維生素 B12 缺乏症的神經精神表現

2022 年 3 月 3 日。
維生素 B12 缺乏症的神經精神表現

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

摘要
維生素 B12 缺乏症可能會出現令人痛苦的神經精神症狀。它可能在抑鬱、焦慮、精神病、癡呆和譫妄等臨床表現中起病因作用，需要對高危人群進行篩查。B12 缺乏症的神經精神表現背後的一些機製包括一碳代謝的改變、遺傳易感性和葉酸代謝的改變。保持老年人血清 B12 水平較高可以預防阿爾茨海默病 (AD)。在已確診的 AD 中，其缺乏與更高的認知能力下降和譫妄風險有關。與維生素 B12 缺乏症相關的其他精神變化包括冷漠、激動、注意力不集中、失眠、被害妄想、幻聽和幻視以及思維過程混亂。除了血清維生素 B12，血漿甲基丙二酸 (MMA) 和同型半胱氨酸也有助於診斷。本章重點介紹維生素 B12 缺乏症的這些神經精神表現的早期識別和有效治療。

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.