Abstract：
Vitamin B12 deficiency can present with a variety of neurological and cognitive symptoms. Especially in elderly patients, vitamin B12 deficiency can be easily overlooked because symptoms may be attributed to comorbid conditions or solely to the aging process. In this case study, we present two patients, a 71-year-old man and a 74-year-old female, with vitamin B12 deficiency. The male patient had a history of (partial) resection of the ileum/jejunum/colon because of intestinal ischemia. The female patient had a history of hypothyroidism, type 2 diabetes with complications (including peripheral neuropathy), mitochondrial myopathy, and chronic lymphocytic leukemia. Both patients presented with severe fatigue, cognitive impairment, and impaired walking. Next to this, the male patient suffered from depressive symptoms and mild disorientation, and the female patient experienced neuropathic pain. She also mentioned a positive family history for B12 deficiency. The first patient had normal to high B12 levels because he was already on B12 injections (once every three weeks) because of an earlier diagnosed B12 deficiency. The female patient had B12 levels within normal range (holotranscobalamin 54 pmol/L) and her diagnosis was confirmed by elevated homocysteine and methylmalonic acid levels. Treatment with frequent hydroxocobalamin injections and other supplements significantly improved their cognitive, emotional, and motor functions. These cases underscore the need for a high level of clinical suspicion in elderly patients, also in cases of normal B12 levels but with clinical signs of deficiency and a positive risk factor, such as stomach or small bowel surgery or positive family history.
Plain language titleA case study of two elderly patients with vitamin B12 deficiency and neurological and cognitive complaintsPlain language summaryVitamin B12 deficiency in elderly patients can be easily overlooked as symptoms can also be caused by other age-related diseases or the aging process. In our article we present two elderly patients, a 71-year-old male and a 74-year-old female, with neurological complaints, such as severe fatigue, cognitive decline, and walking impairment. The male patient had a history of small bowel surgery, and the female patient mentioned that she had several siblings with B12 deficiency. Additionally, the male patient suffered from depressive symptoms and mild disorientation, and the female had severe pain in her legs. The male patient already received B12 injections because of an earlier B12 diagnosis, but with a relatively low frequency. The B12 levels of the female patients were within the normal range. However, her diagnoses could be confirmed with additional laboratory measurements, such as homocysteine and methylmalonic acid. Treatment with frequent B12 injections and other supplements significantly improved their cognitive, emotional, and motor functions. Our study shows that clinicians should carefully consider the possibility of B12 deficiency in elderly patients with cognitive and neurological complaints, also in patients with B12 levels within the normal range, but with risk factors such as family members with B12 deficiency or conditions that may impair the vitamin B12 uptake, such as previous stomach or small bowel surgery.
Plain language titleA case study of two elderly patients with vitamin B12 deficiency and neurological and cognitive complaintsPlain language summaryVitamin B12 deficiency in elderly patients can be easily overlooked as symptoms can also be caused by other age-related diseases or the aging process. In our article we present two elderly patients, a 71-year-old male and a 74-year-old female, with neurological complaints, such as severe fatigue, cognitive decline, and walking impairment. The male patient had a history of small bowel surgery, and the female patient mentioned that she had several siblings with B12 deficiency. Additionally, the male patient suffered from depressive symptoms and mild disorientation, and the female had severe pain in her legs. The male patient already received B12 injections because of an earlier B12 diagnosis, but with a relatively low frequency. The B12 levels of the female patients were within the normal range. However, her diagnoses could be confirmed with additional laboratory measurements, such as homocysteine and methylmalonic acid. Treatment with frequent B12 injections and other supplements significantly improved their cognitive, emotional, and motor functions. Our study shows that clinicians should carefully consider the possibility of B12 deficiency in elderly patients with cognitive and neurological complaints, also in patients with B12 levels within the normal range, but with risk factors such as family members with B12 deficiency or conditions that may impair the vitamin B12 uptake, such as previous stomach or small bowel surgery.
摘要：
维生素B12缺乏可呈现多种神经和认知症状。尤其是老年患者，维生素B12缺乏症很容易被忽视，因为症状可能归因于合并症或仅归因于衰老过程。在这个案例研究中,我们介绍了两个病人,一个71岁的男人和一个74岁的女人,缺乏维生素B12。男性患者因肠缺血而有回肠/空肠/结肠（部分）切除史。女性患者有甲状腺功能减退症病史,2型糖尿病伴并发症（包括周围神经病变），线粒体肌病,和慢性淋巴细胞白血病.两名患者都出现了严重的疲劳,认知障碍，行走受损。在这个旁边,男性患者患有抑郁症状和轻度定向障碍，女性患者经历了神经性疼痛。她还提到了B12缺乏症的积极家族史。第一个患者的B12水平正常到高，因为他已经注射了B12（每三周一次），因为早期诊断的B12缺乏症。该女性患者的B12水平在正常范围内（全反式balamin54pmol/L），并且高半胱氨酸和甲基丙二酸水平升高证实了她的诊断。频繁注射羟钴胺和其他补充剂治疗显著改善了他们的认知，情感,和电机功能。这些病例强调了老年患者需要高度的临床怀疑，在B12水平正常但有临床症状缺乏和积极危险因素的情况下，如胃或小肠手术或阳性家族史。
简单的语言主题两个老年患者维生素B12缺乏和神经和认知抱怨的案例研究简单的语言总结维生素B12缺乏老年患者很容易被忽视，因为症状也可能是由其他年龄相关疾病或衰老过程引起的。在我们的文章中，我们介绍了两名老年患者，一名71岁的男性和一名74岁的女性，有神经系统的抱怨，比如严重的疲劳，认知能力下降,和行走障碍。男性患者有小肠手术史,女性患者提到她有几个B12缺乏症的兄弟姐妹。此外,男性患者患有抑郁症状和轻度定向障碍，雌性的腿剧烈疼痛。由于早期的B12诊断，男性患者已经接受了B12注射，但是频率相对较低。女性患者的B12水平在正常范围内。然而,她的诊断可以通过额外的实验室测量得到证实，如高半胱氨酸和甲基丙二酸。经常注射B12和其他补充剂的治疗显着改善了他们的认知，情感,和电机功能。我们的研究表明，临床医生应仔细考虑有认知和神经系统疾病的老年患者B12缺乏的可能性，也在B12水平在正常范围内的患者中，但有危险因素，如家庭成员缺乏B12或可能损害维生素B12摄取的条件，例如以前的胃或小肠手术。
简单的语言主题两个老年患者维生素B12缺乏和神经和认知抱怨的案例研究简单的语言总结维生素B12缺乏老年患者很容易被忽视，因为症状也可能是由其他年龄相关疾病或衰老过程引起的。在我们的文章中，我们介绍了两名老年患者，一名71岁的男性和一名74岁的女性，有神经系统的抱怨，比如严重的疲劳，认知能力下降,和行走障碍。男性患者有小肠手术史,女性患者提到她有几个B12缺乏症的兄弟姐妹。此外,男性患者患有抑郁症状和轻度定向障碍，雌性的腿剧烈疼痛。由于早期的B12诊断，男性患者已经接受了B12注射，但是频率相对较低。女性患者的B12水平在正常范围内。然而,她的诊断可以通过额外的实验室测量得到证实，如高半胱氨酸和甲基丙二酸。经常注射B12和其他补充剂的治疗显着改善了他们的认知，情感,和电机功能。我们的研究表明，临床医生应仔细考虑有认知和神经系统疾病的老年患者B12缺乏的可能性，也在B12水平在正常范围内的患者中，但有危险因素，如家庭成员缺乏B12或可能损害维生素B12摄取的条件，例如以前的胃或小肠手术。
