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      Blood Concentrations of Homocysteine and Methylmalonic Acid among Demented and Non-Demented Swedish Elderly with and without Home Care Services and Vitamin B12 Prescriptions

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          Abstract

          Background and Aims: Total plasma homocysteine (tHcy) has been suggested as a risk factor of dementia. Our aim was to investigate potential differences in tHcy status in relation to the prescription of vitamin B<sub>12</sub> and dementia diagnosis. We examined whether vitamin B<sub>12</sub> prescriptions, a family history of dementia, or the need for home care service might be associated with tHcy values. Methods: A cross-sectional monocenter study comprising 926 consecutive subjects attending our Memory Care Unit was conducted. Results: Demented subjects being prescribed vitamin B<sub>12</sub> had higher serum vitamin B<sub>12</sub> (p = 0.025) but also higher tHcy (p < 0.001) and serum methylmalonate (p = 0.032), and lower serum folate (p < 0.001) than those who did not receive vitamin B<sub>12</sub> prescriptions. tHcy levels were significantly higher in non-demented subjects receiving home care service (p = 0.007). This group also had lower serum albumin (dementia: p < 0.001; non-dementia: p = 0.004). There was no difference in renal function (estimated glomerular filtration rate) in demented or non-demented subjects with or without vitamin B<sub>12</sub> prescriptions (dementia with/without vitamin B<sub>12</sub> prescription: p = 0.561; non-dementia with/without vitamin B<sub>12</sub> prescription: p = 0.710). Conclusion: Despite vitamin B<sub>12</sub> prescriptions, demented subjects had higher tHcy and methylmalonate values. The elevated metabolite values could not be explained by differences in renal function. Thus, elderly subjects on vitamin B<sub>12</sub> prescription appear to have unmet nutritional needs.

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          Most cited references53

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          Diagnostic and statistical manual of mental disorders.

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            Neuropsychiatric disorders caused by cobalamin deficiency in the absence of anemia or macrocytosis.

            Among 141 consecutive patients with neuro-psychiatric abnormalities due to cobalamin deficiency, we found that 40 (28 percent) had no anemia or macrocytosis. The hematocrit was normal in 34, the mean cell volume was normal in 25, and both tests were normal in 19. Characteristic features in such patients included paresthesia, sensory loss, ataxia, dementia, and psychiatric disorders; longstanding neurologic symptoms without anemia; normal white-cell and platelet counts and serum bilirubin and lactate dehydrogenase levels; and markedly elevated serum concentrations of methylmalonic acid and total homocysteine. Serum cobalamin levels were above 150 pmol per liter (200 pg per milliliter) in 2 patients, between 75 and 150 pmol per liter (100 and 200 pg per milliliter) in 16, and below 75 pmol per liter (100 pg per milliliter) in only 22. Except for one patient who died during the first week of treatment, every patient in this group benefited from cobalamin therapy. Responses included improvement in neuropsychiatric abnormalities (39 of 39), improvement (often within the normal range) in one or more hematologic findings (36 of 39), and a decrease of more than 50 percent in levels of serum methylmalonic acid, total homocysteine, or both (31 of 31). We conclude that neuropsychiatric disorders due to cobalamin deficiency occur commonly in the absence of anemia or an elevated mean cell volume and that measurements of serum methylmalonic acid and total homocysteine both before and after treatment are useful in the diagnosis of these patients.
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              Late-life body mass index and dementia incidence: nine-year follow-up data from the Kungsholmen Project.

              To describe the association between late-life body mass index (BMI) and dementia development with a time perspective and to investigate the effect of weight changes on dementia incidence. Three-, 6-, and 9-year follow-up study. The Kungsholmen Project. One thousand two hundred fifty-five subjects aged 75 and older with baseline BMI data available. Cox-regression models were used to estimate hazard ratios (HRs) for dementia detected at different risk periods in relation to baseline BMI. The association between BMI changes and development of dementia after 3 and 6 years was also analyzed. Subjects with a BMI of 25.0 kg/m2 or higher had a lower risk of developing dementia than subjects with a BMI of 20.0 to 24.9 (HR=0.75, 95% confidence interval (CI)=0.59-0.96), even when cases occurring only during the last follow-up period (6-9 years after BMI assessment) were included (HR=0.66. 95% CI=0.40-1.07). Severe BMI loss (>10%) was related to a greater risk of dementia, but this association was present only for dementia cases detected in the subsequent 3 years (HR=2.18, 95% CI=1.27-3.74). This study does not confirm that being overweight in late life is a risk factor for dementia, although a protective effect for a BMI greater than 25.0 is suggested. In addition, BMI loss is confirmed as a marker of incipient dementia. The findings suggest that, from a clinical perspective, the cognitive profile of elderly persons with unexplained weight loss should be considered and that being moderately overweight at older ages might be indicative of good health status.
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                Author and article information

                Journal
                DEE
                DEE
                10.1159/issn.1664-5464
                Dementia and Geriatric Cognitive Disorders Extra
                S. Karger AG
                1664-5464
                2012
                January – December 2012
                21 September 2012
                : 2
                : 1
                : 387-399
                Affiliations
                aDepartment of Geriatric Medicine, Örebro University Hospital, School of Health and Medical Sciences, Örebro University, and bDepartment of Laboratory Medicine, Division of Clinical Chemistry, Örebro University Hospital, Örebro, cDepartment of Neurobiology, Care Sciences and Society, Section of Clinical Geriatrics, Karolinska Institutet, Stockholm, and dDepartment of Pharmacology and Clinical Neuroscience, Division of Clinical Pharmacology, University Hospital of Northern Sweden, Umeå, Sweden
                Author notes
                *Nils-Olof Hagnelius, Department of Geriatric Medicine, Örebro University Hospital, SE–701 85 Örebro (Sweden), Tel. +46 19 602 1000, E-Mail nils-olof.hagnelius@orebroll.se
                Article
                339669 PMC3522456 Dement Geriatr Cogn Disord Extra 2012;2:387–399
                10.1159/000339669
                PMC3522456
                23277779
                5111cf88-72c9-43de-b05a-7641201352ca
                © 2012 S. Karger AG, Basel

                Open Access License: This is an Open Access article licensed under the terms of the Creative Commons Attribution-NonCommercial 3.0 Unported license (CC BY-NC) ( http://www.karger.com/OA-license), applicable to the online version of the article only. Distribution permitted for non-commercial purposes only. Drug Dosage: The authors and the publisher have exerted every effort to ensure that drug selection and dosage set forth in this text are in accord with current recommendations and practice at the time of publication. However, in view of ongoing research, changes in government regulations, and the constant flow of information relating to drug therapy and drug reactions, the reader is urged to check the package insert for each drug for any changes in indications and dosage and for added warnings and precautions. This is particularly important when the recommended agent is a new and/or infrequently employed drug. Disclaimer: The statements, opinions and data contained in this publication are solely those of the individual authors and contributors and not of the publishers and the editor(s). The appearance of advertisements or/and product references in the publication is not a warranty, endorsement, or approval of the products or services advertised or of their effectiveness, quality or safety. The publisher and the editor(s) disclaim responsibility for any injury to persons or property resulting from any ideas, methods, instructions or products referred to in the content or advertisements.

                History
                Page count
                Tables: 6, Pages: 13
                Categories
                Original Research Article

                Geriatric medicine,Neurology,Cardiovascular Medicine,Neurosciences,Clinical Psychology & Psychiatry,Public health
                Homocysteine,Dementia,Home care service,Vitamin B12 ,Folate

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