Folate and Memory in the Elderly
abstract & commentary
Synopsis: Folic acid, but not necessarily B12, may be important for maximal episodic memory functioning in very old age.
Source: Hassing L, et al. Further evidence on the effects of vitamin B12 and folate levels on episodic memory function: A population-based study of healthy, very old adults. Biol Psychiatry 1999;45:1472-1480.
The relationship between vitamins and memory has been frequently studied, but often with inconclusive or contradictory results. The current study examined the separate and combined effects of serum vitamin B12 and folic acid on episodic memory functioning in very old age. Episodic memory deals with the conscious recall of information about a particular place and time. Episodic memory appears to be much more sensitive to disruption from a variety of causes. Normal aging is associated with decline in both episodic memory and vitamin status. Because B12 and folic acid are vitamins thought to be important to normal brain functioning, the current study attempted to assess the relationship between these two vitamins, both independently and together, in a cohort of healthy, older adults (90-101 years of age). Four study groups were selected—normal B12/normal folic acid, low B12/normal folic acid, normal B12/low folic acid, and low B12/low folic acid. Cutoff levels were 180 pmol/L for vitamin B12 and 13 nmol/L for folic acid. Potential participants included 379 subjects in Stockholm, Sweden. Patients with dementia, major depression, or other impairments that would confound study evaluation (e.g., language difficulties) were appropriately excluded. A health screening was undertaken in order to exclude patients who suffered from other illnesses that might confound the ability to evaluate the relationship between vitamin status and cognitive functioning (e.g., thyroid dysfunction). All blood analyses were performed by the same laboratory. There were no differences with regard to age or education between the four study groups. Memory tasks included face recognition, immediate word recall, object recall, delayed word recall, and word recognition. In general, the results showed no effects of vitamin B12 level in any of the memory tasks or interaction between vitamin B12 and folic acid. However, folic acid level exhibited a clear relationship to some of the memory tasks. Specifically, low levels of folic acid were associated with decreased performance in object recall and word recall. In contrast, there were no vitamin-related effects on any of the recognition tasks. The present study replicates previous findings that folic acid may be more critical than vitamin B12 to memory functioning in late life and extends those findings into very old age.
Comment by Lauren B. Marangell, MD
This study, which used a methodology of comparison groups, as opposed to a correlational analysis, showed a possible relationship between serum folic acid levels and recall in the extremely old. The fact that this type of analysis was more likely to detect an association may indicate that there is a critical level above which the relationship is less apparent. Memory difficulties are frequent complaints in primary care practice. The most common reversible cause of memory impairment is major depression. Other important conditions include thyroid disease, substance abuse, and medications. The roles of B12 and folate have been implicated for quite some time. Although the current study does not address the therapeutic role of folate supplementation, these data support evaluating serum folate levels in elderly patients with memory complaints. As long as other potentially reversible causes of memory decline are evaluated, folate supplementation may be of benefit.
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