Evaluating Cognitive Disfunction/Dementia/Vitamin B12 Deficiency

Discussion in 'Memory concerns and seeking a diagnosis' started by Polaris, Apr 15, 2015.

  1. Polaris

    Polaris Registered User

    Feb 5, 2015
    17
    #1 Polaris, Apr 15, 2015
    Last edited: Apr 15, 2015
    Here are extracts from an important link, (unfortunately, the site does not allow me to post links yet) which could be a vital tool in the differentiation between dementia and vitamin B12 deficiency - reading it made me wonder why our family had to fight so hard for our relative to obtain B12 tests and treatment after wrongly diagnosed dementia & ME when this information was out there all along ?!

    According to the research, B12 deficiency should have been considered earlier, especially with a history of vegetarianism and ME, yet our letters and pleas to the surgery with guidelines and information on B12 def. were ignored and obstructed time after time. This caused delay, worsening symptoms, and risk of permanent damage.

    Extracts:
    "Evaluating cognitive dysfunction requires involvement of family or other independent observers (not just the patient). "

    "We attempt to define and quantify the cognitive impairment, identify any potentially reversible conditions and address comorbidities, such as vascular risk factors in hopes of preventing progression.".

    "Lab testing B12 levels - Methylmalonic acid/homocysteine levels (confirm vitamin B12 deficiency). Potentially reversible syndromes:
    - Depression
    - Medication induced
    - Metabolic derangements

    - Vitamin B12 deficiency
    - Thyroid disorders
    - Thiamine deficiency
    - Chronic disease (e.g., renal failure, hepatic failure, malignancy)"

    "Laboratory testing should be considered to identify potentially reversible conditions that may mimic dementia. Early identification and aggressive management of such disorders may improve a patient’s thinking and daily function. Which laboratory studies to order is controversial. Some clinicians suggest a detailed laboratory evaluation to include complete blood counts (CBC), chemistry panels, erythrocyte sedimentation rate, thyroid function tests (thyroid-stimulating hormone [TSH] and free thyroxine [FT4]), vitamin B12 level, thiamine level and syphilis screening. As tertiary-level neurologists, we tend to agree with this approach for many of our referrals. Others would dispute this assertion from a cost–benefit standpoint, arguing that such evaluations are expensive and usually low yield."

    Metabolic derangements
    Vitamin B12 deficiency The classic dementia work-up includes a vitamin B12 assay. Serum folate should also be measured. An estimated 10–15% of individuals over 60 years of age may be deficient [57]. Hematologic abnormalities may not occur with vitamin B12 deficiency, even with nervous system involvement [58]. In deficient states, vitamin B12 supplementation should improve mentation and prevent the disability associated with progressive myelopathy and peripheral neuropathy. Like depression, vitamin B12 deficiency is more common in AD, although it is unclear why [59]. Physicians need to monitor mental status in patients with vitamin B12 deficiency whose clinical profile is otherwise consistent with AD. If cognitive abnormalities progress even after vitamin B12 levels normalize, a diagnosis of both conditions can be made."

    I hope this information helps others understand, research and ask for the correct tests before a wrong diagnosis is made.
     
  2. Emily M

    Emily M Registered User

    Jan 20, 2015
    178
    Interesting reading. Maybe it is the same old story of the demands on GPs, time and cost, not knowing and sometimes, I am afraid to say, failure to listen the layman. Would it be in order to take supplements as a matter of course after a certain age?
     
  3. lin1

    lin1 Registered User

    Jan 14, 2010
    9,322
    Female
    East Kent
    it was mum who had had dementia. As you can imagine I was quite sensitive to the signs and to my horror I started noticing them in my Dad.

    To cut a long story short, I eventually persuaded dad to see the GP.
    He didn't do well on the brief memory test.
    Fortunately I thought to ask for blood tests to check for anything that could cause his symptoms.
    Now I have no ide if the GP would have done this anyway , but I am so glad I did as dad was found to be very low in Folic Acid
    Soon after dad started treatment I started to get my dad back

    Personally I think such blood tests should be automatic.
     
  4. Polaris

    Polaris Registered User

    Feb 5, 2015
    17
    #4 Polaris, Apr 17, 2015
    Last edited: Apr 17, 2015
    Yes, this vitamin is more important as you get older - stomach acid reduces and it is not as easily absorbed by the parietal cells in the stomach. Vitamin B12 is not toxic - you cannot overdose.

    My sister is now receiving monthly injections and supplementing with Jarrows methylcobalamin B12 5000 mcg., as am I. (available from Amazon). Some people find oral or nasal sprays, patches, etc. effective.

    There has been a dramatic improvement physically but, although much better, we are still hoping for more improvement in memory - although all the official guidelines advise treating urgently to avoid permanent damage, this was not done!

    The Pernicious Anaemia website and B12d.org. is a wealth of information. Hope this helps. Kind regards
     
  5. Polaris

    Polaris Registered User

    Feb 5, 2015
    17
    #5 Polaris, Apr 17, 2015
    Last edited: Apr 17, 2015
    I absolutely agree. It is a scandal that tests are not done, as it is such a simple, cheap and effective treatment. I'm so glad you asked for tests and you have your dad back!

    I can't stress enough that, as you get older, stomach acid reduces so B12 is not as easily absorbed. Many people eat less animal protein and the symptoms of deficiency can mimic dementia. Many more young people (vegan, vegetarian, etc.) are becoming deficient but, if you are over a certain age, GPs are quick to diagnose dementia without looking for this.

    There is an excellent paperback, "Could it be B12? - An Epidemic of Misdiagnoses", by Sally Pacholok & Jeffrey J. Stuart - also out now in the US as a film.

    Kind regards.
     

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