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Vitamin B-12 and cognition in the elderly

¹ From the Oxford Project to Investigate Memory and Ageing, the Department of Physiology, Anatomy and Genetics, University of Oxford, Oxford, United Kingdom (ADS and HR), and the Institute of Basic Medical Science, Department of Nutrition, University of Oslo, Oslo, Norway (HR).

² Presented at the symposium "Is It Time for Mandatory Vitamin B-12 Fortification in Flour?" held at Experimental Biology 2008, San Diego, CA, 8 April 2008.

³ Supported by the Charles Wolfson Charitable Trust (ADS); the Norman Collisson Foundation (ADS); the Alzheimer's Research Trust (ADS and HR); and the Johan Throne Holst Foundation for Nutrition Research, University of Oslo (HR).

⁴ Reprints not available. Address correspondence to AD Smith, Department of Physiology, Anatomy, and Genetics, University of Oxford, South Parks Road, Oxford OX1 3QX, United Kingdom. E-mail: david.smith{at}pharm.ox.ac.uk.

Vitamin B-12 deficiency is often associated with cognitive deficits. Here we review evidence that cognition in the elderly may also be adversely affected at concentrations of vitamin B-12 above the traditional cutoffs for deficiency. By using markers such as holotranscobalamin and methylmalonic acid, it has been found that cognition is associated with vitamin B-12 status across the normal range. Possible mediators of this relation include brain atrophy and white matter damage, both of which are associated with low vitamin B-12 status. Intervention trials have not been adequately designed to test whether these associations are causal. Pending the outcome of better trials, it is suggested that the elderly in particular should be encouraged to maintain a good, rather than just an adequate, vitamin B-12 status by dietary means.

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