The relationship of the use of drugst that disturb the metabolism of vitamin B12 and mild cognitive disorders in patients in primary health care

[M. Ž. Glišić]

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Uvod Dosadašnja istraživanja jesu utvrdila postojanje povezanosti između primene pojedinih medikamenata i deficita vitamin V12, ali mnoge činjenice kao što su potencijalni sinergistički uticaji lekova, prilagođena aspolutna magnituda farmakološkog dejstva kao i tačna patogenetska veza relevantnih molekularnih puteva dejstava lekova, metabolizma vitamina V12 i kognitivnih oštećenja još uvek nisu dovoljno poznate. Metod Istraživanje je sprovedeno iz dva dela pri čemu je prvi deo dizajniran kao studija sekularnog trenda propisivanja lekova i obolevanja na nacionalnom nivu koji testira hipotezu o povezanosti propisivanja lekova koji remete metabolizam vitamina i drugih nutricijenasa koji posledično utiču na pojavu kognitivnih poremećaja, primarno vitamina V12, dok je drugi deo dizajniran kao studija slučaj-kontrola gde su slučajevi bolesnici u primarnoj zdravstvenoj zaštiti kod kojih je skrinig testom detektovan kognitivni poremećaj. Rezultati Dobijeni rezultati analize sekualarnog trenda ukazuju da postoji značajna korelacija obolevanja od kognitivnih poremećaja na teritoriji Republike Srbije i upotrebe medikamenata koji remete metabolizam vitamina V12. Rezultati studije slučaj kontrola potvrđuju početnu hipotezu, prvo da postoji veza između kognitivnog poremećaja i deficita vitamina V12 kod pacijenata u opštoj populaciji na nivou primarne zdravstvene zaštite i drugo, da je istovremeno prisutna i povezanost sa upotrebom lekova za koje se zna ili pretpostavlja da utiču na metabolizam nuticijenasa važnih za morfološko-funkcionalni integritet nervnog tkiva: vitamina V12, V1 i folne kiseline. Zaključak Rezultati naše studije bi mogli da budu doprinos planiranju i sprovođenju daljih istraživanja, ciljanog dizajna, u oblasti kliničke i eksperimentalne medicine i javnog zdravlja.

Introduction Previous research has found an association between the use of certain medications and vitamin B12 deficiency, but many facts such as potential synergistic effects of drugs, adjusted absolute magnitude of pharmacological action as well as the exact pathogenetic link of relevant drug molecular pathways, vitamin B12 metabolism and cognitive impairment they are not known enough. Method The research was conducted in two parts, the first part being designed as a study of the secular trend of prescribing drugs and diseases at the national level, which tests the hypothesis of the connection between prescribing drugs that disrupt the metabolism of vitamins and other nutrients that affect cognitive disorders, primarily vitamin B12 the second part is designed as a case-control study where the cases are patients in primary health care in whom a cognitive impairment was detected by a screening test. Results The obtained results of the analysis of the secular trend indicate that there is a significant correlation between cognitive disorders in the territory of the Republic of Serbia and the use of drugs that disrupt the metabolism of vitamin B12. The results of the case-control study confirm the initial hypothesis, first, that there is a link between cognitive impairment and vitamin B12 deficiency in patients in the general population at the primary health care level, and second, that there is an association with the use of drugs known or suspected to affect metabolism of nutrients important for the morphological and functional integrity of nervous tissue: vitamins B12, B1 and folic acid. Conclusion The results of our study could be a contribution to the planning and implementation of further research, targeted design, in the field of clinical and experimental medicine and public health.

Demencija, vitamin V12, cijankobalamin, kognitivni poremećaj

Dementia, vitamin B12, cobalamin, cognitive impairment.

615.214(043.3)

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