CONCLUSIONS Cognitive functions improved after oral supplementation with modest amounts of vitamins and trace elements . This has considerable clinical and public health significance . We recommend that such a supplement be provided to all elderly subjects because it should significantly improve cognition and thus quality of life and the ability to perform activities of daily living . Such a nutritional approach may delay the onset of Alzheimer 's disease Summary This prospect i ve study finds that ergocalciferol 50,000 IU three times weekly for four weeks effectively and safely corrects vitamin D inadequacy in nursing home residents . Introduction Low vitamin D status is common among nursing home residents and contributes to bone loss , falls and fractures . The objective of this study was to evaluate the efficacy and safety of short course , high dose , oral vitamin D2 ( ergocalciferol ) treatment . Methods This prospect i ve study included 63 nursing home residents . The 25 with low vitamin D status ( serum 25(OH)D ≤ 25 ng/ml ) received oral ergocalciferol 50,000 IU three times weekly for four weeks ; the others received no change to their routine care . Serum total 25(OH)D , 25(OH)D2 , 25(OH)D3 , calcium , parathyroid hormone ( PTH ) , bone turnover markers and neuro-cognitive assessment s were obtained at baseline and four weeks . Results Mean total 25(OH)D concentration increased ( p < 0.0001 ) from 17.3 to 63.8 ng/ml in the treated group and remained unchanged in the comparison group . Serum 25(OH)D3 remained stable in the comparison group , but declined ( p < 0.0001 ) with D2 treatment from 15.4 to 9.1 ng/ml . Serum PTH trended down in the treatment group ( p = 0.06 ) . No treatment-induced improvement in ambulation , cognition or behavior was observed . No hypercalcemia or other adverse effects were observed with ergocalciferol treatment . Conclusion Four weeks of oral vitamin D2 supplementation effectively and safely normalizes serum 25(OH)D in nursing home residents Background / Aims : Recent studies suggest that vitamin D metabolites may be important for preserving cognitive function via specific neuroprotective effects . No large studies have examined the association between vitamin D status and cognition . Methods : In this cross-sectional study , we analyzed the  serum 25-hydroxyvitamin D3 levels and Mini-Mental State Examination ( MMSE ) test scores of 225 older out patients who were diagnosed as having probable Alzheimer ’s disease ( AD ) . In addition to the 25-hydroxyvitamin D3 levels , we analyzed the  serum vitamin B1 , B6 and B12 levels  . Results : An association was found between MMSE test scores and serum 25-hydroxyvitamin D3 levels , with a β-coefficient of 0.05 ( p = 0.01 ) . Vitamin-D-sufficient patients had significantly higher MMSE scores as compared to vitamin-D-insufficient ones . No association was found with the other serum vitamin levels . Conclusions : These data support the idea that a relationship exists between  vitamin D  status and cognition in patients with probable AD . However , given the cross-sectional design of this study , no causality can be concluded . Further prospect i ve studies are needed to specify the contribution of vitamin D status to the onset and course of cognitive decline and AD CONTEXT Data regarding the presence , extent , and reversibility of psychological and cognitive features of primary hyperparathyroidism ( PHPT ) are conflicting . OBJECTIVE This study evaluated psychological symptoms and cognitive function in PHPT . DESIGN This is a case-control study in which symptoms and their improvement 6 months after surgical cure of PHPT were assessed . SETTING S The study was conducted in a university hospital metabolic bone disease unit and endocrine surgery practice . PARTICIPANTS Thirty-nine postmenopausal women with PHPT and 89 postmenopausal controls without PHPT participated in the study . INTERVENTION Participants with PHPT underwent parathyroidectomy . OUTCOME MEASURES Measurements used in the study were : Beck Depression Inventory ( BDI ) ; State-Trait Anxiety Inventory , Form Y ( STAI-Y ) ; North American Adult Reading Test ( NAART ) ; Wechsler Memory Scale Logical Memory Test , Russell revision ( LM ) ; Buschke Selective Reminding Test ( SRT ) ; Rey Visual Design Learning Test ( RVDLT ) ; Booklet Category Test , Victoria revision ( BCT ) ; Rosen Target Detection Test ( RTD ) ; Wechsler Adult Intelligence Scale-Revised Digit Symbol Subtest ( DSy ) ; Wechsler Adult Intelligence Scale Digit Span Subtest ( DSpan ) . RESULTS At baseline , women with PHPT had significantly higher symptom scores for depression and anxiety than controls and worse performance on tests of verbal memory ( LM and SRT 
    Output:
    
Conclusion : These results suggest that lower vitamin D concentrations are associated with poorer cognitive function and a higher risk of AD .