Background. Low serum cobalamin levels are often found in apparently normal older subjects. A major worry of leaving cobalamin de®ciency untreated is that it may lead to subtle deterioration in cognitive function.Objectives. To investigate the eect of supplementation on the cognitive function of older people with cobalamin de®ciency by a randomized trial.Methods. Fifty Chinese subjects more than 60 years old with serum cobalamin level 5120 pmol/l were randomized into supplement and control groups. Fasting serum methylmalonic acid levels (MMA) were measured. A battery of neuropsychological tests was administered. The supplement group received intramuscular cyanocobalamin injections, while the control group received no intervention. They were followed up at around 4 months.Results. 78% of the subjects had raised MMA, indicating metabolic cobalamin de®ciency. Supplemented subjects improved in performance IQ, but the amount of improvement was not signi®cantly more than that of control subjects. Moreover, the supplement group fared worse than the control group at follow-up in some motor function scores. Three out of seven demented subjects had improvement in Mini-Mental State Examination scores, but there was no consistent improvement in other neuropsychological scores.Conclusions. This study suggested that cobalamin de®ciency did not invariably cause cognitive impairment in older people. There remain the possibilities that cobalamin de®ciency causes cognitive impairment or exacerbates coexisting dementia in some older people. #
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