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Time Dependency of Cognitive Recovery with Cobalamin Replacement: Report or a Pilot Study
Author(s) -
Martin David C.,
Francis Joseph,
Protetch Jack,
Huff F. Jacob
Publication year - 1992
Publication title -
journal of the american geriatrics society
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 1.992
H-Index - 232
eISSN - 1532-5415
pISSN - 0002-8614
DOI - 10.1111/j.1532-5415.1992.tb01939.x
Subject(s) - medicine , cobalamin , cognition , dependency (uml) , cognitive impairment , gerontology , psychiatry , vitamin b12 , artificial intelligence , computer science
Objective To examine the effects of cobalamin repletion on cognition in elderly subjects with low serum cobalamin and evidence of cognitive dysfunction. Design Time series data collected in an open trial of parenteral cobalamin therapy. Settings Outpatient geriatric assessment centers, inpatient geropsychiatry unit, and tertiary care university hospital. Participants Twenty‐two subjects with low serum cobalamin (<150 pmol/L) and evidence of cognitive dysfunction were entered consecutively over an 8‐month period of time. Eighteen subjects completed the study. Interventions Subjects received 1000 micrograms of cyanocobalamin intramuscularly daily for 1 week, then weekly for 1 month, then monthly thereafter for a minimum of six months. Outpatient measure The Maths Dementia Rating Scale (DRS) was administered both before and at least 6 months after full cobalamin replacement therapy. The hypothesis that cognitive improvement was dependent on the duration of cognitive symptoms was formulated a posteriori. Results After a minimum of 6 months of cobalamin therapy, 11 of 18 patients showed cognitive improvement. There was a striking correlation between duration of cognitive symptoms and response to therapy. Patients symptomatic for <12 months gained an average of twenty points on the DRS (paired f test P = 0.0076), whereas patients symptomatic >12 months lost an average of three points (paired t test P = .34). Two patients symptomatic for only 3 months normalized their DRS scores, gaining 31 and 28 points, respectively. Conclusion There may be a time‐limited window of opportunity for effective intervention in patients with cognitive dysfunction and low serum cobalamin.