Vitamin Btwelve 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.
Alzhiemer’s disease is a generally occurring problem, particularly in the elderly population. The brand new differential diagnosis of your alzhiemer’s disease syndromes includes a whole lot of issues, out of Alzheimer’s and you will alcoholic dementia in order to posttraumatic and you can vascular alzhiemer’s disease. Hypovitaminosis is amongst the partners issues leading to dementia that are possibly curable now.
Alzhiemer’s disease Of this Nutritional B12 Deficiency
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 actually described a medical facility during the age of 64 decades because of distress and you can collapse. Centered on members of the family and acquaintances regarding really works, O.F. got shown a slowly modern changes of choices and destruction out-of functioning results since a management staff member along side earlier 5 years. Recently he was capable create just the work of a part-go out staff, whether or not the guy willingly worked additional period towards Saturdays. A few times he had been sent family regarding work because of baffled speech, taking walks impediment, and you can inability doing their works accurately. At the same time, the guy showed an expanding detachment out-of societal circumstances and you can a loss of profits of great interest for the past passion.
To your admission to your healthcare he was conscious and you will cooperative, but confused. The guy exhibited major disability regarding cognitive properties and you will brief-name and long-title memories. Formal convinced was slowed. Push, facial expression, impulsive movements, and you can conceptual thought ability was in fact less. He frequently reported regarding memory deficits, and then he had a lack of cravings leading to an encumbrance death of eleven kilogram over a period of 6 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 impoverishment. However, when he encountered special offers, he bought unnecessary amounts of cheap Tacoma escort service 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.