Vitamin B12 deficiency is related to various neuropsychiatric problems including myelopathy, neuropathy, sensory disturbances, gait abnormalities, weakness, cognitive and behavioral disturbances to dementia. These manifest as numbness, tingling, weakness of extremities, abnormal reflexes including impaired vibration (position sense), abnormal or unsteady gait, balance problems, difficulty walking, dizziness, restless legs, tremors, visual disturbances, forgetfulness, memory loss, impotence, urinary incontinence, fecal incontinence, depression, irritability, mania, paranoia, hallucinations, psychosis, violent behavior, and personality changes. Vitamin B12 deficiency causes neurological and psychiatric symptoms in adults between 40 to 90 years of age.
What Are The Neurological Symptoms of Vitamin B12 Deficiency?
Subacute Progressive Degeneration affects spinal cord caused by vitamin B12 deficiency. The degeneration is also known to involve brain, nerves of the eyes, and peripheral nerves. It starts with degeneration of myelin sheath followed by degeneration of nerves. Initial symptoms include paresthesias along with clumsiness. Other symptoms include weakness, visual problems, cognitive disturbances, abnormal reflexes, bladder, and erectile dysfunctions. It becomes necessary to treat patients early, as delayed treatment results in permanent loss of functions.
Peripheral Neuropathy is a common presentation of vitamin B12 deficiency. In this, there is disruption of transmission of nerve signals between the spinal cord and different parts of the body. The problem could be due to either direct damage to the nerve of due to demyelination of myelin sheath that leads to nerve damage. The symptoms include paresthesias and pain depending on the type of nerve involvement and also involve loss of sensation or ataxia. Early treatment is effective with limitation of damage.
Brain Shrinkage and Neurodegenerative Disorders are also associated with vitamin B12 deficiency. Generally, brain atrophy is a normal aging mechanism, but in vitamin B12 deficiency this process is accelerated. Various studies have shown a positive correlation between vitamin B12 deficiency and the presence of Alzheimer’s disease, Parkinson’s disease, and various other conditions related to dementia. However, a conclusive relationship between vitamin B12 deficiency and these diseases is still lacking. Most of the studies that have correlated hyperhomocysteinemia with Alzheimer’s disease and other causes of dementia have reported positive results. This signifies that there is an increased risk of these diseases with an increase in blood levels of homocysteine. There are contradictory studies between the association of vitamin B12 deficiency and multiple sclerosis.
Psychiatric Manifestations of vitamin B12 deficiency include delusions, hallucinations, memory changes, depression and dementia. These problems could be related to abnormal transmission of neurotransmitters and increased levels of homocysteine and methylmalonic acid (MMA). After screening, if there is no other cause of psychiatric disorder then one can consider supplementation of vitamin B12.
Vascular complications have been associated with increased levels of homocysteine in the blood, which is also a recognized risk factor for stroke and other vascular complications. Thus, there exists a possible correlation between vitamin B12 deficiency and vascular diseases.
Vitamin B12 and folate deficiencies have been identified with poor brain development and cognitive functions in fetal and early life. Folate and vitamin B12 have been known to play an important role in brain development, especially during fetal and first 2 years of life. Furthermore, these vitamins are essential for myelin sheath development that continues until puberty after initiation at puberty. As noted above, vitamin B12 deficiency is related to restriction in myelination, and depending on the affected area of nervous system involved, the infant can present with varied cognitive and intellectual problems. Thus, the vitamin B12 supplementation is necessary for the prevention of any neurological complications in pregnant women with folate and B12 deficiency.
Thus, vitamin B12 is a very important micronutrient for proper brain health in both children and adults. Various medical conditions might lead to deficiency of vitamin B12, but if the deficiency is due to dietary cause then early supplementation of this vitamin can prevent damage to the nervous system and thus prevent neurological and psychiatric symptoms. Vitamin B12 is found abundantly in various animal foods and dairy products, also, there are healthy vegan diets fortified with this vitamin available in the market.
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