April 1990

Mental Dysfunction and Cobalamin Deficiency

Author Affiliations

Chapel Hill, NC

Arch Intern Med. 1990;150(4):910-911. doi:10.1001/archinte.1990.00390160150033

To the Editor.—Carmel1 has described a series of pernicious anemia cases defined by a low serum cobalamin level and either an abnormal Schilling test result, absence of intrinsic factor, or presence of anti—intrinsic factor antibodies. A number of these cases displayed only neurologic or neuropsychiatric symptoms, with normal hematologic parameters. In another recent study, Lindenbaum et al2 described similar observations. We agree with these authors and feel that the neuropsychiatric aspects of cobalamin deficiency need to be emphasized. Cobalamin deficiency may present as organic psychosis with neither spinal cord nor hematologic abnormalities.3,4

We have studied two patients who presented with organic psychosis and low vitamin B12 levels in the absence of any neurologic or hematologic abnormalities. One patient showed diffuse slowing on electroencephalographic examination and mild cerebral dysfunction on neuropsychologic testing; both the electroencephalographic and the neuropsychiatric test results became normal after vitamin B12

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