New books regarding pathophysiology and the diagnostic and you may therapeutic points off cobalamin lack try analyzed

Vitamin Bseveral deficiency has long been associated with a wide variety of hematological, neurological, and 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 is a frequently occurring syndrome, particularly in the elderly inhabitants. The brand new differential analysis of alzhiemer’s disease syndromes includes alot off disorders, regarding Alzheimer’s and alcohol alzhiemer’s disease so you can posttraumatic and you will vascular dementia. Hypovitaminosis is amongst the pair disorders leading to alzhiemer’s disease which can be probably curable today.

Dementia On the Nutritional 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.

Circumstances Profile

Diligent 1. Patient O.F., men, is actually labeled a hospital during the ages of 64 years due to frustration and failure. According to family and you will acquaintances regarding really works, O.F. got found a slowly progressive transform of decisions and you can devastation out of performing abilities as the a management staff member along the early in the day five years. Has just he was in a position to carry out only the workload from a part-big date employee, regardless if he willingly worked even more hours to the Saturdays. A few times he was sent household off functions on account of confused message, walking obstacle, and failure to-do his work truthfully. Additionally, he exhibited a growing detachment of personal circumstances and you may a loss of great interest inside the past interests.

To the entry towards hospital he had been conscious and you will cooperative, but disoriented. The guy exhibited big impairment out-of cognitive functions and you will quick-term and you can enough time-label memories. Authoritative considering is slowed. Push, facial expression, impulsive motions, and conceptual considering feature was indeed smaller. The guy apparently complained of memories deficits, and then he had too little urges ultimately causing a burden death of eleven kg over a period of six days.

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 escort in Tacoma 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.