Influence Of Iron-Deficiency Anemia on Cognitive Functions of 5th-Year Students

Authors: Yuliia Kysylychak, Viktoriia  Drozd

Scientific advisor: Viktoriia Drozd

Department of Internal Medicine, Professional diseases and Clinical Pharmacology Bukovinian State Medical University

Introduction. The deficit  of iron is the  most  common pathological condition throughout the world. The WHO reports that more than 30% of the population suffers from iron deficit, and it is more than  2 million people. Iron deficiency  anemia is the clinical and hematological syndrome the base of which is decrease of hemoglobin synthesis as a result of low iron amount in organism. It can be observed during different physiological and pathological conditions.

Daily requirement of iron is 10  mg for men  and 15  mg for women.  This amount is usually compensated by normal and balanced diet,  which  brings us  nearly 12-20 g of iron  per  day. Physiological loss of iron is 1mg per day. So deficit of iron is always the reason of chronic prevalence of element loss over its income.

The  reasons of iron  deficit  may be  many conditions: chronic  bleeding, disturbance of  its absorption, disturbance of  its transport, helminthiasis, high  iron  demand (pregnancy, puberty period)  and alimentary factors. In our investigation we took  into consideration only the  cases in which the reason of iron-deficiency anemia was the violation of diet. Other conditions that can cause iron deficit were excluded.

Aim of research. The aim of the research was to find the frequency of alimentary iron-deficient anemia among 5-year students of Bukovinian state medical university and to examine their cognitive functions in case of anemia.

Materials and methods. We took in to the investigation 63 students, who signed up informed agreement for participation in it. All the students were considered to have  no other  pathology that can cause iron-deficiency anemia. All the participants were asked up with the questionnaire, which we made up using  specific questions, which helped to estimate their daily diet. Questionnaire has

14 questions, every of which was estimated from 1 to 4 points. Diet could be determined as “good,” “satisfactory”, “poor” and “very poor”. ROC-analysis showed that  questionnaire was valid.

After that,  the content of serum iron and the rates of complete blood count  in students were investigated. The blood samples were taken according to the standard method from the finger and elbow, once in the morning, in the amount of 5 ml to determine the serum iron level by reaction with ferrosine without  deproteinization on  the  basis of the  laboratory of the  Department of Internal Medicine, Clinical Pharmacology and Occupational Diseases. The evaluation of the status of iron in the  body was carried out  by comparing the  values we get  with reference values. The serum iron norm  according to the  laboratory is 9.0-30.0 μmol/l. The norm for hemoglobin is 120-140 g/l for women,  130-150 g/l for men.  The norm  of erythrocytes is for women  3.7-4.7∙1012/l, for men  4.0- 5.1∙1012/l.

All the students were tested to determine the cognitive impairment – assessment of attention and memory. For this purpose we used: Münsterberg’s test for selectivity of attention, Burdon’s test for determination of concentration, stability and switching attention, test of estimation of operative memory, Kraepelin’s counting test in modification of Schulte with forms in Kurochkin’s modification for definition  of mental efficiency. The obtained data were then  compared, the relationship between the type of food and the presence of anemia was determining and the impact of anemia on the state of cognitive function  was determining.

The statistical processing of the obtained results was carried out using the software Microsoft Excel 2013. The distribution of samples were checked for normality using the Shapiro-Wilk criterion. The  samples that  had  a normal distribution were  checked using  the  parametric method, the Student’s t-criterion for independent samples. Correlation dependence was checked using  the Pearson coefficient.

Results. The results of survey are next: the nutritional status “good” set in 3 persons (4.7%), “satisfactory” in 33  persons (52.4%),  “poor” in 23  persons (36.6%)  and “very poor” in 4 persons (6.3%).  Also among the  respondents 14  people marked up  regular sports (2-3 times a week), between them 3 persons had a “good” nutrition status and 11 –  “satisfactory”.  Consequently, excessive physical activity could not be the cause of iron deficiency  in the data studied by the normal entry of the element into the body.

Among  the  examined  students, the  blood  iron  level  below  9.0  was found  in 22  (34.9%) students (Fe = (7.33 ± 0.32) μmol/l; Hb = (110.5±1.4) g/l; RBC=(3.8±0.04)∙1012/ L; CI = 0.83 ± 0.012, of which 4 persons had  nutrition  set up as “very poor”, and 18  – “poor”. In this case, those students whose  diet was “very poor” had scores lower than  in the group with “poor” diet (Fe = (4.94 ± 0.19) μmol /l and Fe=(7.8±0.2) μmol/l respectively). In all 22 students, cognitive abilities were reduced, namely:

1. Munsterberg’s test – 16±0.29 words.

2. Burdon’s Test:

• Concentration of attention – 38.77±1.12%;

• Stability of attention – 5.5±0.22;

• Switching attention – 69.09 ±1.26%.

3. Kraepelein’s test (in Schulte’s modification) – 0.62±0.025.

4. Score  of operative memory  – 25.5±0.52 correct sums.

Studying  the  dependence of cognitive  functions and the  level  of serum iron,  we  marked positive  correlation (r = 0.768; p <0.05).

The rest of the students (41 persons – 65.1%) have blood parameters within the normal range: Fe=(16.26±0.7) μmol/l; Hb=(144.3 ± 2) g/l; RBC=(4.42±0.03)∙1012/l; CI = 0.93±0.007. Among them,   the  state of  nutrition   “good”  was found  in  3  persons (7.3%)  – Fe=28.68±1,6 μmol/l; “satisfactory” in  33persons (80.5%)   – Fe=15.98 ±0.59 μmol/l; “poor” in  5persons (12.2%)  – Fe=10.7±0.3 μmol/l.

Results of cognitive tests were above average:

1. Munsterberg’s test – 23.2±0.2 words.

2. Burdon’s Test:

• Concentration of attention – 81.8±1.5%;

• Stability of attention – 15.8±0.29;

• Switching attention – 25.6±2.1%.

3. Kraepelein’s test (in Schulte’s modification) – 0.93 ± 0.005.

4. Score  of operative memory  – 36.7 ± 0.39 correct sums.

Conclusions. 1.The results of our investigation show that  alimentary iron-deficiency anemia is a very frequent pathology and is observed in more than  a third of examined students.

2.  Chronic  hypoxia and  lack  of iron  cause violation  of neuron metabolism,  disturbance  of synthesis of neurotransmitters and inhibition of synapses formation.

3. All these factors are the direct reasons of cognitive dysfunction, which can lead to low level of study and learning.

4. Correction of diet is a simple way to prevent development of iron-deficiency anemia.

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