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      In what extent anemia coexists with cognitive impairment in elderly: a cross-sectional study in Greece

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          Abstract

          Background

          A project aimed at studying the frequency of dementia and depression in the catchment area of the Health Centre of Chrissoupolis (HCCh), Northern Greece, was carried out. This paper reports the association between AD and anemia among the elderly participants in this Greek study.

          Methods

          Eligible participants were people 65 years or over who were (a) living in the Elderly People's Home (all 48 subjects included); (b) visiting the Open Center for Elderly People during a 20 workday period (75 subjects) and (c) visiting the HCCh for routine medical care. The Mini Mental State Examination (MMSE) was used in assessing the cognitive capacity of the participants. Blood was drawn for serum hematocrit, vitamin B12 and folate determination.

          Results

          The prevalence proportions of possible cognitive impairment among anemic and non-anemic males were 55.6% and 34.4%, respectively (X 2 = 5.8, d.f. = 1, p = 0.016). The corresponding proportions in females were 47.5% and 40.1 % (X 2 = 1.1, d.f. = 1, p = 0.305). Using logistic regression analysis, age-group (≥ 80 yrs), type of Institute, vitamin B 12 and anemia had significant independent associations with possible cognitive impairment.

          Conclusions

          Anemia is a frequent finding in elderly and it may be a risk factor for dementia, but the extent of the associated deterioration of cognitive impairment or the relation with AD is not known. GPs should be aware of this coexistence and recommend for screening, assaying and treating elderly people.

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          Most cited references32

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          Neurologic aspects of cobalamin deficiency.

          E B Healton, D G Savage, J C Brust … (1991)
          We reviewed 153 episodes of cobalamin deficiency involving the nervous system that occurred in 143 patients seen over a recent 17-year period at 2 New York City hospitals. Pernicious anemia was the most common underlying cause of the deficiency. Neurologic complaints, most commonly paresthesias or ataxia, were the first symptoms of Cbl deficiency in most episodes. The median duration of symptoms before diagnosis and treatment with vitamin B12 was 4 months, although long delays in diagnosis occurred in some patients. Diminished vibratory sensation and proprioception in the lower extremities were the most common objective findings. A wide variety of neurologic symptoms and signs were encountered, however, including ataxia, loss of cutaneous sensation, muscle weakness, diminished or hyperactive reflexes, spasticity, urinary or fecal incontinence, orthostatic hypotension, loss of vision, dementia, psychoses, and disturbances of mood. Multiple neurologic syndromes were often seen in a single patient. In 42 (27.4%) of the 153 episodes, the hematocrit was normal, and in 31 (23.0%), the mean corpuscular volume was normal. Neutropenia and thrombocytopenia were unusual even in anemic patients. In nonanemic patients in whom diagnosis was delayed, neurologic progression frequently occurred although the hematocrit remained normal. In 27 episodes, the serum cobalamin concentration was only moderately decreased (in the range of 100-200 pg/ml) and in 2 the serum level was normal. Neurologic impairment, as assessed by a quantitative severity score, was judged to be mild in 99 episodes, moderate in 39 and severe in 15. Severity of neurologic dysfunction before treatment was clearly related to the duration of symptoms prior to diagnosis. In addition, the hematocrit correlated significantly with severity, independent of the longer duration of symptoms in nonanemic patients. Four patients experienced transient neurologic exacerbations soon after beginning treatment with cyanocobalamin, with subsequent recovery. Followup evaluation was adequate to assess the neurologic response to vitamin B12 therapy in 121 episodes. All patients responded, and in 57 (47.1%), recovery was complete, with no remaining symptoms or findings on examination. The severity score was reduced by 50% or greater after treatment in 91% of the episodes. Residual long-term moderate or severe neurologic disability was noted following only 7 (6.3%) episodes. The extent of neurologic involvement after treatment was strongly related to that before therapy as well as to the duration of symptoms. The percent improvement over baseline neurologic status after treatment was inversely related to duration of symptoms and hematocrit. Some evidence of response was always seen during the first 3 months of treatment.(ABSTRACT TRUNCATED AT 400 WORDS)
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            Anemia in the elderly.

            Jeffrey Smith (2000)
            Anemia should not be accepted as an inevitable consequence of aging. A cause is found in approximately 80 percent of elderly patients. The most common causes of anemia in the elderly are chronic disease and iron deficiency. Vitamin B12 deficiency, folate deficiency, gastrointestinal bleeding and myelodysplastic syndrome are among other causes of anemia in the elderly. Serum ferritin is the most useful test to differentiate iron deficiency anemia from anemia of chronic disease. Not all cases of vitamin B12 deficiency can be identified by low serum levels. The serum methylmalonic acid level may be useful for diagnosis of vitamin B12 deficiency. Vitamin B12 deficiency is effectively treated with oral vitamin B12 supplementation. Folate deficiency is treated with 1 mg of folic acid daily.
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              Limitations of the Mini-Mental State Examination in diagnosing dementia in general practice.

              F. Schellevis, Rob Berg, Angèle Jonker … (1996)
              The aim of the study was to investigate the value of the Mini-Mental State Examination (MMSE) for use by general practitioners (GPs) in a group of elderly patients in whom the GPs are considering a dementia diagnosis. The study population consisted of 533 elderly patients (aged 65 and older) judged by 36 GPs as suffering from 'minimal to severe' dementia. Cross-sectional data were used to determine the criterion validity of separate items, a set of items and the total MMSE. The GMS/AGECAT diagnosis was used as an external criterion. MMSE items were analysed and two items testing general knowledge were added. The most effective set of items was determined using a stepwise logistic regression analysis. Adjusted for age, sex and education, the differentiating ability of the set of items was compared to that of the total MMSE score. The total MMSE score was divided into three categories (cutoffs 21/22 and 26/27) and into two categories (cutoff 23/24). In total, 114 patients (21%) were diagnosed as having an 'organic syndrome' by the GMS/AGECAT. The differentiating ability of separate items was poor. The following combination of items had the best predictive ability: items concerning the date, the day of the week, the patient's address and the current prime minister. This set of items was just as adequate in differentiating dementia from non-dementia as the total MMSE score (sensitivity 64.9% and 64.8% respectively, specificity 96.4% and 93.3%). The value of the MMSE in diagnosing dementia in general practice is limited. The score on cognitive test items can be one aspect of the individual's overall clinical picture, on which the diagnosis should be based.
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                Author and article information

                Journal
                Journal ID (nlm-ta): BMC Fam Pract
                Title: BMC Family Practice
                Publisher: BioMed Central (London )
                ISSN (Electronic): 1471-2296
                Publication date Collection: 2001
                Publication date (Electronic): 25 October 2001
                Volume: 2
                Page: 5
                Affiliations
                [1 ]Health Centre of Chrisoupolis (HCC), Chrissoupolis 64 200, Macedonia, Greece
                [2 ]Clinic of Social and Family, School of Medicine, University of Crete, PO Box 1393, Heraklion, Crete, Greece
                [3 ]Laboratory of Biostatistics, School of Medicine, University of Crete, PO Box 1393, Heraklion, Crete, Greece
                Article
                Publisher ID: 1471-2296-2-5
                DOI: 10.1186/1471-2296-2-5
                PMC ID: 59691
                PubMed ID: 11707152
                SO-VID: 733a28ff-df10-47a5-a974-b49707c1a39c
                Copyright © Copyright © 2001 Argyriadou et al; licensee BioMed Central Ltd. This is an Open Access article: verbatim copying and redistribution of this article are permitted in all media for any purpose, provided this notice is preserved along with the article's original URL.
                History
                Date received : 30 August 2001
                Date accepted : 25 October 2001
                Categories
                Subject: Research Article

                ScienceOpen disciplines: Medicine
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                ScienceOpen disciplines: Medicine

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