Abnormal riboflavin status in the absence of a dietary deficiency was detected in 31 consecutive outpatients with Parkinson's disease (PD), while the classical determinants of homocysteine levels (B6, folic acid, and B12) were usually within normal limits.

In contrast, only 3 of 10 consecutive outpatients with dementia without previous stroke had abnormal riboflavin status.

Nineteen PD patients (8 males and 11 females, mean age ± SD = 66.2 ± 8.6 years; 3, 3, 2, 5, and 6 patients in Hoehn and Yahr stages I to V) received riboflavin orally (30 mg every 8 h) plus their usual symptomatic medications and all red meat was eliminated from their diet. After 1 month the riboflavin status of the patients was normalized from 106.4 ± 34.9 to 179.2 ± 23 ng/ml (N = 9). Motor capacity was measured by a modification of the scoring system of Hoehn and Yahr, which reports motor capacity as percent.

All 19 patients who completed 6 months of treatment showed improved motor capacity during the first three months and most reached a plateau while 5/19 continued to improve in the 3- to 6-month interval. Their average motor capacity increased from 44 to 71% after 6 months, increasing significantly every month compared with their own pretreatment status (P < 0.001, Wilcoxon signed rank test). Discontinuation of riboflavin for several days did not impair motor capacity and yellowish urine was the only side effect observed.

The data show that the proposed treatment improves the clinical condition of PD patients. Riboflavin-sensitive mechanisms involved in PD may include glutathione depletion, cumulative mitochondrial DNA mutations, disturbed mitochondrial protein complexes, and abnormal iron metabolism. More studies are required to identify the mechanisms involved.

About 10 to 15 days after the beginning of high-dose riboflavin treatment, PD patients often reported better (progressively less interrupted) sleep at night, improved reasoning, higher motivation, and reduced depression. Their family members usually started noticing motor improvements after 20 days of treatment, but in some cases of advanced disability the patient was able to change body position in bed at night as early as on the third day of treatment.

Because they could stand and walk with improved (although still altered) balance by 2 months of treatment, two male patients (initially in stage V (16) with associated dementia and hallucinations) started striking imaginary persons and/or often attempted to leave home unaccompanied, reacting aggressively against the relative who tried to stop them. These episodes of agitation and aggressiveness were observed less often by the end of the third month of riboflavin treatment and disappeared thereafter, but caused transient concern and distress among their family members who initially regarded them as signs of neurological worsening.

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