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Do Some Patients Harbor Atypical Cobalamin Deficiency States?

Dean S. Karnaze, MD; Ralph Carmel, MD

Arch Intern Med. 1987;147(3):429-431.

Abstract
• Serum cobalamin (vitamin B₁₂) levels were analyzed retrospectively in 17 patients with primary degenerative dementia and 11 with specific demonstrable causes of dementia (secondary dementia). The prevalence of low cobalamin levels was significantly increased in primary dementia (29% vs 0% in secondary dementia). Because typical findings of deficiency often seemed absent, we prospectively studied two other patients with primary dementia and low cobalamin levels. Neither of these two had megaloblastic anemia; one had a normal Schilling test while the other's was borderline. Despite this absence of the expected findings, the deoxyuridine suppression test gave biochemical evidence of cobalamin deficiency in both cases. Our survey of 28 patients thus established that low serum cobalamin levels are frequent in primary dementia. Our findings in the two prospectively studied cases (as well as in some of the patients in the survey) indicate that these levels are associated in at least some cases with an atypical deficiency state rather than with disorders such as pernicious anemia. Such atypical deficiency states cannot be identified by classic hematological criteria or by the Schilling test.

(Arch Intern Med 1987;147:429-431)

Author Affiliations
From the Departments of Neurology (Dr Karnaze) and Medicine (Dr Carmel), University of Southern California School of Medicine, and the Los Angeles County-University of Southern California Medical Center (Drs Karnaze and Carmel), Los Angeles.

Footnotes
Accepted for publication July 1, 1986.

Reprint requests to University of Southern California School of Medicine, 2025 Zonal Ave, Los Angeles, CA 90033 (Dr Carmel).

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