Low blood folate levels may be linked to increased risk of dementia and death in older adults

Low blood levels of folic acid (vitamin B9) may be associated with an increased risk of dementia and death from any cause in older adults, according to a study published online in the journal Evidence Based Mental Health

Folate levels should be regularly monitored and folate deficiency corrected in older adults, especially given that blood folate levels tend to decline with age, and it is estimated that as many as one in five older adults have folate, the researchers said.

Evidence to date suggests that folate deficiency affects cognition and neural signaling in the brain, which may be a risk factor for subsequent dementia

But the few studies that have addressed this question have involved only a small number of participants, with mixed results

They added that because dementia takes time to develop, it is difficult to rule out reverse causality, meaning that folate deficiency may be a consequence of preclinical dementia, rather than a cause

Therefore, they hoped to see whether serum folate deficiency was associated with dementia and risk of death from any cause in a large national sample of older adults, including a potential role for reverse causality

They collected the medical records of 27,188 people serving in a state medical facility in Israel

Until the end of 2017, their records were being monitored for dementia or death

About 3418 participants (just under 13%) had folate deficiency, defined as folate levels below 4.

In the folic acid-deficient population, the incidence of dementia was estimated at 7.

In comparison, among those without folate deficiency, the estimated incidence of dementia per 10,000 people was 4.

In terms of percentages, among people with folate deficiency, the incidence of dementia is close to 3.

After taking into account potential contributing factors including diabetes, depression, cognitive decline, vitamin B12 deficiency, smoking, and taking folic acid supplements, people with folic acid deficiency were 68 percent more likely to be diagnosed with dementia and to die Any cause was nearly 3 times more likely

Further analysis did not significantly weaken the observed associations, but reverse causality cannot be ruled out when stratified by length of monitoring period

The researchers acknowledge that this is an observational study, so a cause cannot be established, especially given the potential role of reverse causality

However, folate deficiency may affect homocysteine ​​levels, leading to the risk of vascular dementia, and/or disrupt DNA repair in neurons, making them vulnerable to oxidative damage, thereby accelerating the aging and damage of brain cells, they explain say

They concluded that "serum folate concentrations may serve as a biomarker for modifying the risk of dementia and death
.
" They added that older adults should be routinely screened for folate deficiency
.

"The implications for public health policy appear to be reliable monitoring of serum folate concentrations in older adults as part of preventive measures and/or implemented treatment strategies, along with periodic review of patients' clinical outcomes," they wrote
.