A critical evaluation of the relationship between serum vitamin B12, folate and total homocysteine with cognitive impairment in the elderly

Background: The Neurodegenerative diseases are increasingly affecting the elderly with a severe impact on their brain health. There is a wide gap in supplementation based studies for increasing the cognition levels of the geriatric population especially in the developing countries like India, which are at extreme risk of developing neurological disorders. Vitamin B12 herein has caught much attention lately for improving the cognitive status. Literature has linked the possibility of alleviating neurological disorders in the elderly with effective vitamin B12 management. Abundant animal and human models have proved that supplementation of vitamin B12 is beneficial for the restoration of cognitive functions. Objective: To supplement vitamin B12 deficient mild cognitively impaired geriatric patients with injectable doses of vitamin B12 followed by impact evaluation. Methods: Screening of the mild cognitively impaired patients was carried out using the Mini-Mental State Examination and Yamaguchi Fox Pigeon Imitation test. Baseline information was elicited from the patients residing in urban Vadodara (a district in the state of Gujarat), India. This included socio-demographic, medical and drug history, anthropometric and physical activity pattern as well as biochemical parameters comprising of serum vitamin B12 and glycated haemoglobin profile. A sub-sample of 60 patients with mild cognitive impairment (MCI) demonstrating severe vitamin B12 deficiency were conveniently enrolled for injectable doses of Vitamin B12 in the dosage of 1,000 μg every day for one week, followed by 1,000 μg every week for 4 weeks & finishing with 1,000 μg for the remaining 4 months. Post six months intervention all the parameters were elicited. Results: Vitamin B12 supplementation resulted in a significant (p<0.001) improvement in the MMSE scores of the patients with a rise of 9.63% in the total patients. Gender-wise division also highlighted a significant increase (p<0.001) in the scores by 6.79% and 12.46% in overall males and females and a 10.20% and 8.24% rise for young-old (60-69 yrs) and old- old (70-85 yrs) categories, respectively. As a result, 27 patients progressed towards the category from the MCI state being assessed by MMSE scores. In the same manner, YGFPIT too demonstrated a 38% increase in normal with 35% males, 42% females, 41% young–old and 31% old-old moving to normal status. Thus, a total number of 28 patients progressed to the normal condition as per YGFPIT.Conclusion: Hence, vitamin B12 supplementation was found significantly effective in placing the serum vitamin B12 of MCI patients from the deficiency state to sufficient levels and in turn increased their performance in MMSE and YFPIT scores. Keywords: Mild Cognitive Impairment, vitamin B12, geriatrics, cognition

Download Full-text

Sex Differences in the Relationship of Serum Vitamin B1 and B12 to Dementia Among Memory Clinic Outpatients in Japan

Frontiers in Aging Neuroscience ◽

10.3389/fnagi.2021.667215 ◽

2021 ◽

Vol 13 ◽

Author(s):

Ayako Miki ◽

Ryuta Kinno ◽

Hirotaka Ochiai ◽

Satomi Kubota ◽

Yukiko Mori ◽

...

Keyword(s):

Sex Differences ◽

Cognitive Impairment ◽

Cognitive Function ◽

Vitamin B12 ◽

Vitamin B1 ◽

Serum Vitamin ◽

University Hospital ◽

Memory Clinic ◽

Relationship Of ◽

The Relationship

Dementia and cognitive impairment are considered to be one of the biggest social and medical problems. While there is a definite relationship between vitamin B and cognitive decline, this has yet to be fully assessed with regard to sex differences. Thus, the present study investigated the relationship of vitamin B1 or vitamin B12 with dementia in accordance with the sex in 188 patients who visited the Memory Clinic at Showa University Hospital in Japan from March 2016 to March 2019. Cognitive function was tested by the Japanese version of the Mini-Mental State Examination (MMSE) and Hasegawa Dementia Scale-Revised (HDS-R). Blood tests were performed to measure the vitamin levels. Logistic regression analysis was used to calculate the odds ratio (OR) for dementia and the 95% confidence interval (CI). Compared to the highest vitamin group (third tertile), the lowest vitamin group (first tertile) exhibited a significantly increased OR for dementia defined by MMSE for vitamin B1 (OR:3.73, 95% CI:1.52–9.16) and vitamin B12 (2.97, 1.22–7.28) among women. In contrast, vitamin levels were not significantly associated with dementia determined by MMSE in men. These findings were similar even when dementia was defined by HDS-R. The present study suggests that vitamin B1 plays a role in preventing development of dementia in women. Future longitudinal studies will need to be undertaken in order to examine whether decreasing vitamin levels occur before or after cognitive impairment, and whether maintaining a higher vitamin level can prevent a worsening of cognitive function and the development of dementia.

Download Full-text

FOLATE AND SYNTHETIC FOLIC ACID INTAKE, SERUM B VITAMIN AND HOMOCYSTEINE CONCENTRATIONS, AND COGNITIVE IMPAIRMENT IN ELDERLY BRAZILIANS

Journal of Aging Research and Lifestyle ◽

10.14283/jarcp.2017.5 ◽

2017 ◽

pp. 1-8

Author(s):

V. Ferri Ross Perucha ◽

R. de Cássia de Aquino ◽

N. Gaspareto ◽

E.M. Guerra-Shinohara ◽

P. Mendonça da Silva Amorim ◽

...

Keyword(s):

Cognitive Impairment ◽

Folic Acid ◽

Vitamin B12 ◽

Mental State ◽

Mini Mental State Examination ◽

Serum Vitamin ◽

The Elderly ◽

Acid Consumption ◽

B12 Deficiency ◽

State Examination

Background: An increased risk of cognitive decline in the elderly with B12 deficiency has been associated with excessive synthetic folic acid in food fortification and supplements. Objectives: To assess the dietary folate and folic acid intake from food fortification, as well as serum vitamin B12, folate, iron, and homocysteine concentrations among the elderly and their relationships with cognitive changes. Design: Cross-sectional, observational study. Setting and Participants: Community-dwelling elderly (N = 40), predominantly female (90%), with an average age of 69 years. Measurements: Dietary intake information was collected using four 24-hour dietary recalls, adjusted for iron and folic acid in fortified flour and supplements. Serum vitamin B12, B6, folate, iron, and homocysteine concentrations were determined. Cognitive function was assessed using the Mini-Mental State Examination, adjusted for educational level. Results: Possible serum vitamin B12 deficiency (<258 pmol/L) was present in 5% of the elderly participants, while 27.5% had possible functional deficiency (<400 pmol/L). No serum folate deficiency (<6.8 nmol/L) was observed; however, 15% had possible deficiency (<13.6 nmol/L), and 7.5% had supraphysiological levels. Hyperhomocysteinemia (≥15 µmol/L) was present in 65% of the sample. Almost half of the participants (47.5%) showed cognitive impairment. There were no significant relationships between the Mini-Mental State Examination results and the B12, folate, iron, and homocysteine concentrations. However, the participants with serum vitamin B12 levels <400 pmol/L tended to have poorer Mini-Mental State Examination scores, which were related to older age (P = 0.045) and changes in the oral cavity (P = 0.034). In addition, folic acid consumption was inversely related with serum vitamin B12 levels (P = 0.030). Macrocytosis was not observed. Conclusions: Although Mini-Mental State Examination-assessed cognitive impairment was not related with the investigated biochemical variables, increased folic acid consumption seems to have a negative impact on vitamin B12 metabolism; therefore, fortification may be contributing to functional disability and masking hematological signs in the elderly.

Download Full-text

VITAMIN B12 AND FOLIC ACID VALUES IN PREMATURE INFANTS

PEDIATRICS ◽

10.1542/peds.50.4.584 ◽

1972 ◽

Vol 50 (4) ◽

pp. 584-589

Author(s):

Ambadas Pathak ◽

Herman A. Godwin ◽

Luis M. Prudent

Keyword(s):

Folic Acid ◽

Vitamin B12 ◽

Premature Infants ◽

Serum Vitamin ◽

Serum Folate ◽

Born Infant ◽

Low Concentrations ◽

Folate And Vitamin B12 ◽

Relationship Of ◽

The Relationship

The relationship of serum vitamin B12 and folic acid was studied in 24 premature infants. In 14 of the 24, low serum vitamin B12 values were found around 40 days of age. Serum folic acid concentrations were less frequently depressed and were usually associated with normal red cell folate values. No correlation between hematocrits and vitamin B12 or folate levels was found. It is suggested that low concentrations of serum folate and vitamin B12 result from low dietary intake coupled with increased demand by the prematurely born infant.

Download Full-text

The Relationship between Hypertension and Cognitive Function Impairment in the Elderly

Open Access Macedonian Journal of Medical Sciences ◽

10.3889/oamjms.2019.300 ◽

2019 ◽

Vol 7 (9) ◽

pp. 1440-1445 ◽

Cited By ~ 1

Author(s):

Endy Juli Anto ◽

Laura Oktavina Siagian ◽

Jekson Martiar Siahaan ◽

Hendrika Andriana Silitonga ◽

Sony Eka Nugraha

Keyword(s):

Cognitive Impairment ◽

Cognitive Function ◽

Nursing Homes ◽

Significant Relationship ◽

The Elderly ◽

Research Approach ◽

Impaired Cognitive Function ◽

Function Impairment ◽

The Relationship ◽

Second Degree

BACKGROUND: Hypertension is still a health problem both in developed and developing countries. Hypertension can cause various complications; one of them is cognitive function impairment. AIM: This study aimed to look at the relationship of hypertension with cognitive function. This research can also be useful to help optimise the health of the elderly, maximise quality of life and avoid hypertension as a risk factor for cognitive impairment in the elderly at the Karya Kasih Nursing Homes, Medan from May to June 2018. METHODS: This research was carried out by analytic observational with cross-sectional research approach. In this study, 57 elderly from Karya Kasih Nursing Homes Medan who met the inclusion and exclusion criteria participated. Assessment of cognitive function used Mini-Mental State Examination (MMSE), Six Item Cognitive Impairment Test (6CIT) and Abbreviated Mental Test Score (AMT) instruments. RESULT: This study obtained a significant relationship between the history of hypertension with impaired cognitive function (p = 0.003). The results of the cognitive function examination with MMSE showed that among 57 elderly, 16 people (43.2%) were normal and 21 people (56.8%) had impaired cognitive function in the first degree hypertension group, besides that, 3 people were normal (15%) and 7 people (85%) had impaired cognitive function in the second degree hypertension group (p = 0.031). Based on the result of mild and severe cognitive function impairment, among 12 people (57.1%) and 9 people (42.9%) had a mild and severe cognitive function impairment, respectively, in first-degree hypertension. 3 people (17.6%) and 14 people (82.4%) had a mild and severe cognitive function impairment, respectively, in the second-degree hypertension (p = 0.013). The 6-CIT instrument also showed a significant relationship between the severity of hypertension and impaired cognitive function (p = 0.027), and there was no significant relationship with AMT instruments (p = 0.078). CONCLUSION: There was a relationship between the history or duration and degree of hypertension with cognitive dysfunction in the elderly at the Karya Kasih Nursing Home Medan.

Download Full-text

Improved testing for vitamin B12 deficiency: correcting MMA for eGFR reduces the number of patients classified as vitamin B12 deficient

Annals of Clinical Biochemistry International Journal of Laboratory Medicine ◽

10.1177/0004563218778300 ◽

2018 ◽

Vol 55 (6) ◽

pp. 685-692 ◽

Cited By ~ 1

Author(s):

Saskia LM van Loon ◽

Anna M Wilbik ◽

Uzay Kaymak ◽

Edwin R van den Heuvel ◽

Volkher Scharnhorst ◽

...

Keyword(s):

Data Mining ◽

Vitamin B12 ◽

Methylmalonic Acid ◽

Vitamin B12 Deficiency ◽

The Elderly ◽

Vitamin B ◽

Data Mining Approach ◽

Number Of Patients ◽

B12 Deficiency ◽

The Relationship

Background Methylmalonic acid (MMA) can detect functional vitamin B12 deficiencies as it accumulates early when intracellular deficits arise. However, impaired clearance of MMA from blood due to decreased glomerular filtration rate (eGFR) also results in elevated plasma MMA concentrations. Alternative to clinical trials, a data mining approach was chosen to quantify and compensate for the effect of decreased eGFR on MMA concentration. Methods Comprehensive data on patient’s vitamin B12, eGFR and MMA concentrations were collected ( n = 2906). The relationship between vitamin B12, renal function (eGFR) and MMA was modelled using weighted multiple linear regression. The obtained model was used to estimate the influence of decreased eGFR on MMA. Clinical impact was examined by comparing the number of patients labelled vitamin B12 deficient with and without adjustment in MMA. Results Adjusting measured MMA concentrations for eGFR in the group of patients with low-normal vitamin B12 concentrations (90–300 pmol/L) showed that the use of unadjusted MMA concentrations overestimates vitamin B12 deficiency by 40%. Conclusions Through a data mining approach, the influence of eGFR on the relation between MMA and vitamin B12 can be quantified and used to correct the measured MMA concentration for decreased eGFR. Especially in the elderly, eGFR-based correction of MMA may prevent over-diagnosis of vitamin B12 deficiency and corresponding treatment.

Download Full-text

The Relationship between Cognitive Impairment and Social Vulnerability among the Elderly: Evidence from an Unconditional Quantile Regression Analysis in China

International Journal of Environmental Research and Public Health ◽

10.3390/ijerph16193684 ◽

2019 ◽

Vol 16 (19) ◽

pp. 3684 ◽

Cited By ~ 1

Author(s):

Junkai Zhao ◽

Xinxin Zhang ◽

Zongmin Li

Keyword(s):

Cognitive Impairment ◽

Quantile Regression ◽

Social Vulnerability ◽

Positive Association ◽

The Elderly ◽

Quantile Regression Model ◽

Unconditional Quantile Regression ◽

Quantile Regression Analysis ◽

Physical Limitations ◽

The Relationship

As the global proportion of the elderly population has been growing rapidly, it has become important to better understand the holistic social factors involved in cognitive impairment in the elderly. To investigate the relationship between social vulnerability and cognitive impairment in the elderly, this study applied an unconditional quantile regression model on open source health survey data in China. It was used to estimate the relationship for full sample and subsamples divided by different levels of a specific covariate. It was found that the cognitive impairment had a positive association with social vulnerability, and this relationship is stronger at the higher cognitive impairment quantiles. The cognitive impairment of females and elderly who took less exercise; had lower self-rated health; had greater incidences of depression, chronic diseases, and physical limitations; and consumed less fruit and vegetables, milk and tea were more related to social vulnerability. These results provide some insights into the strategies that could be used by the elderly to decrease the risk of cognitive impairment.

Download Full-text

Relationship between cognition and frailty in elderly: A systematic review

Dementia & Neuropsychologia ◽

10.1590/1980-57642015dn92000005 ◽

2015 ◽

Vol 9 (2) ◽

pp. 110-119 ◽

Cited By ~ 37

Author(s):

Allan Gustavo Brigola ◽

Estefani Serafim Rossetti ◽

Bruna Rodrigues dos Santos ◽

Anita Liberalesso Neri ◽

Marisa Silvana Zazzetta ◽

...

Keyword(s):

Systematic Review ◽

Cognitive Impairment ◽

Search Strategy ◽

Web Of Science ◽

The Elderly ◽

Cross Sectional ◽

Cognitive Domains ◽

The Subject ◽

The Relationship

OBJECTIVE: The aim of this study was to analyze the relationship between cognition and frailty in the elderly. METHODS: A systematic review on the currently existing literature concerning the subject was carried out. The search strategy included LILACS, SCOPUS, SciELO, PsycINFO, PubMed and Web of Science databases. RESULTS: A total of 19 studies were selected for review, from which 10 (52.6%) were cross-sectional and 9 (47.4%) longitudinal, and the majority Brazilian. All of the studies established a link between cognition and frailty. There was a relationship between components of frailty and the cognitive domains. Risk of Mild Cognitive Impairment (MCI), dementia and mortality were all evidenced in the relationship between frailty and cognitive impairment. CONCLUSION: The theory remains limited, but results show the variables that appear to be linked to cognition and frailty in elderly. This data can help in implementing actions to improve the quality of life among elderly.

Download Full-text

Depression and mild cognitive impairment – Comorbidity and/or continuum?

European Psychiatry ◽

10.1016/j.eurpsy.2016.01.430 ◽

2016 ◽

Vol 33 (S1) ◽

pp. S190-S191

Author(s):

G. Sobreira ◽

M.A. Aleixo ◽

C. Moreia ◽

J. Oliveira

Keyword(s):

Risk Factors ◽

Cognitive Impairment ◽

Mild Cognitive Impairment ◽

Cognitive Decline ◽

Late Life ◽

The Elderly ◽

Late Life Depression ◽

Pubmed Database ◽

Competing Interest ◽

The Relationship

IntroductionDepression and mild cognitive impairment are common among the elderly. Half the patients with late-life depression also present some degree of cognitive decline, making the distinction between these conditions difficult.ObjectivesTo conduct a database review in order to understand the relationship between these entities, and treatment approaches.AimsTo create and implement clinical guidelines at our institution, to evaluate and treat elderly patients presenting with depression and mild cognitive impairment.MethodsA PubMed database search using as keywords “late life depression”, “depression”; “cognitive impairment”; “mild cognitive impairment” and “dementia” between the year 2008 and 2015.ResultsLate-life depression and cognitive impairment are frequent among the elderly (10–20%). Depression is also common in the early stages of dementia decreasing as the cognitive decline progresses. The causal relationship between these entities is not well understood and some authors advocate a multifactorial model (genetic risk factors; neuroendocrine changes; vascular risk factors) and the cognitive impairment of said changes is dependent on the individual's cognitive reserve. Regarding treatment of depression in patients with cognitive impairment, most authors advocate a stepped approach with watchful waiting and then, if symptoms persist, the introduction of pharmacotherapy and psychosocial intervention.ConclusionsThe relationship between cognitive impairment and depression is still not clear and probably multifactorial. The diagnosis of depressive symptoms in patients with severe cognitive impairment can be difficult and most forms of pharmacological treatment in this population are not beneficial, making it important to carefully evaluate the benefits of introducing new medication.Disclosure of interestThe authors have not supplied their declaration of competing interest.

Download Full-text

Acquired Hearing Loss and Psychiatric Illness: An Estimate of Prevalence and Co-morbidity in a Geriatric Setting

The British Journal of Psychiatry ◽

10.1192/bjp.147.5.552 ◽

1985 ◽

Vol 147 (5) ◽

pp. 552-556 ◽

Cited By ~ 37

Author(s):

M. R. Eastwood ◽

S. Corbin ◽

M. Reed ◽

H. Nobbs ◽

H. B. Kedward

Keyword(s):

Hearing Loss ◽

Cognitive Impairment ◽

Mental Disorders ◽

Hearing Impairment ◽

Psychiatric Illness ◽

The Elderly ◽

Homes For The Aged ◽

Co Morbidity ◽

Acquired Hearing Loss ◽

The Relationship

Hearing impairment and mental disorders are common among residents of nursing homes and homes for the aged; however, the relationship between sensory deficit and psychiatic illness has been little investigated in this population. The prevalence of hearing impairment, psychiatric illness, and co-morbidity was investigated in a sample of 102 elderly residents from consecutive admissions to a home for the aged. Examining the coincidence of these disorders showed evidence of an association between hearing loss and paraphrenia, and hearing loss and dysphoric states, but not between hearing and cognitive impairment. The results of this survey provide only suggestive evidence regarding aetiology, but strongly support conjoint assessment of the elderly.

Download Full-text