A study of neurobehavioral, clinical psychometric, and P3 changes in vitamin B12 deficiency neurological syndrome.
OBJECTIVE
To evaluate cognitive functions and behavioral changes in the patients with vitamin B12 deficiency neurological syndromes (VBDNS) using detailed clinical psychometric and P3 studies and their response to treatment.


METHODS
The patients with VBDNS  were included and their detailed medical history was recorded. Neurobehavioral and cognitive functions were evaluated by neuropsychiatry inventory (NPI), forward and backward digit span, mini mental state examination (MMSE), Luria's three-step test, trail making test (TMT), motor speed and  precision test (MSPT), Benton's visual retention test (BVRT), clock drawing (CD), category fluency, hospital anxiety and depression (HAD) scale, and cognitive evoked potential using oddball paradigm at baseline and 3 and 6 months following treatment. Complete hemogram, serum chemistry, vitamin  B12, homocysteine, and craniospinal magnetic resonance imaging (MRI) were done.


RESULTS
Thirty-three patients with VBDNS, whose median age was 43 (12-68) years, five (15.2%) of whom were females were included. Twenty-one patients had neurobehavioral/cognitive decline,  26 myelopathy, and 17 neuropathy. MSPT, TMT, CD, and HAD scores improved significantly at 3 months and category naming and MMSE improved at 6 months compared to baseline. The P3 latency also improved significantly at 3 months. The baseline P3 changes correlated with MMSE, Luria's three-step  test, and MSPT. Hemoglobin and mean corpuscular volume also correlated with some of the cognitive tests.


CONCLUSIONS
VBDNS results in frontal-subcortical neurobehavioral and cognitive abnormalities which may be due to cortical and subcortical dysfunction. The reversibility  of these changes is suggestive of metabolic alteration in neuronal or myelin function.
Department of Neurology, Sanjay Gandhi Postgraduate Institute of Medical Sciences, Lucknow, UP, India.
Jayantee
J
Kalita
Ritu
R
Agarwal
Satish
S
Chandra
Usha K
UK
Misra
D000293:Adolescent; D000328:Adult; D000368:Aged; D002648:Child; D003071:Cognition / Q000187:drug effects / Q000502:physiology; D003072:Cognition Disorders / Q000150:complications / Q000503:physiopathology*; D018913:Event-Related Potentials, P300 / Q000187:drug effects* / Q000502:physiology; D005260:Female; D005500:Follow-Up Studies; D006710:Homocysteine / Q000097:blood; D006801:Humans; D008279:Magnetic Resonance Imaging; D008297:Male; D008875:Middle Aged; D009483:Neuropsychological Tests; D011594:Psychometrics / Q000379:methods*; D011795:Surveys and Questionnaires; D014805:Vitamin B 12 / Q000097:blood; D014806:Vitamin B 12 Deficiency / Q000150:complications / Q000503:physiopathology*; D055815:Young Adult
D006710:Homocysteine; D014805:Vitamin B 12