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Vitamin B12 Deficiency in the Nonanemic Elderly

To the Editor:-A recent article' and subsequent correspondence emphasize the present dilemma in defining the significance of BI2 deficiency in the elderly. We wish to report our experience using periodic screening at a retirement community for the elderly. The community consists of 86 individuals with a mean age of 87 years. The institutional policy is to conduct an annual examination on all residents. For the past 12 months, a radioimmunoactive BI2 determination has been included as part of the periodic screening examination. Five residents were receiving BI2 at the time of initiation of the study. Five of the 81 residents screened were found to have low values (75,95, 134,153,255 pg/mL, respectively). The normal value for this determination is 249 to 749 pg/mL. None of these individuals (age 82 to 91 years) was anemic at the time the low BI2 value was found. In all there were other clinical findings consistent with BI2 deficiency. This included macrocytosis (one patient), dementia (one patient), or peripheral neurologic findings such as reflex or posterior column changes (three patients). In these individuals, confirmatory findings such as a Schilling test or antibodies to gastric instrinsic factor were not performed except in one patient who had negative antibodies. We believed that the low BI2 value in these nonanemic patients with other findings consistent with BI2 deficiency warranted treatment. In the individual with macrocytosis, (MCV