Effects of Vitamin-D 3 Supplement on the Cognitive Status in Patient with Systemic Lupus Erythematosus with Neuropsychiatric Phenomenon

Abstract

Systemic Lupus Erythematosus (SLE) is a complicated autoimmune illness that affects several organ systems, including the central nervous system. Neuropsychiatric (NP) SLE (NPSLE) is characterized by neurological and psychiatric symptoms such as cognitive dysfunction, mood problems, and seizures, and has been linked to severe impairments in memory, attention, and executive functioning can lead to altered brain perfusion. Vitamin D3 has shown promise in neuro-protection and cognitive improvement, which may benefit NPSLE patients. This study investigates the effects of Vitamin D3 supplementation on cognitive function and brain perfusion in NPSLE patients. Material & Methods This randomized controlled trial (RCT) included NPSLE patients (N=72), divided into an intervention group (n=34) receiving Vitamin D3 supplementation, and a control group (n=38) without supplementation. Baseline and six-month evaluations of serum Vitamin D levels, Mini-Mental State Examination (MMSE) scores, and brain perfusion using Single-photon emission computed tomography (SPECT) imaging (Z-scores) were conducted at National Institute of Nuclear Medicine & Allied Science (NINMAS), Dhaka. The intervention group received 40,000 IU of Vitamin D3/week for six weeks, followed by a maintenance dose of 2000 IU/day for three months, along with standard SLE management. Both verbal and written informed consent was obtained, and adherence was encouraged through weekly reminders via text or calls. After six months, outcomes were analyzed to assess the impact of Vitamin D3 on cognitive function and brain perfusion in NPSLE patients. xv Results Baseline characteristics (age, gender, BMI, and waist-to-hip ratio/WHR) were indifferent (P>0.05) between groups (Control vs. cases). No significant differences (P>0.05) were found between groups in age (28.24±7.18 vs. 26.32±7.94,), gender distribution (predominantly female), BMI (19.0±1.4 vs.19.2±2.0,), and waist-to-hip ratio (0.78±0.11 vs. 0.76±0.10). Moreover, at baseline, vitamin D levels were low and similar across both groups (14.5±5.3 ng/ml vs. 16.2±4.9, p=0.173). After the study period, a significant (p<0.001) increase in vitamin D3 levels (28.3±5.3 ng/ml) was observed in the intervention group as compared to controls (15.1±3.4 ng/ml), indicating effective supplementation. Moreover, at baseline, MMSE scores were similar (24.1±1.7 vs. 24.3±1.5) between groups (P=0.677) while at the end line, the intervention group (26.5±1.4) showed a significant improvement in MMSE scores than control (23.8±2.25; p<0.001). This suggests a positive effect of Vitamin D3 supplementation on cognitive function. Brain perfusion was analyzed using SPECT imaging techniques (Z-scores), and at baseline, abnormal perfusion was prevalent in both groups (81.6% vs. 88.2%, P=.522), primarily in the frontal, parietal lobes, and precuneus regions (z-score: 1.4 vs. 1.46, P=0.549). This baseline homogeneity indicates effective randomization and establishes comparable initial conditions between the study groups. However, at the end line, mean z-scores were insignificantly (P=.457) higher in the control group (n=13, z-scores=1.84) than intervention group (n=21, z- scores=1.66) while 65.8% (n=25) of the Brain SPECT of the controls were not available at end line, as compared to cases (n=13). On top of that, significant between-group differences emerged in performing perfusion test results (Fisher’s exact test= 6.997, p = 0.028) when considered comparison in missing cases between groups, which indicates among available controls (n=13), eleven xvi showed abnormal brain perfusion. Furthermore, the intervention group demonstrated distinct patterns of perfusion compared to controls, suggesting a potential effect of Vitamin D3 supplementation on cerebral perfusion parameters. These findings suggest that despite the study groups (intervention vs. control) exhibited indifferent (all P>0.05) vitamin D3 levels, MMSE scores, and perfusion characteristics at the baseline, significant differences emerged between groups especially in the MMSE-scores (small effect size, Partial eta squared=.460 for MMSE between case and. control) attributable to the effective vitamin D3 supplementation (High effect size, Partial eta squared=.714 for Vitamin D, Case vs. control) following the intervention period (6-months). Conclusion Vitamin D3 supplementation led to substantial improvements in serum vitamin D levels, cognitive function (MMSE scores), and brain perfusion in the intervention group. These findings support the potential role of Vitamin D3 as an adjunctive therapy in NPSLE, enhancing cognitive performance and cerebral perfusion. Further studies are recommended to validate these results and assess the long-term benefits of Vitamin D3 in managing NPSLE-related cognitive impairment