Cobalamin status and cognition in geropsychiatric patients
Edman, Joel S.
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Few studies have carefully examined the relationship between cobalamin status and psychiatric disorders; there are no cobalamin status measurements that effectively identify cobalamin-related neuropsychiatric abnormalities. This research examined cobalamin status in 58 consecutively admitted patients to the geriatric unit of a private psychiatric hospital - subjects were 47 females and 11 males (mean age 75.1 years). Primary diagnoses included major depression (n=31), bipolar disorder (n=7), dementias (n=11), alcohol abuse (n=6) and other diagnoses (n=3). Of special attention was the sensitivity with which serum methylmalonic acid (MMA) and homocysteine (HCYST) (functional measures of B12) could identify related hematologic and psychiatric pathology. A subset (n=28) of the first group with major depression was therefore interviewed to assess cognition and other factors which might contribute to lower B12 intake and nutritional status. Results of this research indicated that MMA and HCYST are not more sensitive indices of cobalamin status than serum B12 for hematological or psychiatric pathology. The prevalence of deficiency as indicated by the metabolite and serum B12 1evels was not different (9% vs. 11 %). Also, MMA and HCYST did not correlate with MCV, although no indices correlated with MCV. Serum creatinine correlated with MMA (r=.75, p[less than].001) and HCYST(r=.45, p[less than].01). Blood smears showed significant macrocytosis (33% Ss with MCVs [greater than] 95 fl) and hypersegmented PMNs (26 % of 19 Ss). Also, comparisons of psychotic and non-psychotic depressive showed a significant difference for MCV (t=2.0, df=32, p=.05), although there were no significant differences for serum cobalamin, folate, MMA or HCYST. With respect to cobalamin status associations to cognition, there were no single indices that correlated with cognitive measures. When subjects with the lowest cobalamin status were compared to the rest of the subject sample, there were still no significant differences. Factors examined for influence on cobalamin intake and nutritional status did not produce significant effects, although sample sizes were small. However, there was a significant positive association between age of onset of psychiatric disorder and serum HCYST (r=.47, p[less than].01). In summary, this research did not find that MMA and HCYST are more sensitive indicators of cobalamin status than serum cobalamin in this population. However, there may be evidence for inadequate utilization of cobalamin and/or folate in MCVs and PMNs even though serum cobalamin levels were not different. AIso, the findings suggested several factors that could influence these relationships and should be considered in future research.
PLEASE NOTE: This work is protected by copyright. Downloading is restricted to the BU community: please click Download and log in with a valid BU account to access. If you are the author of this work and would like to make it publicly available, please contact firstname.lastname@example.org.Thesis (D.Sc.D.)--Boston University. Henry M. Goldman School of Graduate Dentistry, 1990 (Nutritional Sciences)Bibliography: leaves 136-148.
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