SummaryFolic acid (folate) levels were measured in the serum of patients with various neurological diseases in Japan. Thirty-six patients showed decreased serum folate levels among 343 consecutive neurological patients (10.5%). Folate administration (15mg/d) to folate-deficient patients improved neurological symptoms in 24 of 36 cases (67%). Serum folate levels were significantly lower in female than in male folate-deficient patients. Folate deficient patients showed predominantly axonal neuropathy, which responded to folate sup plementation more markedly. Male patients more frequently exhibited neuropathy, espe cially demyelinating and motor-dominant neuropathy, than females. Anemia was corre lated with male sex and low serum folate levels. Male patients were more responsive than fe males to folate treatment. More male patients had taken excess alcohol or received gastrec tomies than females. Neurological symptoms were more frequently improved by folate sup plementation in patients with neuropathy than exclusive encephalopathy. Serum folate lev els were lower in patients with encephalopathy, especially those with dementia, while folate therapy was more effective in neurological patients without dementia. Dysgeusia and ane mia improved in all patients after folate administration. Neurological patients with malab sorption or treated with continuous drip infusion were resistant to folate therapy. Since fo late-responsive neuroencepahlopathies are not rare among patients with neurological dis eases in Japan, the serum folate level would serve as a valuable indicator for folate supple ment therapy.

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Background:  Folic acid (folate) deficiency causes neurological disorders in aged people, the characteristic features of which were examined. Methods:  Serum folate levels were determined in 343 neurological patients by chemiluminescence. We found 36 folate‐deficient patients (10.5%) who were divided into elderly ≥ 65 years old (12 cases) and younger group, < 65 years old (24 cases), and were administered folate (15 mg/day) for 60 days. Results:  Serum folate levels were not different between the elderly and younger group, while folate levels were lower in elderly females than elderly males. Neuropathy was more frequent in elderly male than elderly female patients. Elderly neurological patients with neuropathy more readily responded to folate supplementation than those without neuropathy. Folate‐deficient patients with dementia were older than those without dementia, although nine younger patients had dementia and four of nine cases showed frontal dementia. Anemia or female sex was more frequent and neuropathy was less frequent among elderly patients with central nervous system involvement. Serum folate levels were lower in elderly anemic than nonanemic patients. Tube feeding was more frequent in elderly folate‐deficient neurological patients than in younger ones. Folate therapy was less effective in elderly patients with dementia, although three cases improved. Elderly folate‐deficient patients treated with tube feeding did not respond to the folate supplement. Conclusion:  Folate deficiency was not rare among aged neurological patients, and its features were different from younger patients. Since folate‐deficient neuroencephalopathies are responsive to folate supplementation in the elderly, the examination of elderly patients’ serum folate level is valuable.

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