We sought to identify any association between whole blood thiamine level and functional status in older hospitalized patients.
Methods:
This cross-sectional study retrospectively analyzed the results of routine measurements of whole blood thiamine levels of 233 older patients who were consecutively hospitalized to a geriatric acute care ward. Nutritional status, depression, and the participants’ cognitive impairment were evaluated using the Mini Nutritional Assessment–Short Form, Depression in Old Age Scale, and Montreal Cognitive Assessment, respectively. Activities of daily living were determined using Barthel Index (BI) on admission and at the time of discharge. Diagnoses of dementia and delirium were derived from the patients’ medical records.
Results:
Of 233 participants (mean age 82.1 [7.1]), 47.0% and 39.0% were at risk of malnutrition and malnourished, respectively. There was no thiamine deficiency (<20 ng/mL) in total population. Nearly all patients (95%) were screened with impaired cognitive function, in which 36% and 9% had the diagnosis of dementia and delirium, respectively. Patients with dementia (P = .040) and delirium (P = .002) demonstrated lower mean thiamine blood levels compared to patients without. Mean blood vitamin B1 was higher in patients with functional recovery (change in BI ≥5 points during hospitalization; P = .018). In a binary logistic regression analysis, blood vitamin B1, weight loss, and female gender were the major independent risk factors for delirium but not for dementia.
Conclusion:
Despite the absence of thiamine deficiency, whole blood thiamine was lower in patients with dementia and delirium compared to those without. Higher thiamine levels were significantly associated with functional recovery during hospitalization.
JannuschKJockwitzCBidmonHJMoebusSAmuntsKCaspersS. A complex interplay of vitamin B1 and B6 metabolism with cognition, brain structure, and functional connectivity in older adults. Front Neurosc. 2017;11:596.
2.
KimHKimGJangWKimSYChangN. Association between intake of B vitamins and cognitive function in elderly Koreans with cognitive impairment. Nutr J. 2014;13(1):118.
3.
MikkelsenKStojanovskaLApostolopoulosV. The effects of vitamin B in depression. Curr Med Chem. 2016;23(38):4317–4337.
4.
MikkelsenKStojanovskaLPrakashMApostolopoulosV. The effects of vitamin B on the immune/cytokine network and their involvement in depression. Maturitas. 2017;96:58–71.
5.
MohajeriMHTroeschBWeberP. Inadequate supply of vitamins and DHA in the elderly: implications for brain aging and Alzheimer-type dementia. Nutrition. 2015;31(2):261–275.
6.
ChangNKimEKimKNKimHKimSYJeongBS. Folate nutrition is related to neuropsychological functions in the elderly. Nutr Res Pract. 2009;3(1):43–48.
7.
GibsonGEHirschJACirioRTJordanBDFonzettiPElderJ. Abnormal thiamine-dependent processes in Alzheimer’s disease. Lessons from diabetes. Mol Cell Neurosci. 2013;55:17–25.
8.
GoldMHauserRAChenMF. Plasma thiamine deficiency associated with Alzheimer’s disease but not Parkinson’s disease. Metab Brain Dis. 1998;13(1):43–53.
9.
LuJPanXFeiG. Correlation of thiamine metabolite levels with cognitive function in the non-demented elderly. Neurosci Bull. 2015;31(6):676–684.
10.
O’KeeffeSTTormeyWPGlasgowRLavanJN. Thiamine deficiency in hospitalized elderly patients. Gerontology. 1994;40(1):18–24.
11.
ZhangGDingHChenH. Thiamine nutritional status and depressive symptoms are inversely associated among older Chinese adults. J Nutr. 2013;143(1):53–58.
MatteiniAMWalstonJDFallinMD. Markers of B-vitamin deficiency and frailty in older women. J Nutr Health Aging. 2008;12(5):303–308.
14.
NgTPAungKCFengLSchererSCYapKB. Homocysteine, folate, vitamin B-12, and physical function in older adults: cross-sectional findings from the Singapore longitudinal ageing study. Am J Clin Nutr. 2012;96(6):1362–1368.
15.
OsiezaghaKAliSFreemanC. Thiamine deficiency and delirium. Innov Clin Neurosci. 2013;10(4):26–32.
16.
PepersackTGarbusinskiJRobberechtJBeyerIWillemsDFussM. Clinical relevance of thiamine status amongst hospitalized elderly patients. Gerontology. 1999;45(2):96–101.
17.
BlazerDG. Depression in late life: review and commentary. J Gerontol A Biol Sci Med Sci. 2003;58(3):249–265.
18.
Chang-QuanHXue-MeiZBi-RongDZhen-ChanLJi-RongYQing-XiuL. Health status and risk for depression among the elderly: a meta-analysis of published literature. Age and ageing. 2010;39(1):23–30.
19.
LeonFGAshtonAKD’MelloDA. Depression and comorbid medical illness: therapeutic and diagnostic challenges. J Fam Pract. 2003;suppl: S19–S33.
20.
LinkaEBartkoGAgardiTKemenyK. Dementia and depression in elderly medical inpatients. Int Psychogeriatr. 2000;12(1):67–75.
21.
WancataJWindhaberJKrautgartnerMAlexandrowiczR. The consequences of non-cognitive symptoms of dementia in medical hospital departments. Int J Psychiat Med. 2003;33(3):257–271.
22.
KaiserMJBauerJMRamschC. Validation of the Mini Nutritional Assessment short-form (MNA-SF): a practical tool for identification of nutritional status. J Nutr Health Aging. 2009;13(9):782–788.
23.
MahoneyFIBarthelDW. Functional evaluation: the Barthel index. Maryland State Med J. 1965;14:61–65.
24.
HeidenblutSZankS. Entwicklung eines neuen Depressionsscreenings für den Einsatz in der Geriatrie [in German]. Z Gerontol Geriatr. 2010;43(3):170–176.
25.
NasreddineZSPhillipsNABedirianV. The Montreal cognitive assessment, MoCA: a brief screening tool for mild cognitive impairment. J Am Geriatr Soc. 2005;53(4):695–699.
26.
World Health Organization. The ICD-10 Classification of Mental and Behavioural Disorders: Diagnostic Criteria for Research. Geneva, Switzerland: World Health Organization; 1993.
27.
Abellan van KanGRollandYMMorleyJEVellasB. Frailty: toward a clinical definition. J Am Med Dir Assoc. 2008;9(2):71–72.
28.
CharlsonMEPompeiPAlesKLMacKenzieCR. A new method of classifying prognostic comorbidity in longitudinal studies: development and validation. J Chron Dis. 1987;40(5):373–383.
29.
Lopes da SilvaSVellasBElemansS. Plasma nutrient status of patients with Alzheimer’s disease: systematic review and meta-analysis. Alzheimers Dement2014;10(4):485–502.
30.
RingaitieneDGineityteDVickaV. Impact of malnutrition on postoperative delirium development after on pump coronary artery bypass grafting. J Cardiothorac Surg. 2015;10:74.
31.
O’KeeffeST. Thiamine deficiency in elderly people. Age and ageing. 2000;29(2):99–101.
32.
KoikeHIijimaMMoriK. Postgastrectomy polyneuropathy with thiamine deficiency is identical to beriberi neuropathy. Nutrition. 2004;20(11-12):961–966.
33.
ZenukCHealeyJDonnellyJVaillancourtRAlmalkiYSmithS. Thiamine deficiency in congestive heart failure patients receiving long term furosemide therapy. Can J Clin Pharmacol. 2003;10(4):184–188.
34.
LeeDCChuJSatzWSilbergleitR. Low plasma thiamine levels in elder patients admitted through the emergency department. Acad Emerg Med. 2000;7(10):1156–1159.
35.
SeligmannHLeviRKonijnAMProkocimerM. Thiamine deficiency in patients with B-chronic lymphocytic leukaemia: a pilot study. Postgrad Med J. 2001;77(911):582–585.
36.
PageGLLaightDCummingsMH. Thiamine deficiency in diabetes mellitus and the impact of thiamine replacement on glucose metabolism and vascular disease. Int J Clin Pract. 2011;65(6):684–690.
37.
BrysMPirragliaERichK. Prediction and longitudinal study of CSF biomarkers in mild cognitive impairment. Neurobiol Aging. 2009;30(5):682–690.
38.
MartinPRSingletonCKHiller-SturmhofelS. The role of thiamine deficiency in alcoholic brain disease. Alcohol Res Health. 2003;27(2):134–142.
39.
BettendorffLMastrogiacomoFKishSJGrisarT. Thiamine, thiamine phosphates, and their metabolizing enzymes in human brain. J Neurochem. 1996;66(1):250–258.
40.
GibsonGESheuKFBlassJP. Reduced activities of thiamine-dependent enzymes in the brains and peripheral tissues of patients with Alzheimer’s disease. Arch Neurol. 1988;45(8):836–840.
41.
RavagliaGFortiPMaioliF. Folate, but not homocysteine, predicts the risk of fracture in elderly persons. J Gerontol A Biol Sci Med Sci. 2005;60(11):1458–1462.
42.
ShaharDLeviMKurtzI. Nutritional status in relation to balance and falls in the elderly: a preliminary look at serum folate. Ann Nutr Metab. 2009;54(1):59–66.
43.
TalwarDDavidsonHCooneyJStJRD. Vitamin B(1) status assessed by direct measurement of thiamin pyrophosphate in erythrocytes or whole blood by HPLC: comparison with erythrocyte transketolase activation assay. Clin Chem. 2000;46(5):704–710.
44.
HerveCBeynePDelacouxE. Determination of thiamine and its phosphate esters in human erythrocytes by high-performance liquid chromatography with isocratic elution. J Chromatogr B Biomed Sci Appl. 1994;653(2):217–220.
45.
WilkinsonTJHangerHCGeorgePMSainsburyR. Is thiamine deficiency in elderly people related to age or co-morbidity?Age and Ageing. 2000;29(2):111–116.
