Vitamin B-12 deficiency should be checked for periodically in HD patients,
especially in the mid to later stages when the person may not be consuming
enough food products to maintain needed levels of B-12. See eMedicine link,
below, on some of the symptoms of vitamin B-12 deficiency causes in neurological
patients....many mimic HD symptoms!

Vitamin B12 Key to Aging Brain
http://health.usnews.com/articles/health/healthday/2008/09/08/vitamin-b12-key-to\
-aging-brain.html
Deficiency led to more brain shrinkage, study shows
By Amanda Gardner HealthDay Report
September 8, 2008

Older individuals with low levels of vitamin B12 seem to be at increased risk of
having brain atrophy or shrinkage, new research suggests.
Brain atrophy is associated with Alzheimer's disease and impaired cognitive
function.

Although the study, published in the Sept. 8 issue of Neurology, can't confirm
that lower levels of B12 actually cause brain atrophy, they do suggest that "we
ought to be more aware of our B12 status, especially people who are vulnerable
to B12 deficiency [elderly, vegetarians, pregnant and lactating women, infants],
and take steps to maintain it by eating a balanced and varied diet," said study
co-author Anna Vogiatzoglou, a registered dietician and doctoral candidate in
the department of physiology, anatomy and genetics at the University of Oxford,
in England.

"It's worth looking at B12 levels. It's a simple blood test," affirmed Dr. Shari
Midoneck, an internist at the Iris Cantor Women's Health Center in New York
City. "It doesn't hurt to take B12."

Good sources of the vitamin include meat, fish, milk and fortified cereals.

According to the study authors, vitamin B12 deficiency is a public health
problem, especially among older people. This study involved 107 volunteers aged
61 to 87 who were cognitively normal at the beginning of the study. All
participants underwent annual clinical exams, MRI scans and cognitive tests and
had blood samples taken.

Individuals with lower vitamin B12 levels at the start of the study had a
greater decrease in brain volume. Those with the lowest B12 levels had a sixfold
greater rate of brain volume loss compared with those who had the highest levels
of the vitamin.

Interestingly, none of the participants were deficient in vitamin B12, they just
had low levels within a normal range.

"They all had normal B12 levels, yet there was a difference between the higher
levels and the lower levels in terms of brain shrinkage, which is new
information which could potentially change what we recommend to people in terms
of diet," said Dr. Jonathan Friedman, an associate professor of surgery and
neuroscience and experimental therapeutics at Texas A&M Health Science
Center College of Medicine and associate dean of the College of Medicine,
Bryan-College Station campus.

Other risk factors for brain atrophy include high blood pressure, diabetes and
high cholesterol.

Not only might B12 levels be a modifiable risk factor for cognitive decline, it
might also be a clue to help clinicians assess cognitive problems earlier on.

Right now, it's not clear what the biological mechanisms behind the link might
be, nor is it clear whether added B12 would avert brain atrophy.

"We are doing a clinical trial in Oxford in which we are giving B vitamins
[including B12] to elderly people with memory impairment," Vogiatzoglou said.
"In this trial, we are doing MRI scans at the start and the end, and so, we will
be able to find out if taking B vitamins really does slow down the shrinking of
the brain. The trial will be completed in 2009."

=========

Possible Deficiency Symptoms - Vitamin B12: megaloblastic anemia, peripheral
nerve degeneration, mental dysfunction, anorexia, glossitis, elevated mean
corpuscularvolume (MCJ9, neutropenia, low foliate utilization, skin sensitivity,
immune suppression

More information:

National Institutes of Health;s Dietary Supplement Fact Sheet - Vitamin B-12
http://ods.od.nih.gov/factsheets/vitaminB12.asp

Vitamin B-12 Associated Neurological Diseases
http://www.emedicine.com/NEURO/topic439.htm
Article Last Updated: Jan 29, 2008
Although the clinical features of vitamin B-12 deficiency may consist of a
classic triad of weakness, sore tongue, and paresthesias, these are not usually
the chief symptoms. Onset is often with a sensation of cold, numbness, or
tightness in the tips of the toes and then in the fingertips, rarely with
lancinating pains. Simultaneous involvement of arms and legs is uncommon, and
onset in the arms is even rarer.Paresthesias are ascending and occasionally
involve the trunk, leading to a sensation of constriction in the abdomen and
chest. Untreated patients may develop limb weakness and ataxia. in 143 patients
with B-12 deficiency: Isolated numbness or paresthesias were present in 33%,
Gait abnormalities occurred in 12%, Psychiatric or cognitive symptoms were noted
in 3%, Low-grade fever that resolves with treatment occurred in 33% of cases,
Constitutional symptoms, including anorexia and weight loss occurred in 50%



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