Vitamin Ba dozen deficiency has long been associated with a wide variety of hematological, neurological, and Stockton CA escort sites psychiatric disorders. The role of vitamin B12 deficiency as one of the few treatable causes of dementia, however, is still controversial. The authors report on 2 elderly patients suffering from cognitive impairment and psychotic symptomatology probably related to cobalamin deficiency, who showed improvement after parenteral vitamin B12 substitution.
Dementia try a typically happening syndrome, particularly in elderly people society. The fresh new differential prognosis of the alzhiemer’s disease syndromes comes with lots of issues, away from Alzheimer’s and you may alcoholic dementia in order to posttraumatic and you can vascular dementia. Hypovitaminosis is just one of the pair disorders leading to dementia that are potentially treatable today.
Alzhiemer’s disease Associated with the Vitamin B12 Lack
The following two case reports illustrate the importance of vitamin B12 deficiency as a possible cause for the development of dementia. They also underline that vitamin B12 deficiency is a frequent condition in the elderly population that is often overlooked in clinical practice. Whereas common routine parameters like the serum level of vitamin B12 or the Schilling test in deficiency, newer functional assays in B12 deficiency as a cofactor for dementia in the future.
Patient step one. Patient O.F., male, is described a hospital during the age of 64 age due to confusion and you can collapse. According to household members and you will colleagues away from works, O.F. got shown a more sluggish modern change off choices and devastation out of operating performance just like the a management staff along side earlier in the day five years. Recently he had been capable carry out only the workload away from a member-big date personnel, regardless if he voluntarily spent some time working more instances on Saturdays. From time to time he had been delivered household away from works due to baffled speech, strolling obstacle, and you will failure to do his really works accurately. In addition, the guy exhibited a growing withdrawal of societal affairs and a loss of profits of interest within the earlier interests.
To the entryway towards the health he was awake and you can collaborative, but disoriented. The guy showed big handicap out of cognitive attributes and you can short-title and long-title memory. Certified thinking is actually slowed. Push, facial phrase, spontaneous motions, and you will abstract convinced function was basically smaller. The guy frequently reported regarding memories deficits, and then he had too little urges resulting in an encumbrance death of eleven kg over a period of 6 months.
Physical examination revealed a pale and dry skin and emphysematic lungs. The neurological examination showed diminished tendon reflexes and a reduced sense of posture and vibration of the legs. Primitive reflexes (palmomental and snout reflexes) were positive. CT scan and MRI of the brain showed a generalized cerebral atrophy. EEG, cerebrospinal fluid, Doppler sonography of the cerebral arteries, and xenon SPECT for the measurement of cerebral blood flow did not show any abnormalities. The serum vitamin B12 level was in the lower normal range (307 pg/ml). The red blood count was normal. The Schilling test was pathological (9% absorption of cobalamin), but normalized after substitution of intrinsic factor (18% absorption), indicating a lack of intrinsic factor. Gastroscopy revealed atrophic gastritis, which was confirmed by biopsy. Serum titers of antibodies specific for parietal cells were not elevated, however.
Detailed psychological testing (complete Wechsler Adult Intelligence Scale–Revised, Benton Visual Retention Test, Trail Making Test, and Mini-Mental State Examination [MMSE]) reflected an average overall IQ (102). Concentration and the ability to solve complex cognitive tasks were reduced, however. At the retest approximately 5 weeks later (under substitution of vitamin B12 and additional therapy with doxepin and lorazepam), the patient showed a significantly better performance IQ (112) and improved cognitive speed.
Patient 2. Patient A.H., male, was admitted to our psychiatric clinic at the age of 77 years. For the previous 13 years he had had the delusional fear of impoverishment. However, when he encountered special offers, he bought unnecessary amounts of cheap and often useless items, which he then collected in his apartment. For the past 11 years he had been known to suffer from pernicious anemia, yet he had only rarely accepted parenteral vitamin B12 substitutions.