Some dementias are reversible. You just need to recognise the clues

Part 3 of How to Prevent Dementia

Here’s a quick quiz question for you. What do laughing gas and a vegan diet have in common?

The answer is dementia and permanent damage to the central nervous system if the source of problem – vitamin B12 deficiency – is not addressed in time.

No laughing matter

Nitrous oxide was originally used as a medical anaesthetic in the late 1700s. Today, it is commonly known as laughing gas and in 2019 was listed as one of the top ten recreational drugs in the world.

Laughing gas is hugely popular among young people. It gives the user a euphoric high, accompanied by a numbing analgesic effect. Less noticeable is the way it inactivates vitamin B12. It appears that the effect is dose-dependent: the more you use, the more depleted you become.

So popular is the gas, and so dangerous the effects, that doctors at a London hospital have drawn up treatment guidelines to prevent the long-term side effects of vitamin B12 deficiency, and all the neurological damage that comes with it.

Vitamin B12 is crucial to the healthy functioning of the central nervous system. It is involved in the formation of the myelin sheath, a fatty, protective layer that wraps around the nerve. It is this myelin sheath that deteriorates without B12.

If the situation continues unchecked, you can expect to experience difficulty walking, and tingling and numbness in the hands and feet. And if you’re not careful, myelopathy. Myelopathy is a general term for degeneration of the spinal cord. If caught in time, it can be reversed. If not, the outcome is permanent pain and disability.

Young people are regularly turning up in hospital after inhaling rather too much nitrous oxide. A typical case was reported in the medical literature in 2022. A 34-year old man was taken to the emergency department feeling weak, disorientated, unable to walk, confused, and making “non-sensical talk”. It transpired that he had been inhaling large quantities of nitrous oxide, and tests revealed he was severely vitamin B12 deficient. He was given B12 immediately, and by the following day was already more coherent. By day six he was much improved and orientated, and discharged from hospital.

“On the rise due to its effects of euphoria, recreational use of nitrous oxide can cause severe neurologic symptoms caused by marked and rapid onset of vitamin B12 deficiency.”

Memory loss and confusion are among the early clues. Memory loss can eventually turn into dementia. Fortunately, this is a form of dementia that if detected early enough can be fully reversible.

B12 deficiency dementia is sometimes referred to as pseudodementia. It can strike even at a young age and is often accompanied by psychiatric issues, including depression, bipolar disorder, delirium, acute psychosis and, rarely, schizophrenia. Low B12 is detected in approximately 20% of psychiatric patients.

In 2011, scientists reported the case of a 27-year-old man who found himself in a hospital psychiatric ward after a year of experiencing forgetfulness, social withdrawal, apathy, poor self-care and weight loss. He was given anti-psychotic medication, but this had minimal effect and eventually he was referred to a neurology outpatient clinic. All the tests were negative – until serum vitamin B12 was measured and found to be “markedly diminished.” He was diagnosed with subacute combined degeneration of the spinal cord, due to vitamin B12 deficiency, and given intramuscular B12 injections. Luckily for him, the cause of his symptoms was discovered just in time and “His psychological and neurological symptoms improved completely over the next 3–4 months”.

Laughing gas was not the cause of this young man’s vitamin B12 deficiency. It was his diet.

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