輕度智能受損與阿茲海默症老人的血清維生素

輕度智能受損與阿茲海默症老人的血清維生素 B12、葉酸與造血相關

指標

Serum vitamin B12、folate and blood relative markers in the elderly

patients with mild cognitive impairment and Alzheimer＇s dementia

本研究的主要目的為比較不同嚴重程度阿茲海默症老人之血清維生素 B12、葉酸 與造血相關指標。受試者經臨床醫師診斷，依 CDR(Clinical Dementia Rating, 臨 床失智評量)分數(CDR = 0.5, 1, 2, 3)分為四組：1.輕度智能受損組(mild cognitive impairment, MCI 組)；2.輕度阿茲海默症組(Alzheimer＇s disease, AD)；3.中度 AD；4.重度 AD。各組有 51、 68、 50 與 49 人，共 218 人參與。所有資料皆 由病歷摘取。四組的 MMSE 得分各為 27.1 ± 2.3、19.8 ± 4.7、16.4 ± 4.2 and 4.7 ± 2.7 分。 MCI、輕、中、重度 AD 四組的血清維生素 B12 各為 724.7 ± 410.7、656.1 ± 452.8、491.2 ± 215.1 及 328.6 ± 130.7 pg / mL；MCI 或輕度 AD 的比中、重度 AD 為高。四組血清葉酸各為：14.1 ± 5.1、14.8 ± 6.5、13.0 ± 4.8 及 9.7 ± 3.9 ng / mL；MCI 或輕度 AD 的比重度 AD 為高。根據 Hb(Hct)，四組貧血發生率各 為 43.1(33.3)、41.2 (42.6)、50.0(50.0)與 36.7 %(24.5 %)。四組 MCV 過高發生率 各為 7.8、20.6、14.0 與 8.2 %。四組低 Alb 血症(即蛋白質 - 營養不良)發生率各 為 5.9、5.9、6.0 與 14.3 %。根據 sGPT，四組的肝功能不佳佔 2.0 ~ 2.9 %。 本研究結論：血清維生素 B12 隨 MCI 至 AD 嚴重度發展而下降。血清葉酸隨著 AD 嚴重度加重而下降。Hb 與 Hct 或 MCV 相比，為貧血較敏銳之指標，四組中， 重度 AD 的貧血(Hct)發生率雖最低，也達 24.5 %。重度 AD 的低 Alb 血症發生率 最高：14.3 %。本研究受試者肝功能不佳者佔 2.0 ~ 2.9 %。 中文關鍵詞：輕度智能受損、阿茲海默症、老人、維生素 B12、葉酸 英文摘要

This study was to compare serum vitamin B12、folate and blood-making related factors in the elderly with mild cognitive impairment (MCI) or various severity of Alzheimer＇s disease (AD). MCI or AD was diagnosed by doctors. CDR (clinical dementia rating) was used to evaluate cognitive function. CDR scores of 0.5 were classified as MCI；1 as mild AD；2 as moderate AD and 3 as severe AD. All data required for the study were extracted from medical charts. A total of 218 subjects involved: 51 were MCI, 68 were mild AD, 50 were moderate AD and 49 were severe

AD.

MMSE scores in MCI, mild, moderate and severe AD groups were 27.1 ± 2.3、19.8 ± 4.7、16.4 ± 4.2 and 4.7 ± 2.7points, respectively. Serum vitamin B12 were 724.7 ± 410.7、656.1 ± 452.8、491.2 ± 215.1 and 326.6 ± 130.7 pg / mL. MCI or mild AD group had higher serum vitamin B12 than moderate and severe AD groups. Serum folate in four groups were 14.1 ± 5.1、14.8 ± 6.5、13.0 ± 4.8 and 9.7 ± 3.9 ng / mL. MCI or mild AD group had higher serum folate than severe AD group. Four groups had anemia according to Hb (Hct):MCI 43.1(33.3) %、mild AD 41.2(42.6) %、 moderate AD 50.0(50.0) % and severe AD group 36.7 %(24.5 %). The prevalence of high MCV in four groups:7.8、20.6、14.0 and 8.2 %. Hypoalbuminemia occurred as 5.9、5.9、6.0 and 14.3 % in four groups. Poor liver function as indicated by high sGPT level was uncommon, only 2.0 ~ 2.9 % in four groups of subjects.

In conclusion, serum vitamin B12 and folate decline as AD deteriorates.

Anemia is common in the elderly with MIC or various degree of AD as indicated by blood related markers Hb、Hct or MCV and Hb is the most sensitive markers of anemia. Hypoalbuminemia occurs in 14.3 % of the elderly with severe AD, the highest prevalence among four groups. Keywords : Alzheimer’s disease, mild cognitive impairment, elderly,