Confusional States in Relation to Vitamin Deficiencies in the Elderly

Abstract

The author uses case abstracts to illustrate deficiencies of thiamine! vltamln-B complex and vitamin C associated with confusional states in the elderly. The biochemical indicators were chiefly the pyruvate metabolism test and the level of ascorbic acid in the leukocyte layer ("buffy coat") of the blood. The confusional states usually disappeared or improved with appropriate vitamin therapy.Nutritional deficiencies are being recognized with increasing frequency in the practice of geriatric medicine. Among elderly people in countries like Great Britain it is not uncommon to see "subclinical" vitamin deficiency, in contrast to the frank avitaminosis seen in less affluent countries.The following are 28 illustrative cases of confusional states associated with various vitamin deficiencies.Two hundred and fifty-four patients were admitted during a period of six months (May-November) to a Geriatric Unit of 96 beds. For this study, elderly patients with confusional states were selected at the time of admission; in addition, one 38-year-old patient was "inherited" from a psychiatric ward. Vitamin deficiency was detected by the pyruvate metabolism test! (P.M.T.) (1) and in some cases by the determination of ascorbic acid in the "buffy coat" (blood leukocyte layer)," and vitamin C in the serum. THIAMINE/VITAMIN-B COMPLEX DEFICIENCYE. F., a 66-year-old female, living with her husband, had arteriosclerosis and Parkinson's disease. She was taking orphenadrine hydrochloride three times daily. She was re-admitted because of deterioration in gait and mobility, and a confusional state. Examination showed the signs and symptoms of parkinsonism and also glossitis and angular stomatitis (the latter attributable to dentures). Results of the P.M.T. two days after admission were: 1) 1.2 mg; 2) 1.8 mg; 3) 2.5 mg. per 100 ml. Ascorbic acid values (leukocyte layer) were normal. The patient was treated for two weeks by oral administration of a concentrated solution of vitamin-B complex," The confusional state cleared up, and mobility and gait improved.

The neuropsychiatric effects of vitamin C deficiency: a systematic review

“…Nonetheless, the overall trend from the studies included in this systematic review indicates that vitamin C deficiency is associated with an increase in depression [21,24,25] and cognitive impairment [27][28][29]. Scurvyi.e., vitamin C deficiency with physical manifestationsis also associated with depression [22,23] and confusion [26]. Given the paucity of research in this area to date, one fruitful avenue for future research would be specifically investigating whether vitamin C deficiency is linked to other psychiatric diagnoses, including psychosis and anxiety.…”

“…In this present systematic review, the included studies in this review employed a number of different measurement techniques for vitamin C, including blood levels, leucocyte levels and a vitamin C saturation test. For the included case series of clinical vitamin C deficiency, two older studies published in 1968 and 1971 primarily utilised leucocyte ascorbic acid level [22,26]. Walker [22] measured vitamin C in milligram per 100 mg of white blood cells, while Mitra [26] measured vitamin C in milligram per 100 g of white blood cells.…”

“…For the included case series of clinical vitamin C deficiency, two older studies published in 1968 and 1971 primarily utilised leucocyte ascorbic acid level [22,26]. Walker [22] measured vitamin C in milligram per 100 mg of white blood cells, while Mitra [26] measured vitamin C in milligram per 100 g of white blood cells. (The former study likely reported incorrect measurements; vitamin C in leucocyte layer is typically reported in milligram per 100 g of white blood cells [42].)…”

“…One woman also reported lethargy and depression. It is reported that one of these women recovered with a fortnight of ascorbic acid 1 g daily [26].…”

Appropriateness of Vitamin and Mineral Prescription Orders for Residents of Health Related Facilities*

“…This deficiency may occur because of a low dietary intake or because of malabsorption. Mitra (31) concluded that B 12 deficiency, along with folic‐acid deficiency, may be a cause of dementia and confusional states in the elderly. Elsborg et al (32) investigated serum B 12 levels in 273 geriatric patients and found a low level in one‐third of them.…”