Should testing for vitamin B12 deficiency be part of a standard geriatric workup? Should methylmalonic acid (MMA) and folic acid tests be included in that lab work? — Anna Rufo, MSN, McMinnville, Ore.

The evaluation of any patient should be focused and evidence-based. If you are concerned an older adult is experiencing signs of dementia, there are several diagnostic tests that will help identify some treatable causes that should not be missed.


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This would include a complete blood count (to rule out anemia or possible infection), serum chemistries and thyroid and liver functions tests to rule out a metabolic disorder. Vitamin B12 and folic acid may be deficient in an older adult and can be treated easily with appropriate supplementation.

MMA and homocysteine should be considered if the vitamin B12 level is at the lower end of normal. These are just a few of the diagnostic considerations. Further information and resources are available online from Hartford Institute for Geriatric Nursing. — Deborah L. Cross, MPH, CRNP, ANP-BC (164-3)

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