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to see the letter to the editor regarding B12 and Alzheimer Disease

"If you're interested in personal health, public health, or you just want to read an amazing story, I highly recommend this book."

Dr. Eric Norman

What the Experts Say

Roach, et al.
"80 to 90 percent of untreated patients will develop disorders of the nervous system....If treatment is initiated within 3-6 months after onset of neurologic dysfunction, most neurologic deficits will resolve"24

Halliday, et al.
"Neuropsychiatric disturbances due to cobalamin deficiency in the absence of anemia should not be overlooked. The failure to make an early diagnosis will delay an effective therapy and result in possible irreversible neurologic deficits."67

Martin, et al.
"...Cobalamin therapy may lead to cognitive recovery in some patients...The window of opportunity for effective intervention may be as short as one year from the onset of medical symptoms...Clinicians should remain vigilant in screening for B12 deficiency, especially in patients with the recent onset of mental changes".25

"Projections from existing data suggest that millions of elderly Americans have low cobalamin levels or metabolic evidence of cobalamin deficiency."68

"Screening of the elderly asymptomatic populations should be considered as the initial signs and symptoms of cobalamin deficiency may be subtle."69

"The concentration of cobalamin in serum at a certain point may not necessarily reflect the amounts of MMA accumulated in tissues, whereas urine excretion of MMA is likely to be more reliable in this respect. Moreover, collection of blood is fraught with known biohazards; it is invasive to the patient and more expensive than random urine collection."40

Eggersten et al.
"In conclusion, our results support the views in the recent timely review by Stabler8 that cobalamin deficiency is found frequently enough in older people to justify screening."70

"Many of the patients with severe permanent neurologic disability had neurologic manifestations attributable to B12 deficiency years prior to diagnosis, and diagnosis often had been delayed because the individual had slight or no anemia. ……. Accordingly, data from our studies indicate undiagnosed B12 deficiency in the apparently healthy elderly is a major health problem which can be prevented to a large degree through early detection by uMMA screening and treatment before irreversible neurologic damage is suffered."13

"In the individual with macrocytosis, (MCV = 112) mean corpuscular volume reverted to normal and in the patient with early dementia, a dramatic clinical improvement occurred. These observations (6% incidence) agree with those of Norman supporting his contention that B12 deficiency in the apparently healthy elderly is a major problem, and that periodic screening should be recommended."71

Pruthi and Tefferi.
"Because of the difficulties in diagnosing cobalamin (Cbl) deficiency, alternatives to measuring Cbl have been sought. Determining the uMMA level is a less invasive, more practical, and possibly, more sensitive method."41

Panke T.
"SMMA suffers from falsely high values in patients with renal insufficiency and/or in patients with intravascular volume depletion. Therefore, it is highly recommended that uMMA be ordered. In suMMAry, routine reliance on serum vitamin B12 levels to confirm early deficiencies is not sufficient to detect all cases. Especially where there are neuropsychiatric symptoms, one should order uMMA levels."72

"Of these three tests (serum B12, uMMA, and Hcys), the uMMA assay is perhaps the best test because it is sensitive, noninvasive, and relatively convenient for the patient." 73

"The uMMA assay is effective for identifying early metabolic cobalamin deficiency."5

"..there is a strong, graded association between Hcys levels and the risk of AD .. similar to the increase in the risks of death from cardiovascular causes and stroke…Hcys levels measured 8 years before .. suggest that elevation of Hcys preceded the onset of dementia".64

(Note Importance of Preventive Medicine Section where Hcys levels in nonanemic seniors with mild B12 deficiency exceed double the risk factor for developing AD or cardiovascular disease.)

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