Slides example for Journal Club based on STROBE CHECKLIST.pptx

Slides example for Journal Club based on STROBE CHECKLIST

1. JOURNAL CLUB The Association of Vitamin D Status with Mild Cognitive Impairment and Dementia Subtypes: A Cross-Sectional Analysis in Dutch Geriatric Outpatients PRESENTER: SYAFEQAH BINTI MOHD ABDUL WAHAB (GS 67192) JC: 25/4/2025

2. Why I chose this topic for JC? To get a better understanding on cross sectional study This study explores more on the association of Vitamin D status on Mild Cognitive Impairment (MCI) and other subtypes of Dementia among geriatrics As one of the common problems during geriatric rotation (memory clinic) in second year Part of primary care management in geriatrics outpatients 2

3. STROBE CHECKLIST Confidence-building strategies

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6. Selecting visual aids Enhancing your presentation TITLE Title is clear - objective Stated the type of study design (Cross-Sectional Analysis) Mentioned the setting / location – Dutch Geriatric Outpatients (in which study took place in the Netherlands and focused on elderly patients receiving outpatient care)

7. Presentation title 7 Background/Rationale Objectives Study Design Setting Participants (Sample size, inclusion & exclusion criteria) Variables Measurements Results Interpretation ABSTRACT

8. Background/Rationale The background explains the relevance of Vitamin D deficiency in dementia and its subtypes. Objective Clearly states the objective: "To investigate the association of 25-hydroxy vitamin D (25(OH)D) status with dementia subtypes in an outpatient geriatric population.“ Study Design The cross-sectional design was mentioned in the methods section Setting Specifies the study setting: "Outpatient memory clinic in The Netherlands.“ Does not specify the exact institution or region within the Netherlands. Participants (Sample size) Sample size: 1,758 patients ( Inclusion/exclusion criteria are not detailed in the abstract ) Variables Clearly defines exposure (Vitamin D levels) and outcome (dementia subtypes). 8

9. Measurements Vitamin D levels were measured at first visit Cognitive disorders diagnosed using international clinical standards The specific diagnostic criteria or tools used are not mentioned Results Provides estimates for Vitamin D levels across dementia subtypes Confidence intervals (CI) and p-values are reported No significant difference found between MCI, Lewy body, and mixed dementia subtypes Interpretation Conclusion states that AD and VaD patients had lower Vitamin D levels , but no difference in other dementia subtypes Presentation title 9

10. INTRODUCTION Presentation title 10 Scientific Background: This highlights the growing burden of dementia and the need for research . The paper describes different types of dementia, such as Alzheimer’s disease (AD) and vascular dementia ( VaD ), and discusses known risk factors like genetics, cardiovascular health, and diet. c

11. Rationale of study: Uncertainty in Vitamin D’s role in Dementia Lack of Research on Vascular Dementia and other Dementia types Scientific background:- This highlights previous findings that suggest vitamin D deficiency might contribute to cognitive decline, but also acknowledges existing uncertainties Presentation title 11

12. Prespecified Hypothesis - stated Specific Objective -Clearly stated Presentation title 12

13. STUDY DESIGN : Cross-sectional study Presentation title 13

14. SETTING: Presentation title 14 Location: Outpatient clinic, geriatric department, non-academic hospital in Ede, the Netherlands Recruitment period : January 2011 – June 2015 Exposure : Vitamin D levels (25-hydroxy vitamin D [25(OH)D]) Method of measurement : Blood sampling, stored at -20°C , analyzed weekly via HPLC (High-Performance Liquid Chromatography). Vitamin D supplementation (both prescribed and over-the-counter ) was recorded and included in the analysis

15. No follow up mentioned – cross sectional study Patients were assessed at a single time point (during their first visit to the memory clinic). 15 Data Collection (Cognitive Diagnosis & Other Factors) Neuropsychological tests & imaging were done when necessary

16. Other data collected: Clearly stated there Demographics: Age, gender, education Lifestyle Factors: Smoking, alcohol use, season of blood sampling Clinical Factors: BMI, kidney function (eGFR), glucose, calcium levels Medication Use: Polypharmacy (≥5 prescriptions) Presentation title 16

17. Presentation title 17 Inclusion Criteria: Clearly stated there Cognitive problems Falls or other reasons ( but only if cognitive complaints were present ) – underwent standardized cognitive analysis Age 60 years or olde r Exclusion Criteria: Clearly stated there Vitamin D levels must have been measured within 3 months of their visit Patients with frontotemporal lobe dementia (FLD) (excluded due to low sample size, n = 15) Dementia not otherwise specified/of uncertain etiology

18. FLOW CHART OF STUDY POPULATION Presentation title 18

19. Sources of population Methods of selection Presentation title 19

20. Presentation title 20 Primary outcome: Mentioned clinical diagnosis of MCI and subtypes of dementia & significant correlation between types of dementia and Vitamin D Potential Cofounder Effect modifier Unfortunately, they did not mentioned a sample size calculation or power analysis to justify the number of participants – based on inclusion criteria

21. They did not only include patients with known dementia but also those with mild cognitive complaints or even people referred for other reasons (e.g., falls). They used a consistent and standardized diagnostic process for all participants, regardless of their referral reason. This reduces differential selection bias, ensuring that the same diagnostic criteria were applied to all patients. They reported that 31% of the sample did not have cognitive impairment, suggesting that the study did include a mix of patients, not just those with severe dementia (Possible selection effect – partially reduce selection effect) Presentation title 21 Selection Bias is reduced in this paper as: Results may not be generalizable to all elderly individuals

22. Other Bias Potential issue Efforts to reduce bias Information (Due to recall bias- forget to take and misreporting – does not know the exact dosage taken) Self-reported vitamin D supplement use may be inaccurate Cross checking self reported data with medication lists Reverse causation Dementia may cause low vitamin D, rather than vice versa Acknowledging Reverse Causation as a Limitation Measurement Single vitamin D measurement may not reflect long-term levels Standardized blood collection timing Controlled storage HPLC analysis Seasonal adjustments Presentation title 22

23. Vitamin D levels (25(OH)D) were skewed, so the authors used a square-root transformation to make the data closer to normal distribution. Many statistical tests (like ANCOVA) assume normality for valid results. This ensures that variables with different distributions are summarized appropriately. Presentation title 23

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28. Presentation title 28 Key results were summarized with reference to study objective

29. Limitations & Intepretation : Presentation title 29

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31. Thank you