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. 2009 Aug 5;25(4):209–215. doi: 10.1007/s12264-009-0224-9

An investigation of vitamin B12 deficiency in elderly inpatients in neurology department

神经科住院老年患者维生素 B12 缺乏的调查

Yu-Hui Wang 1,✉, Fang Yan 1, Wen-Bo Zhang 1, Gang Ye 1, Yun-Yun Zheng 1, Xu-Hua Zhang 1, Fu-Yuan Shao 2
PMCID: PMC5552550  PMID: 19633703

Abstract

Objective

To investigate the status of vitamin B12 deficiency in elderly inpatients in the department of neurology.

Methods

A total number of 827 patients in the department of neurology of Shanghai Punan hospital, from March 2007 to July 2008, were employed in the present study. They were 60 years or older, and the average age was 77.1±7.5 years old. All the patients were diagnosed with no severe hepatic or renal dysfunction, without any usage of vitamin B12 during the previous 3 months before the detection. The levels of serum vitamin B12, folate and homocysteine (Hcy) were evaluated. The patients with vitamin B12 deficiency were screened. The resulting symptoms, positive signs of neurological examination, and the neuroelectricphysiological results were compared between patients with or without vitamin B12 deficiency.

Results

Vitamin B12 deficiency was found in 163 patients (19.71% of the total patients), and was more prevalent in female than in male patients, also with increased incidences with aging. Patients with low levels of serum vitamin B12 exhibited higher rate of gastrointestinal diseases, while only 9.82% of the vitamin B12 deficient patients had megaloblastic anemia. Symptoms of vitamin B12 deficiency included unsteadily walking in the darkness and hypopallesthesia, and some chronic diseases such as cerebral ischemia, hypertension, Parkinson’s disease (Parkinsonism), diabetes mellitus and coronary heart disease. Most of the vitamin B12 deficient patients had neuroelectricphysiological abnormalities.

Conclusion

Vitamin B12 deficiency is remarkably common in elderly patients in neurology department, with various and atypical clinical manifestations, and the neurological symptoms are more common than megaloblastic anemia symptoms.

Keywords: aging, elderly inpatients, neurology, vitamin B12 deficiency

References

  • [1].Loikas S., Koskinen P., Irjala K., Lopponen M., Isoaho R., Kivela S.L., et al. Vitamin B12 deficiency in the aged: a population-based study. Age Ageing. 2007;36:177–183. doi: 10.1093/ageing/afl150. [DOI] [PubMed] [Google Scholar]
  • [2].Lindenbaum J., Rosenberg I.H., Wilson P.W., Stabler S.P., Allen R.H. Prevalence of cobalamin deficiency in the Framingham elderly population. Am J Clin Nutr. 1994;60:2–11. doi: 10.1093/ajcn/60.1.2. [DOI] [PubMed] [Google Scholar]
  • [3].Wolters M., Strohle A., Hahn A. Cobalamin: a critical vitamin in the elderly. Prev Med. 2004;39:1256–1266. doi: 10.1016/j.ypmed.2004.04.047. [DOI] [PubMed] [Google Scholar]
  • [4].Andres E., Loukili N.H., Noel E., Kaltenbach G., Abdelgheni M.B., Perrin A.E., et al. Vitamin B12 (cobalamin) deficiency in elderly patients. CMAJ. 2004;171:251–259. doi: 10.1503/cmaj.1031155. [DOI] [PMC free article] [PubMed] [Google Scholar]
  • [5].Obeid R., Schorr H., Eckert R., Herrmann W. Vitamin B12 status in the elderly as judged by available biochemical markers. Clin Chem. 2004;50:238–241. doi: 10.1373/clinchem.2003.021717. [DOI] [PubMed] [Google Scholar]
  • [6].Allen L.H. Folate and vitamin B12 status in the Americas. Nutr Rev. 2004;62:S29–33. doi: 10.1111/j.1753-4887.2004.tb00069.x. [DOI] [PubMed] [Google Scholar]
  • [7].van Asselt D.Z., Blom H.J., Zuiderent R., Wevers R.A., Jakobs C., van den Broek W.J., et al. Clinical significance of low cobalamin levels in older hospital patients. Neth J Med. 2000;57:41–49. doi: 10.1016/S0300-2977(00)00048-6. [DOI] [PubMed] [Google Scholar]
  • [8].Figlin E., Chetrit A., Shahar A., Shpilberg O., Zivelin A., Rosenberg N., et al. High prevalences of vitamin B12 and folic acid deficiency in elderly subjects in Israel. Br J Haematol. 2003;123:696–701. doi: 10.1046/j.1365-2141.2003.04658.x. [DOI] [PubMed] [Google Scholar]
  • [9].Shahar A., Feiglin L., Shahar D.R., Levy S., Seligsohn U. High prevalence and impact of subnormal serum vitamin B12 concentrations in Israeli elders admitted to a geriatric hospital. J Nutr Health Aging. 2001;5:124–127. [PubMed] [Google Scholar]
  • [10].Yajnik C.S., Deshpande S.S., Lubree H.G., Naik S.S., Bhat D.S., Uradey B.S., et al. Vitamin B12 deficiency and hyperhomocysteinemia in rural and urban Indians. J Assoc Physicians India. 2006;54:775–782. [PubMed] [Google Scholar]
  • [11].Gupta A.K., Damji A., Uppaluri A. Vitamin B12 deficiency. Prevalence among South Asians at a Toronto clinic. Can Fam Physician. 2004;50:743–747. [PMC free article] [PubMed] [Google Scholar]
  • [12].Clarke R., Grimley Evans J., Schneede J., Nexo E., Bates C., Fletcher A., et al. Vitamin B12 and folate deficiency in later life. Age Ageing. 2004;33:34–41. doi: 10.1093/ageing/afg109. [DOI] [PubMed] [Google Scholar]
  • [13].Reynolds E. Vitamin B12, folic acid, and the nervous system. Lancet Neurol. 2006;5:949–960. doi: 10.1016/S1474-4422(06)70598-1. [DOI] [PubMed] [Google Scholar]
  • [14].Moretti R., Torre P., Antonello R.M., Cattaruzza T., Cazzato G., Bava A. Vitamin B12 and folate depletion in cognition: A review. Neurol India. 2004;52:310–318. [PubMed] [Google Scholar]
  • [15].Bjorkegren K., Svardsudd K. Reported symptoms and clinical findings in relation to serum cobalamin, folate, methylmalonic acid and total homocysteine among elderly Swedes: a population-based study. J Intern Med. 2003;254:343–352. doi: 10.1046/j.1365-2796.2003.01199.x. [DOI] [PubMed] [Google Scholar]
  • [16].Hin H., Clarke R., Sherliker P., Atoyebi W., Emmens K., Birks J., et al. Clinical relevance of low serum vitamin B12 concentrations in older people: the Banbury B12 study. Age Ageing. 2006;35:416–422. doi: 10.1093/ageing/afl033. [DOI] [PubMed] [Google Scholar]
  • [17].Carmel R. Current concepts in cobalamin deficiency. Annu Rev Med. 2000;51:357–375. doi: 10.1146/annurev.med.51.1.357. [DOI] [PubMed] [Google Scholar]
  • [18].Puri V., Chaudhry N., Goel S., Gulati P., Nehru R., Chowdhury D. Vitamin B12 deficiency: a clinical and electrophysiological profile. Electromyogr Clin Neurophysiol. 2005;45:273–284. [PubMed] [Google Scholar]
  • [19].Misra U.K., Kalita J., Das A. Vitamin B12 deficiency neurological syndromes: a clinical, MRI and electrodiagnostic study. Electromyogr Clin Neurophysiol. 2003;43:57–64. [PubMed] [Google Scholar]
  • [20].Andres E., Perrin A.E., Demangeat C., Kurtz J.E., Vinzio S., Grunenberger F., et al. The syndrome of food-cobalamin malabsorption revisited in a department of internal medicine. A monocentric cohort study of 80 patients. Eur Intern Med. 2003;14:221–226. doi: 10.1016/S0953-6205(03)00074-8. [DOI] [PubMed] [Google Scholar]
  • [21].Andres E., Affenberger S., Vinzio S., Kurtz J.E., Noel E., Kaltenbach G., et al. Food-cobalamin malabsorption in elderly patients: clinical manifestations and treatment. Am J Med. 2005;118:1154–1159. doi: 10.1016/j.amjmed.2005.02.026. [DOI] [PubMed] [Google Scholar]
  • [22].Carmel R., Aurangzeb I., Qian D. Associations of food-cobalamin malabsorption with ethnic origin, age, Helicobacter pylori infection, and serum markers of gastritis. Am J Gastroenterol. 2001;96:63–70. doi: 10.1111/j.1572-0241.2001.03453.x. [DOI] [PubMed] [Google Scholar]
  • [23].Carmel R. Cobalamin, the stomach, and aging. Am J Clin Nutr. 1997;66:750–759. doi: 10.1093/ajcn/66.4.750. [DOI] [PubMed] [Google Scholar]
  • [24].Allen L.H. How common is vitamin B-12 deficiency? Am J Clin Nutr. 2009;89:693S–696S. doi: 10.3945/ajcn.2008.26947A. [DOI] [PubMed] [Google Scholar]
  • [25].Robertson J., Lemolo F., Stabler S.P., Allen R.H., Spence J.D. Vitamin B12, homocysteine and carotid plaque in the era of folic acid fortification of enriched cereal grain products. CMAJ. 2005;172:1569–1573. doi: 10.1503/cmaj.045055. [DOI] [PMC free article] [PubMed] [Google Scholar]
  • [26].He K., Merchant A., Rimm E.B., Rosner B.A., Stampfer M.J., Willett W.C., et al. Folate, vitamin B6, and B12 intakes in relation to risk of stroke among men. Stroke. 2004;35:169–174. doi: 10.1161/01.STR.0000106762.55994.86. [DOI] [PubMed] [Google Scholar]
  • [27].Balk E.M., Raman G., Tatsioni A., Chung M., Lau J., Rosenberg I.H. Vitamin B6, B12, and folic acid supplementation and cognitive function. Arch Intern Med. 2007;167:21–30. doi: 10.1001/archinte.167.1.21. [DOI] [PubMed] [Google Scholar]

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