COGNITIVE IMPAIRMENTS IN VITAMIN B12 AND FOLIC ACID DEFICIENCIES AND HYPERHOMOCYSTEINEMIA
https://doi.org/10.17650/1818-8338-2015-1-18-23
Abstract
Vitamin metabolic disorders can cause diverse dysfunctions of both the peripheral and central nervous systems. There is conclusive evidence that cyanocobalamin (vitamin B12) and folic acid deficiencies may lead to diminished cognitive functions even to the extent of developing dementia. Cognitive impairments may be accompanied by involvement of other regions of the central nervous system, the corticospinal tract in particular, less frequently by brainstem and cerebellar disorders. Changes in nervous system functions in the presence of cyanocobalamin deficiency may predominate in the clinical picture, ahead of the occurrence of hematological changes. The paper considers the possible mechanisms for involvement of brain neurons in deficiency of cyanocobalamin and in that of folic acid in particular in patients with hyperhomocysteinemia. The low serum concentration of folic acid or cyanocobalamin in the elderly raises the risk of developing Alzheimer’s disease in future (by almost twice) and vascular dementia. The authors give the results of randomized clinical trials evaluating the efficacy of the vitamins used in patients with cognitive impairments. Thus, there are data that the use of cyanocobalamin in patients with lacunar infarcts and moderate cognitive impairments may give rise to their complete recovery and reduce the risk of depressive disorders. Intramuscular cyanocobalamin used in a daily dose of 1000 μg for 5 days, then 1000 μg once monthly is demonstrated to be efficacious. This therapy may be effective in patients with different types of dementia and cognitive diminution, primarily in those with these conditions and its serum concentration of less 150 pmol/l. Among the side effects while taking folic acid, there may be higher incidence rates of convulsive attacks. A number of trials have shown the efficacy of cyanocobalamin, pyridoxine, and folic acid in preventing acute cerebral ischemic episodes; however, not all the investigations could confirm this relationship. This may be related to patients’ age, therapy duration, blood inflammatory marker concentrations, and other factors.
About the Authors
P. R. Kamchatnov
Department of Neurology, Neurosurgery, and Medical Genetics, Faculty of Therapeutics, N.I. Pirogov Russian National Research Medical University, Ministry of Health of Russia; 1 Ostrovityanovа St., Moscow, 117997, Russia;
Russian Federation
Russian Federation
I. V. Damulin
Department of Nervous System Diseases, and Neurosurgery, Faculty of Therapeutics, I.M. Sechenov First Moscow State Medical University, Ministry of Health of Russia; 2 Bld. 4 Bolshaya Pirogovskaya St., Moscow, 119991, Russia
Russian Federation
Russian Federation
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Review
For citations:
Kamchatnov P.R., Damulin I.V. COGNITIVE IMPAIRMENTS IN VITAMIN B12 AND FOLIC ACID DEFICIENCIES AND HYPERHOMOCYSTEINEMIA. The Clinician. 2015;9(1):18-23. (In Russ.) https://doi.org/10.17650/1818-8338-2015-1-18-23
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