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).
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/standard) and/ or folic acid and also B6 (http://archinte.jamanetwork.com.proxy.library.rcsi.ie/article.aspx?articleid=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
> 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]