ABSTRACT
Introduction:
Postmenopausal women often face Vitamin B12 deficiency, a condition crucial for neurological health. Sensorimotor deficits, which affect sensory and motor functions, are common in this demographic and can lead to falls, reduced mobility, and decreased quality of life. This study aims to investigate the correlation between Vitamin B12 deficiency and sensorimotor deficits in postmenopausal women.
Materials and Methods:
The study was conducted, focusing on postmenopausal women attending the outpatient department. This cross-sectional and observational study investigated sensorimotor deficits in 100 postmenopausal women meeting the inclusion criteria. Exclusions included histories of orthopedic surgeries, paralysis, thalassemia, diabetes, and uncontrolled hypertension. Blood samples were collected to assess Vitamin B12 levels sensorimotor assessments included pain evaluation with an algometer, crude touch, temperature sensation with a tuning fork and warm water, position sense with eyes closed, vibration sense with a tuning fork, discriminative sense tests, coordination assessments, and muscle evaluations for bulk, symmetry, tone, strength (graded by the Medical Research Council scale), and reflexes in both limbs.
Results:
Eighteen percent of postmenopausal women were found to have a deficiency in Vitamin B12, while 82% did not have a deficiency. Among patients with Vitamin B12 deficiency, the sensory deficit was present in 52.9% patients and the motor deficit was present in 33.3% patients. The association between them was found to be statistically significant. Among patients with Vitamin B12 deficiency, sensory and motor deficit was present in 32% of patients. The association between them was found to be statistically significant.
Conclusion:
In this study, we conclude that the association of sensory and motor deficits with Vitamin B12 deficiency was found to be statistically significant. The prevalence of Vitamin B12 deficiency in postmenopausal women is 18%.
Keywords: Motor, postmenopausal women, sensory, Vitamin B12
INTRODUCTION
Vitamin B12 plays a crucial role in various physiological processes, including hematopoiesis, DNA synthesis, and neurological function. The neurological manifestations of Vitamin B12 deficiency can manifest as peripheral neuropathy, subacute combined degeneration of the spinal cord, cognitive impairment, and psychiatric symptoms.[1,2]
Menopause is defined as the time of the final menstrual period at the end of the reproductive period followed by 12 months of amenorrhea. It is commonly associated with symptoms such as hot flashes, irritability, mood swings, insomnia, dry vagina, difficulty in concentration, mental confusion, stress incontinence, urge incontinence, osteoporotic symptoms, depression, and headache.
Postmenopausal women are susceptible to nutritional deficiencies, including Vitamin B12 deficiency, due to the factors such as dietary habits, gastrointestinal changes, and decreased absorption efficiency. The prevalence of Vitamin B12 deficiency in postmenopausal women varies across different populations, with studies reporting rates ranging from 6% to 30%. This wide variability underscores the importance of understanding the contributing factors and clinical implications of Vitamin B12 deficiency in this demographic group.[3]
As many symptoms of postmenopausal syndrome overlap with that of Vitamin B12 deficiency symptoms, it is important to see the prevalence of Vitamin B12 deficiency in postmenopausal women as it will help detect patients who can be treated with Vitamin B12 supplements and alleviate of symptoms. Several studies have investigated the association between Vitamin B12 deficiency and neurological dysfunction in various populations, including older adults and individuals with underlying medical conditions. However, limited research specifically focuses on the correlation between Vitamin B12 deficiency and sensorimotor deficits in postmenopausal women.
This study is planned to evaluate sensorimotor deficits in postmenopausal women and its correlation to the prevalence of Vitamin B12 deficiency.
MATERIALS AND METHODS
Ethical clearance was obtained on September 27, 2022, with Ref No. MDC/JNMCIEC164 from the institutional ethical committee for this study was conducted at a tertiary center, focusing on postmenopausal women attending the hospital’s outpatient department. This cross-sectional and observational study aimed to investigate the sensorimotor deficits in postmenopausal women. A total of 100 postmenopausal women meeting the inclusion criteria were recruited after taking informed consent [Consort Diagram 1]. Inclusion criteria encompassed postmenopausal status, whereas exclusion criteria comprised a history of orthopedic surgeries, stroke, thalassemia, diabetes, and uncontrolled hypertension. Sensorimotor deficits assessments included various clinical examinations such as pain evaluation using an algometer, crude touch assessment, temperature sensation testing with a tuning fork and warm water, position sense evaluation with eyes closed, vibration sense examination with a tuning fork, discriminative sense tests, coordination assessments, muscle evaluation for bulk and symmetry, assessment of muscle tone, and strength and reflex testing in both upper and lower limbs. Blood samples were collected for Vitamin B12 levels. Statistical analysis was carried out using SPSS version 16 (IBM, Andhra Pradesh, India), with descriptive statistics presenting categorical variables as frequencies and percentages. Inferential statistics, particularly the Chi-square test, were used to determine the significance of differences between groups, considering a P < 0.05 as statistically significant. Ethical considerations included thorough explanation of the study to patients, obtaining informed consent, maintaining an option for patients to opt out without restrictions, and ensuring complete confidentiality of patient information throughout the study period.
Consort Diagram 1.
Flow diagram of how the participants of study were recruited
RESULTS AND OBSERVATIONS
In our study, 45% of the patients belong to early postmenopausal age group and 55% belong to late postmenopausal women [Table 1]. Eighteen percent of postmenopausal women were found to have a deficiency in Vitamin B12, while 82% did not have a deficiency [Table 2]. The sensory deficit was present in 25%, the motor deficit was present in 17% patients, and sensory and motor deficit was present in 32%.
Table 1.
Correlation of Vitamin B12 deficiency with age according to STRAW STAGING system
| STRAW STAGING system | Vitamin B12 deficiency | Total, n (%) | P | |
|---|---|---|---|---|
|
| ||||
| Yes, n (%) | No, n (%) | |||
| Early | 10 (55.5) | 35 (42.7) | 45 (45.0) | 0.32 |
| Late | 8 (44.5) | 47 (57.3) | 55 (55.0) | |
| Total | 18 (100.0) | 82 (100.0) | 100 (100.0) | |
Table 2.
Distribution of patients based on Vitamin B12 deficiency
| Vitamin B12 deficiency | Frequency (%) |
|---|---|
| Yes | 18 (18.0) |
| No | 82 (82.0) |
| Total | 100 (100.0) |
DISCUSSION
In this study, 18% of postmenopausal women were found to have a deficiency in Vitamin B12, while 82% did not have a deficiency [Table 2]. A study conducted by Dhonukshe-Rutten et al.[4] reported the prevalence rates ranging from 5% to 50% among postmenopausal women in different regions. Similarly, data from the National Health and Nutrition Examination Survey in the United States showed that approximately 6% of women aged 50 years and older had Vitamin B12 deficiency.[5]
In this study, the sensory deficit was present in 25%, the motor deficit was present in 17% patients, and the sensory and motor deficit was present in 32%. Among patients with Vitamin B12 deficiency, sensory deficit was present in 52.9% patients, and the motor deficit was present in 33.3% patients [Table 3]. The association between them was found to be statistically significant. Among patients with Vitamin B12 deficiency, sensory and motor deficit was present in 50% of patients. The association between them was found to be statistically significant. Sensory and motor deficits are prevalent among postmenopausal women, with studies highlighting a range of manifestations including peripheral neuropathy, balance disturbances, and muscle weakness. A study by Leveille[6] found that approximately 20% of postmenopausal women reported difficulty with balance or walking, while a systematic review by Wesson-Sides[7] reported a high prevalence of peripheral neuropathy symptoms among older adults, including postmenopausal women. Several factors contribute to the development of sensory and motor deficits in postmenopausal women, including age-related changes in neuromuscular function, hormonal fluctuations, and comorbidities such as diabetes mellitus and peripheral vascular disease. In addition, emerging evidence suggests that Vitamin B12 deficiency may play a role in the pathogenesis of sensory and motor deficits due to its essential role in nerve function and myelination.[8] Vitamin B12 deficiency has been implicated in the development and progression of sensory and motor deficits among postmenopausal women. Studies have shown that Vitamin B12 deficiency is associated with peripheral neuropathy, characterized by sensory symptoms such as numbness, tingling, and pain in the extremities, as well as motor symptoms including muscle weakness and impaired balance.[8,9] Furthermore, Vitamin B12 supplementation has been shown to improve neurological symptoms and functional outcomes in individuals with deficiency.[1]
Table 3.
Distribution of patients based on sensory and motor deficits
| Vitamin B12 deficiency | Total, n (%) | P | ||
|---|---|---|---|---|
|
| ||||
| Yes, n (%) | No, n (%) | |||
| Sensory deficit | ||||
| Yes | 9 (52.9) | 16 (19.7) | 25 (25.5) | 0.01 |
| No | 8 (47.1) | 65 (80.3) | 73 (74.5) | |
| Motor deficit | ||||
| Yes | 6 (33.3) | 11 (13.4) | 17 (17.0) | 0.05 |
| No | 12 (66.7) | 71 (86.6) | 83 (83.0) | |
| Sensory and motor deficit | ||||
| Yes | 9 (50.0) | 23 (28.0) | 32 (32.0) | 0.05 |
| No | 9 (50.0) | 59 (72.0) | 68 (68.0) | |
| Total | 18 (100.0) | 82 (100.0) | 100 (100.0) | |
In this study, 100% of patients with Vitamin B12 deficiency had normal touch sensation. The association between them was found to be statistically not significant [Table 4]. Studies have reported a significant association between Vitamin B12 deficiency and impaired touch sensation.[10] Tuncel[10] conducted a study examining the neurological manifestations of Vitamin B12 deficiency in older adults and found that a significant proportion of patients with deficiency exhibited impaired touch sensation, suggesting a potential link between Vitamin B12 status and tactile perception. Conversely, Allen et al.[11] investigated the clinical spectrum of cobalamin deficiency and found that touch sensation was relatively preserved in most individuals with deficiency, particularly in the absence of severe neurological complications. This finding suggests that other sensory modalities may be more affected by Vitamin B12 deficiency than touch sensation.
Table 4.
Distribution of patients based on the relationship between Vitamin B12 deficiency and sensory functions
| Vitamin B12 deficiency | Total, n (%) | ||
|---|---|---|---|
|
| |||
| Yes, n (%) | No, n (%) | ||
| Touch | |||
| Normal | 18 (100.0) | 79 (96.3) | 97 (97.0) |
| Abnormal | 0 | 3 (3.7) | 3 (3.0) |
| Pain | |||
| Normal | 17 (94.4) | 77 (93.9) | 94 (94.0) |
| Exaggerated | 1 (5.6) | 5 (6.1) | 6 (6.0) |
| Temp | |||
| Normal | 17 (94.4) | 80 (97.6) | 97 (97.0) |
| Abnormal | 1 (5.6) | 2 (2.4) | 3 (3.0) |
| Vibration | |||
| Normal | 17 (94.4) | 76 (92.7) | 93 (93.0) |
| Abnormal | 1 (5.6) | 6 (7.3) | 7 (7.0) |
In this study, 94.4% of patients with Vitamin B12 deficiency had normal pain perception and 5.6% patients had exaggerated pain perception [Table 4]. The association between them was found to be statistically not significant. Gröber[12] conducted a review highlighting the role of Vitamin B12 in pain treatment and neuropathic pain management. The review discussed the mechanisms by which Vitamin B12 deficiency may contribute to altered pain perception, including neuronal damage, neurotransmitter imbalances, and impaired nerve regeneration. Chang[13] evaluated the clinical efficacy of methylcobalamin, an active form of Vitamin B12, in the treatment of diabetic neuropathy-related pain. The study found that methylcobalamin supplementation was effective in alleviating neuropathic pain and improving pain thresholds in individuals with Vitamin B12 deficiency.
In this study, 94.4% of patients with Vitamin B12 deficiency had normal temperature sensation, and 5.6% patients had abnormal temperature sensation [Table 4]. The association between them was found to be statistically not significant. Rosenstock[14] conducted a study that found that impaired temperature sensation was a common clinical feature among individuals with deficiency. The study suggested that Vitamin B12 deficiency may disrupt sensory nerve function, leading to abnormalities in temperature perception. Conversely, Kalezic[15] investigated the relationship between Vitamin B12 deficiency and bone mineral density but found no significant association with temperature sensation. This finding suggests that other factors may contribute to alterations in temperature sensation independently of Vitamin B12 status.
In this study, 94.4% of patients with Vitamin B12 deficiency had normal vibration sense and 5.6% patients had abnormal vibration sense [Table 4]. The association between them was found to be statistically not significant. A study by Lindenbaum et al.[16] found that Vitamin B12 deficiency led to neurological symptoms in nearly two-thirds of the patients, with diminished vibration sense being one of the most common manifestations. This study highlighted the importance of considering Vitamin B12 deficiency in the evaluation of sensorimotor deficits, especially in older adults. Furthermore, another study by Scalabrino et al.[17] investigated the effects of Vitamin B12 deficiency on the peripheral nervous system and found that impaired vibration sense was one of the earliest detectable signs of neurological damage in patients with low serum B12 levels. A meta-analysis conducted by Oosterhuis et al.[18] examined the relationship between Vitamin B12 deficiency and neurological manifestations, including sensory abnormalities. The analysis concluded that Vitamin B12 deficiency was significantly associated with sensory impairments, such as diminished vibration sense, highlighting the importance of adequate B12 levels for maintaining sensory-motor function.
In this study, 94.4% of patients with Vitamin B12 deficiency had normal joint position sense and 5.6% patients had abnormal joint position sense [Table 5]. The association between them was found to be statistically not significant. A study by Filla et al.[19] found that impaired proprioception was a common neurological finding in patients with low serum B12 levels. Aroda et al.[20] evaluated the relationship between Vitamin B12 levels and proprioception over time in a cohort of postmenopausal women. The study found that lower serum B12 levels were significantly associated with poorer proprioceptive function, as assessed by joint position sense tests.
Table 5.
Association between Vitamin B12 deficiency and various sensory functions
| Vitamin B12 deficiency | Total, n (%) | ||
|---|---|---|---|
|
| |||
| Yes, n (%) | No, n (%) | ||
| Joint position (UL/LL) | |||
| Normal | 17 (94.4) | 79 (96.3) | 96 (96.0) |
| Abnormal | 1 (5.6) | 3 (3.7) | 4 (4.0) |
| Tactile localization | |||
| Normal | 14 (77.8) | 74 (90.2) | 88 (88.0) |
| Abnormal | 4 (22.2) | 8 (9.8) | 12 (12.0) |
| Tactile discrimination | |||
| Normal | 15 (83.3) | 77 (93.9) | 92 (92.0) |
| Abnormal | 3 (16.7) | 5 (6.1) | 8 (8.0) |
| 2 point discrimination | |||
| Normal | 13 (72.2) | 74 (90.2) | 87 (87.0) |
| Abnormal | 5 (27.8) | 8 (9.8) | 13 (13.0) |
| Figure writing | |||
| Normal | 18 (100.0) | 77 (93.9) | 95 (95.0) |
| Abnormal | 0 | 5 (6.1) | 5 (5.0) |
| Coordination | |||
| Normal | 17 (94.4) | 80 (97.6) | 97 (97.0) |
| Abnormal | 1 (5.6) | 2 (2.4) | 3 (3.0) |
In this study, 77.8% of patients with Vitamin B12 deficiency had normal tactile localization and 22.2% patients had abnormal tactile localization. The association was found to be statistically not significant. A study by Agarwal et al.[21] assessed sensory abnormalities in patients with Vitamin B12 deficiency and found that impaired tactile sensation was a common neurological finding. While this study did not specifically focus on tactile localization, it suggests that B12 deficiency can indeed affect various aspects of sensory function. van der Elst et al.[22] investigated the relationship between Vitamin B12 levels and cognitive function, including tactile perception, in older adults.
In this study, 94.4% of patients with Vitamin B12 deficiency had normal coordination and 5.6% patients had abnormal coordination [Table 5]. The association between them was found to be statistically not significant. Lindenbaum et al.[16] examined neuropsychiatric disorders caused by cobalamin deficiency and found that impaired coordination and balance were common clinical findings in patients with low serum B12 levels. Penninx et al.[23] investigated the association between Vitamin B12 levels and physical performance in older adults and found that lower B12 levels were associated with poorer performance on measures of balance and coordination.
In this study for attitude: 100% of patients with vitamin B12 deficiency had a normal attitude, Bulk: 100% of patients with vitamin B12 deficiency had normal bulk. Tone: 94.4% of patients with vitamin B12 deficiency had normal tone and 5.6% patients had abnormal tone. The association between them was found to be statistically not significant. Power: 88.9% of patients with vitamin B12 deficiency had normal power and 11.1% patients had abnormal power. The association between them was found to be statistically not significant. Reflexes: 77.8% of patients with vitamin B12 deficiency had normal reflexes and 22.2% patients had abnormal reflexes. The association between them was found to be statistically significant. Fasciculations: 11.1% of patients with vitamin B12 deficiency had fasciculations and 88.9% patients had abnormal fasciculations. The association between them was found to be statistically not significant [Table 6].
Table 6.
Association between Vitamin B12 deficiency and various motor functions
| Vitamin B12 deficiency | Total, n (%) | ||
|---|---|---|---|
|
| |||
| Yes, n (%) | No, n (%) | ||
| Attitude | |||
| Normal | 18 (100.0) | 82 (100.0) | 100 (100.0) |
| Bulk | |||
| Normal | 18 (100.0) | 82 (100.0) | 100 (100.0) |
| Tone | |||
| Normal | 17 (94.4) | 82 (100.0) | 99 (99.0) |
| Abnormal | 1 (5.6) | 0 | 1 (1.0) |
| Power | |||
| Normal | 16 (88.9) | 77 (93.9) | 93 (93.0) |
| Abnormal | 2 (11.1) | 5 (6.1) | 7 (7.0) |
| Reflexes | |||
| Normal | 14 (77.8) | 77 (93.9) | 91 (91.0) |
| Abnormal | 4 (22.2) | 5 (6.1) | 9 (9.0) |
| Fasciculations | |||
| Yes | 2 (11.1) | 2 (2.4) | 4 (4.0) |
| No | 16 (88.9) | 80 (97.6) | 96 (96.0) |
The study’s primary limitation pertains to the scope of data collection. The research may have been conducted within a specific time frame, geographic location, or demographic group, which could limit the generalizability of the findings to a broader population.
Another potential limitation is that a small or nondiverse sample might lead to biased or limited conclusions, impacting the study’s validity.
The study’s methodology may have its limitations, such as the use of self-reported data, potential researcher bias, or methodological design flaws, which could introduce errors.
Overall, these limitations should be carefully considered when interpreting the study’s results and should motivate future research to address these constraints for a more comprehensive understanding.
CONCLUSION
In this study, we conclude that the association of sensory and motor deficits with Vitamin B12 deficiency was found to be statistically significant. The prevalence of Vitamin B12 deficiency in postmenopausal women is 18%.
Conflicts of interest
There are no conflicts of interest.
Funding Statement
Nil.
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