THIAMINE-DEFICIENCY IN HOSPITALIZED ELDERLY PATIENTS

Necropsy studies suggest that thiamine deficiency is underdiagnosed in life, in part because the classical clinical presentations are uncomm on. Anecdotal reports suggest that thiamine deficiency may contribute to the development of delirium, heart failure and peripheral neuropath y in elderly patients, but little systematic research has been reporte d. We examined thiamine levels in 36 consecutive non-demented, communi ty-dwelling patients admitted to an acute geriatric unit. Marginal thi amine deficiency [thiamine pyrophosphate effect (TPPE) 15-24%] was pre sent in 11 (31%) and definite thiamine deficiency (TPPE > 25%) in 6 (1 7%) patients. Delirium occurred in 6/19 (32%) patients with normal thi amine status and 13/17 (76%) thiamine-deficient patients (p < 0.025, c hi(2) test). One or more other possible causes for delirium were prese nt in all cases. One patient had ocular signs and a dramatic clinical response to vitamin B complex therapy. Absent ankle jerks were noted i n 2/19 (10%) patients with normal thiamine status and 7/17 (41%) patie nts with thiamine deficiency (p = 0.06). There was no difference in an thropometric indices or in the prevalence of other nutrient deficienci es between the two groups. Thiamine deficiency is common in elderly pa tients admitted to hospital and may contribute to the development of d elirium.