Correlations between cognitive, behavioural and psychological findings and levels of vitamin B12 and folate in patients with dementia.

BACKGROUND: Associations between low levels of folate and vitamin B12 and cognitive impairment in patients with dementia have been reported. Some studies revealed correlations between low levels of vitamin B12 and behavioural and psychological signs and symptoms of dementia (BPSD) in Alzheimer's disease (AD) patients. Given the lack of studies in frontotemporal dementia (FTD) and on folate and given the methodological shortcomings of former publications, we set up a prospective study. METHODS: At inclusion, AD (n=152) and FTD (n=28) patients underwent a neuropsychological examination. Behaviour was assessed using a battery of behavioural assessment scales. Determination of serum vitamin B12 and red cell folate levels were performed within a time frame of two weeks of inclusion. RESULTS: In both patient groups, significantly negative correlations between levels of serum vitamin B12 and red cell folate and the degree of cognitive deterioration were found. No correlations with BPSD were found in the AD patient group. In FTD patients, levels of vitamin B12 were negatively correlated with both hallucinations (p=0.022) and diurnal rhythm disturbances (p=0.036). CONCLUSIONS: The observed negative correlations between levels of vitamin B12 and folate and cognitive impairment in both AD and FTD patients, raise the possibility of a non-specific etiological role. Although levels of vitamin B12 and folate did not correlate with BPSD in AD patients, negative correlations between serum vitamin B12 levels and BPSD in FTD patients were revealed. Decreased serum vitamin B12 levels may predispose FTD patients to develop hallucinations and diurnal rhythm disturbances.

Sarcoidosis and sarcoid-like reaction following Hodgkin's disease. Report of two cases.

The occurrence of a sarcoidosis associated with Hodgkin's disease is an infrequent but well-described event. Moreover it has been described for many decades that some malignancies may present with simultaneous granulomatous manifestations named sarcoid-like reactions. To differentiate sarcoidosis from the sarcoid-like reactions is not an easy step in the final diagnosis. No author in the past has included the use of 2-deoxy-2[18F]fluoro-D-glucose positron emission tomography (FDG-PET) in order to help in this differentiation. We report two patients with Hodgkin's disease complicated with a typical form of sarcoidosis and with diffuse sarcoid-like reactions. We discuss the use of FDG-PET as a tool in the making of the final diagnosis and the difficulties associated with this technique in the interpretation of different hypermetabolic tissues.

Imaging of large vessel vasculitis with (18)FDG PET: illusion or reality? A critical review of the literature data.

Fluorine-18 fluorodeoxyglucose positron emission tomography ((18)FDG PET) plays a major role in the management of oncology patients. Owing to the singular properties of the glucose tracer, many patients suffering from non-malignant diseases such as inflammatory or infectious diseases may also derive clinical benefit from the appropriate use of metabolic imaging. Large vessel vasculitides such as giant cell arteritis and Takayasu arteritis are other examples that may potentially extend the field of (18)FDG PET indications. The purpose of the present article is to assess the feasibility of metabolic imaging in vasculitis on the basis of the current literature data. In particular, the clinical context and the (18)FDG imaging patterns seen in patients with large vessel vasculitis are analysed in order to identify potential indications for metabolic imaging.