Cobalamin deficiency in the elderly: aetiology and management: a study of 125 patients in a geriatric hospital.

INTRODUCTION: Cobalamin deficiency is frequent in elderly patients and the main aetiologies are food-cobalamin malabsorption and pernicious anaemia. The aim of our retrospective study was to identify the causes and methods of management of cobalamin deficiency at Nice geriatric university hospital. METHODS: A retrospective monocentric study was conducted over 14 months at Nice geriatric hospital, which included patients with cobalamin deficiency having received supplementation. The clinical and paraclinical data, etiological diagnosis, treatment and follow-up modalities were analyzed retrospectively. RESULTS: We studied 125 elderly patients whose median age was 85.5 ± 7 years. The etiological diagnosis was food-cobalamin malabsorption for 72 patients (57.6 %), nutritional cobalamin deficiency for 15 patients (12 %), pernicious anaemia for 12 patients (9.6 %) and there was no etiological diagnosis for 26 patients (20.8 %). Concerning cobalamin therapy, 111 patients (88.8 %) received oral therapy and 14 (11.2 %) intramuscular therapy. Vitamin B12 levels increased significantly after supplementation (p<0.001) but cobalamin administration varied according to the diagnoses (p<0.001) and was less effective in patients with dementia (p=0.04) and food-cobalamin malabsorption. CONCLUSION: Our study showed the importance of food-cobalamin malabsorption in etiological diagnosis in accordance with the literature, but also the non-negligible share of nutritional cobalamin deficiency. Mainly oral cobalamin supplementation was used in our study with a significant increase in vitamin B12 levels. An oral cobalamin regimen is proposed for elderly patients with cobalamin deficiency but with no severe neurological signs.

Course of neuropsychiatric symptoms during a 4-year follow up in the REAL-FR cohort.

INTRODUCTION: The multicenter PHRC REAL-FR cohort study was designed to follow community-dwelling patients with a diagnosis of Alzheimer's Disease. The present study describes the evolution of neuropsychiatric symptoms (NPS) over 4 years. METHOD: 686 patients were recruited at baseline from 16 French clinical centers. 151 patients were followed over the 4-year interval with 5 Neuropsychiatric evaluations. Neuropsychiatric symptoms were assessed using the Neuropsychiatric inventory (NPI). NPS symptoms were divided into 4 subgroups according to the European Alzheimer Disease Consortium NPI analysis; psychotic subgroup (hallucinations, delusions), hyperactivity subgroup (agitation, aggression, euphoria, disinhibition, irritability, aberrant motor behavior), apathy subgroup (apathy, eating) and affective subgroup (depression, anxiety). Secondly we studied the evolution of the population divided in 4 groups: Apathy only, Hyperactivity only, both Apathy and Hyperactivity, no Apathy no Hyperactivity. RESULTS: At baseline, 100 patients (66%) presented with one or more clinically significant NPI symptoms. This figure increased to 88% at the end of 4-year follow-up (Linear by linear chi square, p<0, 0012). Five NPI symptoms showed significant increases in prevalence: agitation (17,9 to 29,1%), apathy (43,0 to 62,9%) , disinhibition (2,6 to 14,6%), hallucination (2 to 4,6%) and aberrant motor behavior (13,9 to 29,1%). Prevalence of hyperactivity and apathy subgroups increased significantly during the follow-up while the prevalence of affective and psychotic subgroups did not. The number of patients with both apathy and hyperactivity increased (27% to 44%) during the follow-up period whereas the number of patients without these symptoms decreased (p = .009). CONCLUSION: The present study shows that 2 types of symptoms increased primarily over time: Apathy and Hyperactivity. The coexistence of such opposite symptoms over time according to our result should be taken into consideration by clinicians treating those patients.