BACKGROUND: Serum folic acid tests are routinely ordered by physicians for evaluating anemia and sometimes ordered for evaluating dementia and altered mental status. OBJECTIVE:To determine the utility of routine folic acid testing for patients with anemia or dementia/ altered mental status in the era of folic acid fortification. DESIGN:Retrospective analysis of consecutive folic acid tests performed on adults over a 4-month period; chart review of patients without anemia. MEASUREMENTS AND MAIN RESULTS:Serum folic acid level, mean corpuscular volume (MCV), and hematocrit. We reviewed 1,007 folic acid tests performed on 980 patients. The average age was 63.8 years, and 62% of the tests were from outpatient facilities. Only 4 (0.4%) patients had folic acid levels <3 ng/mL, while 10 (1%) patients had levels of 3-4 ng/mL (borderline). Thirty-five percent of the folic acid tests were performed on patients who were not anemic; most of these were ordered to evaluate dementia or altered mental status and folic acid level was normal in all these patients. Only 7% of the patients tested had a macrocytic anemia; these patients were more likely than those without macrocytic anemia to have low folic acid levels (2.8% vs 0.4%, p<.03).CONCLUSION: Low serum folic acid levels were rarely detected in a series of patients being evaluated for anemia, dementia, or altered mental status. The test should be reserved for patients with macrocytic anemia and those at high risk for folic acid deficiency.KEY WORDS : folic acid, anemia, dementia.

Background: Elderly patients are undergoing invasive cardiac diagnostic procedures more frequently. Preprocedural sedation is often prescribed, intraprocedural medications administered, and appropriate concern raised regarding post procedure delirium and adverse consequences in the elderly. The objective of this prospective randomized study was to investigate the effect of premeditation on new onset delirium and procedural care. Methods: Patients ≤ 70 years old and scheduled for elective cardiac catheterization were screened for enrollment. All patients underwent a mini mental status exam (MMSE) and delirium assessment using confusion assessment method (CAM) prior to the procedure and repeated at 4 hours and prior to discharge or the next morning. Patients were randomly assigned to receive either diphenhydramine and diazepam (25 mg / 5 mg po) or no premedication. Patient cooperation during the procedure and ease of post-procedure management by nursing staff was measured using Visual Analog Scale (VAS). The degree of alertness was assessed immediately on arrival to the floor, at one and two hours using Observer’s Assessment of Alertness/Sedation Scale (OAA/S). Results: Total of 93 patients enrolled in the study, of which 47 patients received premedication prior to the procedure. The mean age was 77 ± 4.2 years, 56% were male. The baseline mean MMES was similar in each group (27.6± 1.4 in premedication group versus 28.17±1.4 in patients without premedication). Patients with premedication were less alert immediately and at one hour after arrival on the floor (p<0.01), but no patient in either group developed delirium after the procedure as measured by CAM. The ease of procedure was greater, pain medication requirement lower and nursing reported an improvement with patient management after the procedure in the premedicated group (all p<0.05). Conclusion : Premedication did not cause delirium or confusion in elderly patients undergoing cardiac catheterization. The reduced pain medication requirement, perceived procedural ease and post procedure management favors premedication in elderly patients under going cardiac catheterization.