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Hi, George, Is your study in print yet? Could I request a citation? I was unable to find it in Pubmed. Also, did it stratify at all by specific conditions? I am specifically thinking of MTHFR polymorphisms. Many thanks! - Patricia On Mon, Jun 10, 2013 at 7:51 PM, George Mnatzaganian < [log in to unmask]> wrote: > Dear all, > > I've recently done a brief review of the literature assessing the benefits > and harms of b12/folate supplementation in different clinical conditions > and my conclusion [this far] is that there is no substantial evidence to > indicate that b12 is beneficial. > > Here are some of my findings: > > • The Dutch FACIT randomised, double-blind, placebo controlled trial > on 818 participants assessed the effect of folic acid (administered daily > for a period of 3 years) on cognitive performance. The 3-year change in: > memory, information processing speed, and sensorimotor speed were all > significantly better in the treatment group than the placebo. [1] > > The report also presented a review of 10 RCTs on the effect of folic acid > alone or together with vitamins B on cognitive function. > > Two studies used folic acid alone in which: > • One study showed a positive effect in the treatment group > • One study showed no effect in the treatment group > > The other 8 studies assessed the effect of folic acid together with > vitamins B on cognitive function and: > > • In 5 out of 8 studies, treatment had no effect on cognitive > function > • In 1 study, treatment showed an improvement in cognitive function > • In 1 study, treatment worsened cognitive function > • In 1 study, treatment reduced verbal fluency but, when stratified > by age, folic acid improved cognitive learning abilities. > > • A systematic review of randomised trials that assessed the effect > of vitamin B6, B12, and folic acid supplementation on cognitive function > concluded that there is no substantial evidence to an effect of these > vitamins on cognitive function in people with either normal or impaired > cognitive function. (The review evaluated 14 randomised trials). [2] > > > 1. Durga, J., M. P. van Boxtel, et al. Effect of 3-year folic acid > supplementation on cognitive function in older adults in the FACIT trial: a > randomised, double blind, controlled trial. Lancet, 2007; 369: 208-216. > 2. Balk, E. M., G. Raman, et al. Vitamin B6, B12, and folic acid > supplementation and cognitive function: a systematic review of randomized > trials. Arch Intern Med. 2007; 167: 21-30. > > > All the best, > George > > ---------------- > Dr. George Mnatzaganian > Senior Research Fellow > Australian Catholic University > Melbourne, Victoria, Australia > > ________________________________________ > From: Evidence based health (EBH) [[log in to unmask]] > on behalf of Amy Price [[log in to unmask]] > Sent: Monday, 10 June 2013 9:30 PM > To: [log in to unmask] > Subject: Re: Does correction of vitamin B12 deficiency improve cognitive > function? > > I agree, it is inexpensive, relatively safe and could provide at least > quality of life benefit so why not treat and monitor for benefits or lack > thereof. Sometimes the tools used to measure improvement are coarse but > this does not mean there was no benefit. > > Best > Amy > > On 6/10/13 7:36 AM, "Djulbegovic, Benjamin" <[log in to unmask]> > wrote: > > >Anthony, > >Although chances of improvement is low, it is not zero. Regret of not > >treating ( i.e., failing to benefit) is much higher than regret of > >treating ( I,e., giving unnecessary B12 injections) that I routinely > >treat patients like these ( although success stories are not common, with > >my rough estimate of NNT probably around 100 or even higher). > >Ben > > > >Sent from my iPad > >( please excuse typos & brevity) > > > >On Jun 10, 2013, at 5:37 AM, "Anthony Cummins" <[log in to unmask]> > >wrote: > > > >> Dear all > >> > >> This is the first question I have posed to the group. > >> I have looked at possible resolutions already but I wonder if I have > >>all the picture. > >> I apologise in advance that the story is a little vague in terms of > >>time periods but bear with me. > >> > >> A patient, a woman currently in her 80s, has established dementia, most > >>probably Alzheimer dementia. > >> Several years earlier she had been diagnosed with pernicious anemia and > >>treated accordingly with B12 IM. > >> Some time later she apparently stopped coming to her GP for her B12 > >>injections and this non-treatment persisted without any apparent review > >>by her GP. > >> > >> When she was first diagnosed with dementia she did not undergo > >>investigations, which would have been routine some years earlier, to > >>exclude secondary organic causes of dementia, including VDRL, B12 etc. > >>It was some time before the old age psychiatry department realised that > >>she had had a history of B12 deficiency. B12 treatment has since been > >>restarted. > >> > >> The question now is: will this have any positive impact on her > >>cognitive function? The family are not naive enough to think it will > >>"cure" her but even if it leads to a modest improvement or delays > >>deterioration in her cognitive function then that would be a good > >>outcome. The treatment is safe and relatively cheap plus she has been > >>exposed to it previously without problems. > >> > >> I have seen systematic reviews of both vitamin B12 > >>( > http://onlinelibrary.wiley.com/doi/10.1002/14651858.CD004394/pdf/standar > >>d) and/ or folic acid and also B6 > >>( > http://archinte.jamanetwork.com.proxy.library.rcsi.ie/article.aspx?artic > >>leid=411489) in this context which showed no significant improvement on > >>cognitive impairment. Does anyone in the group know of other studies > >>that showed any other outcomes? > >> > >> Many thanks > >> > >> > >> > >> Dr. Anthony Cummins > >> Lecturer > >> Department of General Practice > >> RCSI Medical School > >> St. Stephen's Green > >> Dublin 2 > >> Tel +35314028604 > >> Email [log in to unmask] > >> Mondays, Tuesdays & Thursdays only. > >> At other times please phone General Practice directly on +35314022304/ > >>2306 or email [log in to unmask] > > > -- Patricia Anderson, [log in to unmask] Emerging Technologies Librarian University of Michigan http://www.lib.umich.edu/users/pfa