the high prevalence of vitamin B12 and folate deficiency observed in older people indicates a particular need for vigilance for deficiency of these vitamins. Reliable detection and treatment of vitamin deficiency could reduce the risk of deficiency-related disability in old age.

Use of tHcy or MMA among older persons with borderline vitamin concentrations may identify those at high risk of vitamin B-12 deficiency who should be considered for treatment.

Background: Elevated total homocysteine (tHcy) concentrations have been associated with cognitive impairment, but it is unclear whether low vitamin B-12 or folate status is responsible for cognitive decline. Objective: We examined the associations of cognitive decline with vitamin B-12 and folate status in a longitudinal cohort study performed from 1993 to 2003 in Oxford, United Kingdom. Design: Cognitive function was assessed with the Mini-Mental State Examination on ͧ3 occasions during 10 y and related to serum concentrations of vitamin B-12, holotranscobalamin (holoTC), tHcy, methylmalonic acid (MMA), and folate with the use of linear mixed models in 1648 participants who provided blood in 1995. Results: Cognitive function declined abruptly at younger ages in some participants but remained intact in others until very old age. In multivariate regression analyses after adjustment for established risk factors, concentrations of holoTC (a marker of reduced vitamin B-12 status), tHcy, and MMA predicted cognitive decline, but folate did not. A doubling in holoTC concentrations (from 50 to 100 pmol/L) was associated with a 30% slower rate of cognitive decline (Ҁ0.137 to Ҁ0.083), whereas a doubling in tHcy (from 10 to 20 mol/L) or MMA (from 0.25 to 0.50 mol/L) was associated with 50% more rapid cognitive decline (Ҁ0.090 to Ҁ0.169) and (Ҁ0.104 to Ҁ0.169), respectively. After adjustment for all vitamin markers simultaneously, the associations of cognitive decline with holoTC and MMA remained significant. Conclusions: Low vitamin B-12 status was associated with more rapid cognitive decline. Randomized trials are required to determine the relevance of vitamin B-12 supplementation for prevention of dementia.Am J Clin Nutr 2007;86:1384 -91.

low vitamin B12 concentrations are associated with cognitive impairment and missing ankle tendon jerks in older people in the absence of anaemia. Large-scale trials of vitamin B12 supplementation are required to assess the clinical significance of these associations.

No abstract

Cobalamin and folate status showed a statistically significant association with cognitive performance. Given the high prevalence of deficiencies in these nutrients, folate and cobalamin supplementation trials are required to measure any beneficial effect on cognition.

A commercially available holotranscobalamin (holo-TC) radioimmunoassay (RIA) (Axis-Shield, Dundee, Scotland) was evaluated in four laboratories and compared with a holoTC ELISA run in one laboratory. The performance of the holoTC RIA assay was comparable in three of the four participating laboratories. The results from these three laboratories, involving at least 20 initial runs of "low", "medium" and "high" serum-based controls (mean holoTC concentrations 34, 60 and 110 pmol/L, respectively) yielded an intra-laboratory imprecision of 6-10%. No systematic inter-laboratory deviations were observed on runs involving 72 patient samples (holoTC concentration range 10-160 pmol/L). A fourth laboratory demonstrated higher assay imprecision for control samples and systematic deviation of results for the patient samples. Measurement of holoTC by ELISA showed an imprecision of 4-5%, and slightly higher mean values for the controls (mean holoTC concentrations 40, 70 and 114 pmol/L, respectively). Comparable results were obtained for the patient samples. The long-term intra-laboratory imprecision was 12% for the holoTC RIA and 6% for the ELISA. In conclusion, it would be prudent to check the calibration and precision prior to starting to use these holoTC assays in research or clinical practice. The results obtained using the holoTC RIA were similar to those obtained using the holoTC ELISA assay.

Methylmalonic acid (MMA) in serum is an established marker of cobalamin deficiency. MMA and other short-chain dicarboxylic acids react with 1-pyrenyldiazomethane to form stable, highly fluorescent 1-pyrenylmethyl monoesters. We have analyzed these esters in human blood by capillary electrophoresis (CE) combined with laser-induced fluorescence detection, and here we describe our approach to achieve long-term reproducibility, which is a prerequisite for routine clinical application. To stabilize CE performance and to minimize solute adsorption to the capillary wall, we coated capillaries with linear polyacrylamide, used hydroxypropyl methylcellulose and dimethylformamide as buffer additives, and extensively diluted derivatized samples prior to injection. A discontinuous buffer system was used for sample stacking. Separation was performed in Tris-citrate buffer, pH 6.4, under reversed polarity conditions (negative potential at the inlet vial). The assay was linear for serum MMA concentrations in the range 0.1-200 mumol/L, the total run time was 26 min, the sample output was about 50 samples/24 h, and the coefficients of variation ranged between 3 and 12%, depending on the MMA concentration. Comparison of our assay with two established GC/MS methods demonstrated good correlation and measuring agreement.