Whether they admit it or not, a lot of middle-aged and older people worry about senility. By this, they mean cognitive difficulties or even dementia, perhaps coupled with physical frailty. However, getting old by itself does not necessarily bring on such declines. Instead, the trouble might be a vitamin B12 deficiency, as one reader reports.

Early Onset Senility?  

Q. A few years ago I thought I was experiencing early onset senility: depression, lack of concentration, near-paralysis when faced with decisions to make. It threatened to ruin my career.

At the time, my doctor told me it was stress and that I should take it easy. Then I started waking at night with the painful sensation that my hands were three times their normal size (they weren’t). A new doctor ran tests that showed a vitamin B deficiency. A transdermal patch with vitamin B12 made an immediate and dramatic difference. We never found a reason for the deficiency.

Symptoms of Vitamin B12 Deficiency:

A. Vitamin B12 deficiency can lead to symptoms such as numbness and tingling in hands and feet, balance problems, constipation, weakness, poor appetite, memory difficulties, burning tongue, confusion, depression and even dementia. In addition to testing for low vitamin B12 (cobalamin) levels in blood, doctors may need to test for high levels of methylmalonic acid. The combination offers a more reliable assessment of vitamin B12 deficiency.

Vitamin patches are relatively new and somewhat controversial. You can usually correct vitamin B12 deficiency with a fairly high dose of oral cobalamin. (You require only a few micrograms of vitamin B12 daily, so just 1 milligram would be a whopping dose, far more than you can absorb. A healthy person can absorb about 10 mcg or a 500 mcg dose.) Ask your doctor to monitor you to make sure you are achieving the proper level of this essential nutrient.

Causes of Vitamin B12 Deficiency:

Frequently, doctors can’t determine why someone develops a vitamin B12 deficiency, so that aspect of your experience is not surprising. When people don’t make adequate stomach acid they don’t absorb the vitamin effectively. Often, older people have trouble absorbing cobalamin from their food (CMAJ, Aug. 3, 2004). Perhaps this helps explain how a deficiency might be confused with senility. In addition, patients with pernicious anemia lack intrinsic factor, which is essential for vitamin B12 absorption. Such individuals will need transdermal patches or injections to get around their absorption difficulties. 

Plants do not contain vitamin B12, so strict vegetarians and vegans run the risk of low levels of this nutrient. Moreover, certain medicines, especially those that suppress stomach acid production, can also contribute to deficiency. The diabetes drug metformin and the antibiotic chloramphenicol have also been associated with inadequate vitamin B12 levels. If you are concerned about the possibility of senility, be sure to ask your health care provider to check your vitamin B12 levels first.

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