维生素 B12 缺乏症的神经精神表现

2022 年 3 月 3 日。
维生素 B12 缺乏症的神经精神表现

https://pubmed.ncbi.nlm.nih.gov/35337631/

摘要
维生素 B12 缺乏症可能会出现令人痛苦的神经精神症状。它可能在抑郁、焦虑、精神病、痴呆和谵妄等临床表现中起病因作用，需要对高危人群进行筛查。B12 缺乏症的神经精神表现背后的一些机制包括一碳代谢的改变、遗传易感性和叶酸代谢的改变。保持老年人血清 B12 水平较高可以预防阿尔茨海默病 (AD)。在已确诊的 AD 中，其缺乏与更高的认知能力下降和谵妄风险有关。与维生素 B12 缺乏症相关的其他精神变化包括冷漠、激动、注意力不集中、失眠、被害妄想、幻听和幻视以及思维过程混乱。除了血清维生素 B12，血浆甲基丙二酸 (MMA) 和同型半胱氨酸也有助于诊断。本章重点介绍维生素 B12 缺乏症的这些神经精神表现的早期识别和有效治疗。

2022 Mar 3.
Neuropsychiatric manifestations in vitamin B12 deficiency

https://pubmed.ncbi.nlm.nih.gov/35337631/

Prashant Sahu 1, Harish Thippeswamy 2, Santosh K Chaturvedi 3

Affiliations

• 1Prospect Park Hospital, Berkshire Healthcare NHS Foundation Trust, Reading, Berkshire, United Kingdom.
• 2National Institute of Mental Health & Neurosciences, Bangalore, India.
• 3Leicestershire Partnership NHS Trust, Leicester, United Kingdom. Electronic address: [e-mail].

Abstract
Vitamin B12 deficiency can have distressing neuropsychiatric symptoms. It can have an etiological role in clinical presentations like depression, anxiety, psychosis, dementia, and delirium, requiring screening of at-risk populations. Few mechanisms that underlie the neuropsychiatric manifestations of B12 deficiency include alteration in one-carbon metabolism, genetic vulnerability, and alteration in folate metabolism. Maintaining a high serum B12 level in elderly can be protective against Alzheimer's disease (AD). In an established AD, its deficiency is associated with higher cognitive decline and risk for delirium. The other mental changes associated with B12 deficiency include apathy, agitation, impaired concentration, insomnia, persecutory delusions, auditory and visual hallucinations, and disorganized thought-process. Besides serum vitamin B12, plasma methylmalonic acid (MMA) and homocysteine helps in diagnosis. The chapter focuses on early recognition and effective treatment of these neuropsychiatric manifestations of vitamin B12 deficiency.