Oleh admin kalbemed pada November 27, 2017 06:00

Apakah Vitamin B12 dapat Mencegah Penurunan Fungsi Kognitif Pasien Lansia Diabetik?

Diabetes melitus dikaitkan dengan infark lakunar, stroke dan demensia vaskular serta penyakit Alzheimer. Mekanismenya tidak diketahui dengan pasti tetapi diduga berhubungan dengan amiloid dan metabolisme protein. Selain itu, penyakit serebrovaskuler mempuyai efek tambahan yang kuat pada fungsi kognitif penyakit Alzheimer.

Pasien lansia dengan diabetes mempunyai risiko tinggi terjadi penurunan fungsi kognitif. Dari suatu penelitian selama 18 bulan, 16% subyek diabetes yang berusia lebih dari 75 tahun menunjukkan penurunan fungsi kognitif yang bermakna. Pada saat yang bersamaan, penderita diabetes juga mempunyai risiko defisiensi vitamin B12 yang lebih tinggi karena penggunaan metformin. Risiko defisiensi vitamin B12 semakin meningkat seiring dengan bertambahnya usia, yang disebabkan karena gastritis atrofi dan malabsorpsi intestinal.

Vitamin B12 adalah koenzim unuk sintesis S-adenosylmethionine yang merupakan donor methyl universal, terlibat dalam sintesis neurotransmiter, fosfolipid dan mielin di otak, serta defisiensi vitamin B12 memicu produksi amiloid. Terdapat bukti epidemiologi yang menyebutkan bahwa defisiensi vitamin B12 berkaitan dengan gangguan kognitif dan penyakit Alzheimer. Menariknya, satu penelitian Cohort pada lansia non-demented ditemukan peningkatan relative risk dari penyakit Alzheimer akibat defisiensi vitamin B12 yang lebih besar dibandingkan dengan fungsi kognitif sebelumnya.

Ada beberapa penelitian sebelumnya yang telah meneliti efek suplementasi vitamin B12 pada fungsi kognitif lansia. Dari penelitian acak, tersamar ganda pada pasien lansia dengan defisiensi vitamin B12 ringan yang diberikan suplementasi vitamin B12 dengan atau tanpa folat tidak menunjukkan hasil perbaikan yang bermakna pada tes neuropsikologikal setelah 6 bulan. Oleh karena itu, dilakukan penelitian dengan tujuan untuk menilai efek suplementasi vitamin B12 terhadap risiko penurunan kognitif pada lansia dengan diabetes yang disertai dengan defisiensi vitamin B12. Desain dan metodenya adalah dengan mengumpulkan pasien diabetik non-demented yang berusia di atas 70 tahun dan mempunyai kadar vitamin B12 plasma anatar 150-300 μmol/L sebanyak 271 kemudian subyek diacak menjadi 2 kelompok. Kelompok perlakuan mendapatkan methylcobalamin 1000 mcg dalam sehari selama 27 bulan dan kelompok kontrol mendapatkan plasebo. Semua subyek diikuti sampai bulan ke-9 dan ke-27.  Parameter primer yang dinilai adalah penurunan kognitif. Yang dimaksud dengan penurunan kognitif adalah peningkatan clinical dementia rating scale (CDR). Sedangkan parameter sekunder yang dinilai adalah neuropsychological test battery (NTB) z-scores, serum methymalonic acid (MMA) dan homosistein. Hasilnya menunjukkan pada bulan ke-9 dan 27 terjadi penurunan serum MMA dan homosistein secara bermakna pada kelompok perlakuan dibandingkan plasebo (p<0,0001). Sedangkan pada bulan ke-27, tidak ada perubahan pada CDR dan NTB z-scores pada kedua kelompok. (LAI)

Image: Ilustrasi
Referensi:
1. Timothy K, Jenny L, Ronald CM, Samuel YW, Kenny K, Augustine LH, et al. A randomized placebo controlled trial of vitamin B12 supplementation to prevent cognitive decline in cognitively normal older diabetic people with borderline low serum vitamin B12. Clinical Nutrition. 2016. doi: 10.1016/j.clnu.2016.10.018.
2. Malouf R, Areosa SA. Vitamin B12 for cognition. Cochrane Database Syst Rev 2003:3.CD004326.

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