[Folate/cobalamin in the elderly--deficiency symptoms are common and difficult to catch]

Elderly persons are especially exposed to folate deficiency, whereas normal/subnormal folate levels do not exclude tissue deficiency. Accompanying diseases, medication, and life style factors may contribute to/cause deficiency. Among available determinants of folate/cobalamin state homocysteine is a swift and sensitive marker. Symptoms of deficiency can be haematological, neurological or neuropsychiatric but there are probably also cardio-vascular manifestations. The association is generally stronger between homocysteine levels and symptoms than between vitamin-related levels and symptoms. The duration and the severity of symptoms are of importance for the improvement of neurological and neuropsychiatric symptoms when substitution is performed. The physician should make an individualized investigation to establish the probable cause, where nutritional factors and atrophic gastritis are most prominent. Folate enriched food as well as multivitamin supplementation are reported to be safe and beneficial for blood folate and homocysteine normalisation.