Does Dementia Associated with Vitamin B12 Deficiency Respond to Treatment? (P02.057)

Abstract

Objective: To assess the reversibility of the dementia associated with vitamin B12 deficiency. Background The determination of B12 levels in patients with dementia is a routine practice to identify a reversible cause of dementia. However, conflicting evidence exists regarding the effects of B12 replacement on the dementia. Design/Methods: We reviewed the clinical courses of patients who had presented to our dementia clinic and were found to have a B12 deficiency, defined as a low B12 level and elevated methylmalonic acid (MMA) and homocysteine levels. A comparison group of patients with probable Alzheimer9s disease, matched for age, sex and baseline Mini-Mental State Examination (MMSE) score were also identified. Chi-square and Mann-Whitney U test were used for comparison of variables. Results: From a cohort of 1548 consecutive patients, 33 with B12 deficiency were identified. Mean age was 78.8±8.8 years; mean MMSE 21.6±4.8; mean B12 level 153.3 ±33.3 pg/ml. They were treated with B12 and followed for a mean duration of 26.6 months. There was no significant difference in baseline characteristics between the B12 deficiency group and the Alzheimer9s group except for initial vitamin B12 levels. Between the two groups, there was no difference in the rate of decline of the MMSE score (-0.19±0.37 vs -0.12±0.16, p=0.45), absolute change in MMSE score (-4.3±4.8 vs -6±7.8, p=0.17), or the number whose MMSE scores were stable or improved (30% vs 27%, p=0.78). None experienced a dramatic clinical reversal of their dementia with B12 replacement. Conclusions: Compared to patients with Alzheimer9s disease, our results showed no evidence of reversibility, stabilization, or retardation of progression of their dementia with B12 replacement. We acknowledge our patients with B12 deficiency may also have had Alzheimer9s. Considering our patient population, the dementia associated with B12 deficiency appears unlikely to reverse. Disclosure: Dr. Bhargava has nothing to disclose. Dr. Ala has received personal compensation for activities with The Dunn Group, MEDA Corp, The Council of Advisors, and the Gerson Lehrman Group as a consultant. Dr. Ala has received research support from Teva Pharmaceutical Industries, Neurochem, Ono Pharmaceutical Company, and Elan Pharmaceuticals.