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[Neurologic and psychologic disorders in folic acid deficiency].

Folic acid deficiency is the most common of all vitamin deficiencies in North America and in Western Europe, usually in association with other vitamin deficiencies. Alcoholism is considered to be the most frequent cause of folic acid deficiency, as far as the Western world is concerned. Severe neurological and mental disturbances can develop in case of folate deficiency probably long before the manifestation of macrocythaemia. Among the neurological sequelae of folic acid deficiency the main phenomena that are discussed as likely are polyneuropathy, funicular disease of the spine and restless legs. The psychic or mental symptoms that can be ascribed to folic acid deficiency are non-specific and correspond with the symptoms of a psychosis that can have physical causes. Administration of folic acid has repeatedly resulted in significant improvements of neurological and mental symptoms in folic acid deficiency. The exact mechanisms involved in a damage to the nervous system are not sufficiently clarified for folic acid deficiency. Diagnosis is effected mainly by determining the folic acid concentration in the serum. Daily administration of approx. 1.25-15 mg folic acid (oral and/or parenteral) is recommended. Mild side effects such as tiredness and irritability have been noted only with high folic acid dosage levels.

Folic Acid Deficiency↗

[Management, prevention and control of megaloblastic anemia, secondary to folic acid deficiency].

Folic acid deficiency is the second most common cause of anemia in our environment, after anemia secondary to iron deficiency. Folates are essential components of human and animal diet. Folic acid is mainly in poliglutamate form, and it is hydrolyzed in the proximal jejunum. It is important to identify adequately the exact vitamin deficiency that causes megaloblastic anemia, because vitamin B12 administration in folate deficiency may correct partially megaloblastic alterations, but administration of folic acid in cobalamin deficient patients improves haematological parameters but deteriorates the neurological syndrome. Main causes of anemia secondary to folate deficiency are inadequate dietetic administration, increased requirements, impaired absorption and pharmacologic interactions. Folates are altered by light, high temperature and by water affinity, which facilitates its elimination by washing or cooking.

Anemia, Megaloblastic↗

The plasma clearance of injected doses of folic acid as an index of folic acid deficiency.

The folic acid clearance test of Chanarin (1958) has been studied in normal white subjects, patients with megaloblastic anaemia, healthy Bantu males, Bantu females, hospital patients without anaemia, and in patients with scurvy. The test clearly distinguishes patients with megaloblastic anaemia, where clearance from the plasma of injected folic acid is abnormally rapid, from normal subjects. The rate of clearance of folic acid is abnormally rapid both in vitamin B(12) and in folic acid deficiency. Rapid clearance of injected folic acid in patients with primary B(12) deficiency may be the result of a conditioned deficiency of folic acid. The test is sufficiently sensitive to detect body deficiency of folic acid before the development of anaemia. In patients with scurvy, folic acid is cleared from the plasma abnormally rapidly. It is suggested that this may be the result of an associated dietary deficiency of folic acid.

Anemia↗

The effect of aminopterin-induced folic acid deficiency on spermatogenesis.

Folic acid deficiency was produced by injecting aminopterin into adult male albino rats, resulting in inhibition of spermatogenesis. Bone marrow smears were studied to serve as an index of folic acid deficiency; however, changes in spermatogenesis were noticed earlier than the bone marrow changes. Meiotic division was affected more than mitotic division. The nuclei of spermatogenic cells showed degenerative changes. Chromosomal abnormalities, chiefly sticky chromosomes, were noticed in squashed preparations of seminiferous tubules.

Aminopterin↗

Sparing effect of folic acid deficiency on the development of vitamin B12 deficiency in baboons fed a vitamin B12 deficient diet.

The effect of a vitamin B12 and folic acid deficient diet on juvenile and adolescent baboons (Papio cynocephalus anubis) was studied. The baboons developed clinical and hematological signs characteristics of folacin deficiency, although they were less severe in juvenile baboons. The signs disappeared when folic acid was replaced in the diet. The serum vitamin B12 levels increased in all baboons fed the vitamin B12 and folic acid deficient diet. When folic acid was added to the diet, the levels gradually decreased in adolescent baboons, liver vitamin B12 levels decreased to a lesser extent when fed a vitamin B12 and folic acid deficient diet than when fed a vitamin B12 deficient diet. In juvenile baboons fed a vitamin B12 and folic acid deficient diet, for 7 months and a vitamin B12 deficient diet for a further 11 months, liver vitamin B12 levels did not decrease at any time but were similar to those in baboons fed a vitamin B12 and folic acid supplemented diet.

Aging↗

Early detection of folic acid deficiency in elderly patients.

Folic acid deficiency is very common in elderly patients who have a mean red cell volume greater than 94 fl. Eighteen out of 40 elderly patients with red cell macrocytosis who initially had normal red cell folate and serum B12 levels subsequently developed folic acid deficiency.

Aged↗

Pancytopenia--a rare manifestation of folic acid deficiency.

In the western world folic acid deficiency is a relatively rare cause of anaemia in the elderly population. A 79-year-old woman presented with pancytopenia (haemoglobin 3.4 mmol l-1, leucocytes 1.2.10(9)l-1, thrombocytes 22.10(9)l-1) due to folic acid deficiency. The deficiency was caused by an extremely low dietary intake. The case was complicated with infection and haemorrhagic manifestations. Administration of folic acid increased the number of erythrocytes, leucocytes and thrombocytes markedly. Beside vitamin B12 deficiency folic acid deficiency must be borne in mind in megaloblastic anaemias complicated with leucopenia and/or thrombocytopenia. Since the body stores of folic acid are low, rapid diagnosis and treatment are important.

Aged↗

Treatment of iron-deficiency anemia complicated by scurvy and folic acid deficiency.

We present a case of a child with iron-deficiency anemia, folic acid deficiency, and scurvy. His anemia proved refractory to treatment with iron until he received both folic acid and vitamin C supplementation. This case illustrates the importance of the evaluation of ascorbic acid and folate status in treating iron-deficiency anemia initially refractory to iron supplementation, because multiple nutrient deficiencies may coexist.

Anemia, Hypochromic↗

[Manifest and latent folic acid deficiency in the aged (author's transl)].

The serum folate level of 100 aged persons (after 70) was decreased (less than 4 ng/ml) in 41% of the cases (manifest deficiency of folic acid). In the group of aged persons having normal folate values, in 41% of the cases the clearance method proved a latent folic acid deficiency, being the 15 minute value after 15 gamma/kg folic acid i.v., less than 25 ng/ml.

Adult↗

Elderly psychiatric patients at risk of folic acid deficiency: a case controlled study.

In the elderly, folic acid deficiency may result in psychiatric symptoms or the increases in severity of other organic and non-organic mental diseases. We aimed to characterize elderly, community-dwelling, newly admitted patients to a large urban psychiatric hospital who are suffering from untreated folic acid deficiency in comparison with elderly inpatients who do not suffer from this deficiency. During a 2-year period, all subjects aged 65 years or older admitted to the large psychiatric center were tested for levels of serum folic acid levels. Subjects suffering from folic acid deficiency were compared (unpaired t-test) with matched patients with normal serum levels. Of the 293 newly admitted elderly patients 45 (15.7%) suffered from folic acid deficiency. Mean age for the folic acid deficient group was 77.3+/-8.1 years, 38% were diagnosed as suffering from dementia, 22% were depressed and 51% were living alone. In the comparison group mean age was 77.3+/-6.3 years, 33% were diagnosed as suffering from dementia, 24% were suffering from depression and 57% were living alone. We conclude that we could not find any "characteristic" of elderly subjects at risk of folic acid deficiency.

Aged↗

Folic acid deficiency in leukemia and lymphomas.

Serum folic acid levels and the urinary excretion of Figlu have been studied in patients with leukaemia or lymphomas. The results indicate that folic acid deficiency is a common complication of these diseases. Bone marrow examinations of those with evidence of such a deficiency frequently show megaloblastic erythropoiesis. The Figlu test appears to be a useful screening test for folic acid deficiency in patients with leukaemia or lymphomas.

Adolescent↗