Demir eksikliği anemisi olan yetişkinlerde yürütücü işlevler ve psikiyatrik bozukluklar

Year 2023, Volume: 48 Issue: 2, 394 - 401, 02.07.2023

Yavuz Yılmaz , Hatice Terzi , Burak Taşova

https://doi.org/10.17826/cumj.1252790

Cited By: 1

Abstract

Amaç: Demir eksikliğinin çoğunlukla hematolojik komplikasyonlarına odaklanılmış, hematolojik olmayan komplikasyonlar ise daha az araştırılmıştır. Bilişsel fonksiyonlar üzerine etkileri ise çoğunlukla çocuk ve ergen grubunda araştırılmıştır. Çalışmamızda demir eksikliği anemisi tanısı almış yetişkinlerde eşlik eden psikiyatrik bozukluk olup olmadığını ve sağlıklı kontrollere kıyasla yürütücü işlevlerini değerlendirmeyi amaçladık.
Gereç ve Yöntem: Demir eksikliği anemisi tanısı konulmuş 42 hasta ve 44 sağlıklı kontrol çalışmaya dahil edildi. Katılımcılara, psikiyatrik bozukluk varlığı araştırmak için DSM-5 Klinisyen Versiyonu için Yapılandırılmış Klinik Görüşme uygulandı. Yürütücü işlevleri değerlendirmek için Stroop testi ve sayı dizisi öğrenme testi kullanıldı.
Bulgular: Demir eksikliği anemisi grubunda kontrol grubuna kıyasla Stroop test bölüm 1-5 tamamlama süreleri daha uzundu. Düzeltme ve hata sayıları özelinde değerlendirildiğinde sonuçlar benzerdi. Sayı dizisi öğrenme testi puanları arasında farklılık izlenmedi. Demir eksikliği anemisi grubunda toplam 18 katılımcıda (%43) psikiyatrik bozukluk tespit edilirken bu sayı kontrol grubunda 6 (%13.6) idi. Eşlik eden psikiyatrik hastalık yönünden değerlendirildiğinde gruplar arasında farklılık izlendi.
Sonuç: Bulgularımız demir eksikliği anemisi olan kişilerin yürütücü işlevler yönünden sağlıklı kontrollere göre daha kötü performans sergileyebileceğini ve psikiyatrik hastalık görülme sıklığının da bu grupta daha fazla olabileceğini göstermektedir. Demir eksikliği anemisinin sağlıkla ilgili sonuçlarının kapsamlı şekilde ele alınması son derece önemlidir.

Keywords

Demir eksikliği, anemi, yürütücü işlevler, psikiyatrik bozukluklar

Executive functions and psychiatric disorders in adults with iron deficiency anemia

Abstract

Purpose: The focus has been on the hematological complications of iron deficiency, while the nonhematological complications have been less studied. Its effects on cognitive functions were mostly investigated in children and adolescents. The purpose of this study is to compare the executive functioning of persons with iron deficiency anemia to healthy controls in order to determine whether they have any comorbid psychiatric disorders.
Materials and Methods: 42 patients with iron deficiency anemia and 44 healthy controls participated in this study. To investigate whether any psychiatric disorders existed, the individuals were given a Structured Clinical Interview for DSM-5 Clinician's Version. Executive functioning was assessed using the Stroop Test and the Number Sequence Learning Test.
Results: When compared to the control group, the IDA group took longer on average to complete parts 1–5 of the Stroop Test. There was no difference between the groups with regards to the results of number sequence learning test. Psychiatric illnesses were more common (43%) in the IDA group than they were in the control group (13.6%). The difference was significant when the groups were compared in terms of psychiatric disorders.
Conclusion: According to the study's findings, those with iron deficiency anemia have worse executive functioning scores than healthy controls and are more likely to have psychiatric disorders. An extensive assessment of the health consequences of iron deficiency anemia is extremely important.

Keywords

iron deficiency, anemia, executive functions, psychiatric disorders

References

• Snook J, Bhala N, Beales ILP, Cannings D, Kightley C, Logan RP et al. British society of gastroenterology guidelines for the management of iron deficiency anaemia in adults. Gut. 2021;70:2030-51.
• Petry N, Olofin I, Hurrell RF, Boy E, Wirth JP, Moursi M et al.The proportion of anemia associated with iron deficiency in low, medium, and high human development index countries: A systematic analysis of national surveys. Nutrients. 2016;8:693.
• Kassebaum NJ, Jasrasaria R, Naghavi M, Wulf SK, Johns N, Lozano R et al. A systematic analysis of global anemia burden from 1990 to 2010. Blood. 2014;123:615-24.
• Agarwal R. Nonhematological benefits of iron. Am J Nephrol. 2007;27:565-71.
• Musallam KM, Taher AT. Iron deficiency beyond erythropoiesis: should we be concerned? Curr Med Res Opin. 2018;34:81-93.
• Lopez A, Cacoub P, Macdougall IC, Peyrin-Biroulet L. Iron deficiency anaemia. Lancet. 2016;387:907-16.
• Pompano LM, Haas JD. Increasing iron status through dietary supplementation in iron-depleted, sedentary women increases endurance performance at both near-maximal and submaximal exercise intensities. J Nutr. 2019;149:231-39.
• Perçinel İ, Yazıcı KU. Iron deficiency in the pathophysiology of attention deficit hyperactivity disorder. Current Approaches in Psychiatry. 2015;7:41–55.
• Lozoff B, Beard J, Connor J, Barbara F, Georgieff M, Schallert T. Long-lasting neural and behavioral effects of iron deficiency in infancy. Nutr Rev. 2006;64:34-43.
• Falkingham M, Abdelhamid A, Curtis P, Fairweather-Tait S, Dye L, Hooper L. The effects of oral iron supplementation on cognition in older children and adults: A systematic review and meta-analysis. Nutr J. 2010;25:9:4.
• Hermoso M, Vucic V, Vollhardt C, Arsic A, Roman-Viñas B, Iglesia-Altaba I et al. The effect of iron on cognitive development and function in infants, children and adolescents: A systematic review. Ann Nutr Metab. 2011;59:154-65.
• Qubty W, Renaud DL. Cognitive impairment associated with low ferritin responsive to iron supplementation. Pediatr Neurol. 2014;51:831-3.
• Greig AJ, Patterson AJ, Collins CE, Chalmers KA. Iron deficiency, cognition, mental health and fatigue in women of childbearing age: A systematic review. J Nutr Sci. 2013;29:2:e14.
• Fernandez-Jimenez MC, Moreno G, Wright I, Shih PC, Vaquero MP, Remacha AF. Iron deficiency in menstruating adult women: Much more than anemia. Womens Health Rep (New Rochelle). 2020;1:26-35.
• Wenger MJ, Murray-Kolb LE, Nevins JE, Venkatramanan S, Reinhart GA, Wesley A et al. Consumption of a double-fortified salt affects perceptual, attentional, and mnemonic functioning in women in a randomized controlled trial in India. J Nutr. 2017;147:2297-308.
• Scott SP, Murray-Kolb LE, Wenger MJ, Udipi SA, Ghugre PS, Boy E et al. Cognitive performance in indian school-going adolescents is positively affected by consumption of iron-biofortified pearl millet: A 6-month randomized controlled efficacy trial. J Nutr. 2018;148:1462-71.
• Sharief SM, Shaik AP, Parveen SA, Hussain SM. Correlation of iron deficiency anemia with cognitive function in young adults. IOSR Journal of Dental and Medical Sciences. 2019;18:47-54.
• Chen MH, Su TP, Chen YS, Hsu JW, Huang KL, Chang WH et al. Association between psychiatric disorders and iron deficiency anemia among children and adolescents: A nationwide population-based study. BMC Psychiatry. 2013;13:161.
• Shafi M, Taufiq F, Mehmood H, Afsar S, Badar A. Relation between depressive disorder and Iron deficiency. Anemia among adults reporting to a secondary healthcare facility: A hospital-based case control study. J Coll Physicians Surg Pak. 2018;28:456–59.
• Semiz M, Uslu A, Korkmaz S, Demir S, Parlak I, Sencan M et al. Assessment of subjective sleep quality in iron deficiency anaemia. Afr Health Sci. 2015;15:621-27.
• Demirci K, Yildirim Baş F, Arslan B, Salman Z, Akpinar A, Demirdaş A. The investigation of symptoms and diagnoses of adult-attention deficit/ hyperactivity disorder in women with iron deficiency anemia. Noro Psikiyatr Ars. 2017;54:72-77.
• Lee HS, Chao HH, Huang WT, Chen SC, Yang HY. Psychiatric disorders risk in patients with iron deficiency anemia and association with iron supplementation medications: A nationwide database analysis. BMC Psychiatry. 2020;20:216.
• TÜİK, Adrese Dayalı Nüfus Kayıt Sistemi Sonuçları, 2022. Erişim: 15.03.2023. https://www.tuik.gov.tr/
• First MB, Williams JB, Karg RS, Spitzer RL. User's guide for the SCID-5-CV structured clinical interview for DSM-5® disorders: Clinical version. American Psychiatric Publishing, Inc. 2016.
• Elbir M, Alp Topbaş Ö, Bayad S, Kocabaş T, Topak OZ, Çetin Ş et al. DSM-5 bozuklukları için yapılandırılmış klinik görüşmenin klinisyen versiyonunun türkçeye uyarlanması ve güvenilirlik çalışması. Turk Psikiyatri Derg. 2019;30:51-56.
• Stroop J. R. Studies of interference in serial verbal reactions. J. Exp. Psychol. 1935;18:643–62.
• Karakaş S, Erdoğan E, Soysal AŞ, Ulusoy T, Ulusoy İ, Alkan S. “Stroop Testi TBAG Formu: Türk kültürüne standardizasyon çalışmaları,” Klinik Psikiyatr. Derg. 1999;2:75–88.
• Zangwill OL. Clinical tests of memory impairment. Proc R Soc Med 1943;36:576-80.
• Karakaş S, Erdoğan Bakar E, Doğutepe Dinçer E. Nöropsikolojik testlerin yetişkinler için araştırma ve geliştirme çalışmaları: BİLNOT-Yetişkin (Cilt I). Konya, Eğitim Yayınevi, 2013a.
• Karakaş S, Erdoğan Bakar E, Doğutepe Dinçer E. Nöropsikolojik testlerin yetişkinler için araştırma ve geliştirme çalışmaları: BİLNOT-Yetişkin (Cilt II). Konya, Eğitim Yayınevi, 2013b.
• Tamura T, Goldenberg RL, Hou J, Johnston KE, Cliver SP, Ramey SL et al. Cord serum ferritin concentrations and mental and psychomotor development of children at five years of age. J Pediatr. 2002;140:165-70.
• Sandstead HH, Frederickson CJ, Penland JG. History of zinc as related to brain function. J Nutr. 2000;130:496–502.
• Atamna H, Walter PB, Ames BN. The role of heme and iron-sulfur clusters in mitochondrial biogenesis, maintenance, and decay with age. Arch Biochem Biophys. 2002;397:345–53.
• Georgieff MK. Long-term brain and behavioral consequences of early iron deficiency. Nutr Rev. 2011;69:43–48.
• Black MM. Micronutrient deficiencies and cognitive functioning. J Nutr. 2003;133:3927–31.
• MacLeod CM. Half a century of reseach on the stroop effect: An integrative review. Psychol Bull. 1991;109:163–203.
• Lambert A, Knaggs K, Scragg R, Metcalf P, Schaaf D. Effects of iron treatment on cognitive performance and working memory in non-anaemic, iron-deficient girls. New Zealand Journal of Psychology. 2002;31:19–28.
• Cook RL, O'Dwyer NJ, Parker HM, Donges CE, Cheng HL, Steinbeck KS et al. Iron deficiency anemia, not iron deficiency, is associated with reduced attention in healthy young women. Nutrients. 2017;9:1216.
• Drachman DA, Arbit J. Memory and the hippocampal complex. II. Is memory a multiple process?. Arch Neurol. 1966;15:52-61.
• Eslinger PJ, Grattan LM. Altered serial position learning after frontal lobe lesion. Neuropsychologia. 1994;32:729-739.
• Szajewska H, Ruszczynski M, Chmielewska A. Effects of iron supplementation in nonanemic pregnant women, infants, and young children on the mental performance and psychomotor development of children: A systematic review of randomized controlled trials. Am J Clin Nutr. 2010;91:1684–90.
• Hidese S, Saito K, Asano S, Kunugi H. Association between iron-deficiency anemia and depression: A web-based Japanese investigation. Psychiatry Clin Neurosci. 2018;72:513–21.
• König P, Jimenez K, Saletu-Zyhlarz G, Mittlböck M, Gasche C. Iron deficiency, depression, and fatigue in inflammatory bowel diseases. Z Gastroenterol. 2020;58:1191-1200.
• Leung W, Singh I, McWilliams S, Stockler S, Ipsiroglu OS. Iron deficiency and sleep - A scoping review. Sleep Med Rev. 2020;51:101274.