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Koike T, Kuzuya M, Kanda S, Okada K, Izawa S, Enoki H, Iguchi A. Raised homocysteine and low folate and vitamin B-12 concentrations predict cognitive decline in community-dwelling older Japanese adults. Clin Nutr 2008; 27:865-71. [DOI: 10.1016/j.clnu.2008.08.006] [Citation(s) in RCA: 15] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/28/2007] [Revised: 07/28/2008] [Accepted: 08/25/2008] [Indexed: 11/30/2022]
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Smith AD. The Worldwide Challenge of the Dementias: A Role for B Vitamins and Homocysteine? Food Nutr Bull 2008; 29:S143-72. [DOI: 10.1177/15648265080292s119] [Citation(s) in RCA: 147] [Impact Index Per Article: 9.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
Abstract
Dementia has reached epidemic proportions, with an estimated 4.6 million new cases worldwide each year. With an aging world population, the prevalence of dementia will increase dramatically in the next few decades. Of the predicted 114 million who will have dementia in 2050, about three-quarters will live in less developed regions. Although strongly age-related, dementia is not an inevitable part of aging but is a true disease, caused by exposure to several genetic and nongenetic risk factors. Prevention will be possible when the nongenetic risk factors have been identified. Apart from age, more than 20 nongenetic risk factors have been postulated, but very few have been established by randomized intervention studies. Elevated blood concentrations of total homocysteine and low-normal concentrations of B vitamins (folate, vitamin B12, and vitamin B6) are candidate risk factors for both Alzheimer's disease and vascular dementia. Seventy-seven cross-sectional studies on more than 34,000 subjects and 33 prospective studies on more than 12,000 subjects have shown associations between cognitive deficit or dementia and homocysteine and/or B vitamins. Biologically plausible mechanisms have been proposed to account for these associations, including atrophy of the cerebral cortex, but a definite causal pathway has yet to be shown. Raised plasma total homocysteine is a strong prognostic marker of future cognitive decline, and is common in world populations. Low-normal concentrations of the B vitamins, the main determinant of homocysteine concentrations, are also common and occur in particularly vulnerable sections of the population, such as infants and elderly. Large-scale randomized trials of homocysteine-lowering vitamins are needed to see if a proportion of dementia in the world can be prevented.
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Total serum homocysteine levels do not identify cognitive dysfunction in multimorbid elderly patients. J Nutr Health Aging 2008; 12:411-6. [PMID: 18548180 DOI: 10.1007/bf02982675] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 09/29/2022]
Abstract
OBJECTIVES Total blood homocysteine (Hcys) and folate levels have been investigated in association with cognitive dysfunction in healthy but not in multimorbid elderly patients. We hypothesized that total serum Hcys is an adequate marker to identify multimorbid elderly patients with cognitive dysfunction assessed by the Short Cognitive Performance Test (SKT) and Mini-Mental State Examination (MMSE). DESIGN Cross-sectional study. SETTING The study center was an acute geriatric hospital. PARTICIPANTS A total of 189 multimorbid elderly patients were recruited. METHODS Cognitive dysfunction was determined according to the SKT and MMSE. Biochemical parameters (Hcys, folate, vitamin B12, hemoglobin), nutritional status (BMI, Mini Nutritional Assessment, nutritional intake), and activities of daily living were assessed. RESULTS According to the SKT, 25.4% of patients showed no cerebral cognitive dysfunction, 21.2% had suspected incipient cognitive dysfunction, 12.7% showed mild cognitive dysfunction, 9.0% had moderate cognitive dysfunction, and 31.7% of patients were demented. The median plasma Hcys value was elevated by approximately 20% in multimorbid elderly patients, independent of cognitive dysfunction. Serum folate and vitamin B12 concentrations were within normal ranges. We did not find significant differences in nutritional status, activities of daily living, numbers of diseases or medications, or selected biochemical parameters between the SKT groups. CONCLUSION Elevated serum Hcys levels with normal plasma folate and vitamin B12 concentrations were observed in multimorbid elderly patients. The plasma Hcys level did not appear to be an important biological risk factor for cognitive dysfunction in multimorbid geriatric patients.
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Herrmann W, Obeid R. Biomarkers of folate and vitamin B(12) status in cerebrospinal fluid. Clin Chem Lab Med 2008; 45:1614-20. [PMID: 17892439 DOI: 10.1515/cclm.2007.310] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/01/2023]
Abstract
Folate and vitamin B(12) are essential cofactors for the methionine/homocysteine cycle in the brain. These vitamins mediate the remethylation of homocysteine (Hcy), which affects the production of the universal methyl donor, S-adenosylmethionine (SAM), in the brain among other organs. Additionally, increased plasma concentrations of total Hcy (tHcy) are associated with cerebrovascular disease and can compromise the blood-brain barrier. tHcy concentrations in the brain and cerebrospinal fluid become increased in several psychiatric and neurological disorders. Disturbances in the transmethylation pathway indicated by abnormal SAM, S-adenosylhomocysteine or their ratio have been reported in many neurodegenerative diseases, such as dementia, depression or Parkinson's disease. Cobalamin is essential for neuronal generation and its deficiency can cause degeneration of the nervous system. Available data emphasize that deficiency of folate and vitamin B(12) can lead to elevated concentrations of tHcy and disturbed methylation potential in the brain. Therefore, acquired or inherited disorders in these metabolic pathways are associated with brain abnormalities and severe neurological symptoms that are mostly irreversible, even after providing the missing cofactors. This review discusses the relationship between brain and blood levels of key vitamins and metabolites related to one carbon metabolism.
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Affiliation(s)
- Wolfgang Herrmann
- Department of Clinical Chemistry and Laboratory Medicine, Faculty of Medicine, University Hospital of Saarland, Homburg/Saar, Germany.
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Nilsson K, Gustafson L, Hultberg B. Homocysteine, cystatin C and N-terminal-pro brain natriuretic Peptide. Vascular risk markers in elderly patients with mental illness. Dement Geriatr Cogn Disord 2008; 25:88-96. [PMID: 18057891 DOI: 10.1159/000111994] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 09/21/2007] [Indexed: 12/26/2022] Open
Abstract
BACKGROUND There is increasing evidence that vascular disease contributes to cognitive impairment and dementia. Clarification of the role of vascular risk factors in dementia is important because most are modifiable, in contrast to other risk factors such as age and genetics. METHODS In 451 patients with mental illness we have investigated three biochemical markers related to vascular disease, total plasma homocysteine (tHcy), cystatin C, and N-terminal-pro brain natriuretic peptide (NT-proBNP), and their association with vascular disease, diagnoses, and brain imaging findings (CT). RESULTS Plasma tHcy, serum cystatin C, and serum NT-proBNP showed significantly increased frequencies of elevated levels in patients with vascular disease, in patients with a pathological CT finding indicating cerebrovascular disease, and in patients above 75 years of age. CONCLUSION It is possible that the control of conventional vascular risk factors and therapy could be guided by the level of plasma tHcy, serum cystatin C, and serum NT-proBNP. Patients with an elevation of any of these three parameters could be selected for a lower target level of risk factors such as blood pressure, hyperlipidemia etc. than conventional target levels.
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Affiliation(s)
- Karin Nilsson
- Department of Psychogeriatrics, Clinical Science Lund University Hospital, Lund, Sweden
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Vidal JS, Dufouil C, Ducros V, Tzourio C. Homocysteine, Folate and Cognition in a Large Community-Based Sample of Elderly People – The 3C Dijon Study. Neuroepidemiology 2008; 30:207-14. [DOI: 10.1159/000126914] [Citation(s) in RCA: 26] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/06/2007] [Accepted: 01/23/2008] [Indexed: 11/19/2022] Open
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Abstract
PURPOSE OF REVIEW Homocysteine and B vitamins have been investigated in association with cognitive dysfunction in healthy and in multimorbid elderly patients. Whether reduction of hyperhomocystemia is reducing the risk of dementia or Alzheimer's disease is still under investigation. RECENT FINDINGS High homocysteine concentrations are associated with poorer cognitive function but can be influenced by a number of factors. The results of epidemiological studies are inconsistent in showing an association between elevated homocysteine levels and dementia or Alzheimer disease. Although prospective studies show a trend towards a benefit of homocysteine-related B vitamin substitution, consistent data are expected from upcoming clinical intervention trials. Data from recent clinical randomized trials including various cognitive tests, different aging groups and supplements in different doses are not sufficient to allow recommendation of homocysteine-reducing therapy with folate or vitamin B12 substitution. According to the published data it remains to be proven whether a reduction in homocysteine will improve cognitive performance. SUMMARY Homocysteine by itself is not a useful marker for screening cognitive decline, or Alzheimer disease but works as a surrogate parameter for malnutrition and organ insufficiency in the cognitive-declining patient.
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Affiliation(s)
- Ralf-Joachim Schulz
- Charité - Universitätsmedizin Berlin, Campus Virchow-Klinikum, Research Group on Geriatrics at 'Ev. Geriatriezentrum Berlin', Berlin, Germany.
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Berr C, Akbaraly TN, Nourashemi F, Andrieu S. Épidémiologie des démences. Presse Med 2007; 36:1431-41. [PMID: 17560760 DOI: 10.1016/j.lpm.2007.04.022] [Citation(s) in RCA: 16] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/10/2007] [Accepted: 04/17/2007] [Indexed: 11/29/2022] Open
Abstract
Dementia is a major public health problem and its burden will increase in the 30 years to come. Prevalence increases with age and incidence is slightly higher in women than men, especially after the age of 80 years. Survival after the onset of dementia is approximately 5 years. Lifestyle and health habits are a keystone for dementia: risk factors include physical, intellectual and social activity and nutritional habits. Data from well-conducted intervention studies are necessary to show whether better care for hypertension, diabetes, and dyslipidemia might decrease the incidence of dementia.
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Affiliation(s)
- Claudine Berr
- Inserm, U888, Université Montpellier 1, Montpellier (34).
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Garcia A. Cobalamin and homocysteine in older adults: Do we need to test for serum levels in the work0up of dementia? Alzheimers Dement 2007; 3:318-24. [DOI: 10.1016/j.jalz.2007.07.003] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/03/2007] [Accepted: 07/12/2007] [Indexed: 01/31/2023]
Affiliation(s)
- Angeles Garcia
- Department of Medicine (Geriatrics)Queen's UniversityKingstonOntarioCanada
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Roebothan BV, Carmichael J, Barter V, Aucoin J, Murphy M. Mandatory folic acid fortification in Newfoundland and Labrador. CAN J DIET PRACT RES 2007; 68:143-5. [PMID: 17784973 DOI: 10.3148/68.3.2007.143] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022]
Abstract
PURPOSE Dietary folic acid (FA) intakes were analyzed in random samples of 302 young women (aged 18 to 34) and 337 seniors (aged 65 to 74) residing in Newfoundland and Labrador (NL). The analyses were an attempt to estimate the amount of FA they would consume solely because of mandatory fortification of foods. METHODS Secondary analysis was performed on raw data collected through single 24-hour recalls as part of a larger study. RESULTS The dietary FA contributed by fortified foods eaten in the specified amounts was estimated to be 136 to 148 mcg/day (226 to 247 DFE/day) for young women and 151 to 160 mcg/day (252 to 267 DFE/day) for seniors. Most of this FA was contributed to the diet by enriched white flour. CONCLUSIONS Mandatory fortification of foods appears to have improved the total mean intake of folate by young women and seniors residing in NL.
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Domínguez RO, Marschoff ER, Guareschi EM, Repetto MG, Famulari AL, Pagano MA, Serra JA. Insulin, glucose and glycated hemoglobin in Alzheimer’s and vascular dementia with and without superimposed Type II diabetes mellitus condition. J Neural Transm (Vienna) 2007; 115:77-84. [PMID: 17726571 DOI: 10.1007/s00702-007-0804-7] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/26/2007] [Accepted: 08/02/2007] [Indexed: 01/11/2023]
Abstract
Increased concentrations of insulin, glucose and glycohemoglobin are associated with Type II diabetes mellitus (DM) and recognized as characteristic markers of the disease; in Alzheimer's (AD), Vascular dementia (VaD), and both dementia's with superimposed diabetes (AD + DM, VaD + DM) the knowledge is scarce. The sample (n = 122; males = 60; mean age = 73 +/- 7) comprised DM, AD, VaD, AD + DM, and VaD + DM patients, and healthy controls (C). The ANOVA's yielded significant differences between groups: Insulin p = 3.7 x 10(-3); Glucose p < 10(-12); Glycohemoglobin p = 9.2x10(-4). Comparisons between groups (DM vs. C, AD + DM vs. AD, VaD + DM vs. VaD, and demented DM vs. non-demented DM) resulted significant for all variables (Bonferroni's statistic, alpha = 0.05). Diabetic and diabetic demented patients presented significant increases largely different from controls (0.01 < p < 0.001), unlike the non-significant changes in their non-diabetic counterparts; linear relationships were found across all groups. The correlation's insulin/glucose and insulin/glycohemoglobin change to positive within demented groups, indicating a different performance of insulin in demented and non-demented subjects.
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Affiliation(s)
- R O Domínguez
- Facultad de Medicina, Hospital Sirio-Libanés, UBA, FACENE, Buenos Aires, Argentina
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Raman G, Tatsioni A, Chung M, Rosenberg IH, Lau J, Lichtenstein AH, Balk EM. Heterogeneity and lack of good quality studies limit association between folate, vitamins B-6 and B-12, and cognitive function. J Nutr 2007; 137:1789-94. [PMID: 17585032 DOI: 10.1093/jn/137.7.1789] [Citation(s) in RCA: 38] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
We conducted a systematic review to evaluate the association between folate, vitamin B-6, vitamin B-12, and cognitive function in the elderly. Our search was conducted in Medline for English-language publications of human subjects from 1966 through November 2006; we supplemented these results with information from article reviews and domain experts. We included longitudinal cohort and case-control studies of B vitamins and analyses of cognitive tests or Alzheimer's disease. We evaluated the quality and heterogeneity of study outcomes and assessed 30 different cognitive function tests. Of 24 studies that met eligibility criteria, 16 were determined to be of fair quality. A majority of the studies reviewed 2 or more B vitamins. Considerable heterogeneity was found among B-vitamin-level thresholds, comparisons, and data analyses. Six of 10 folate studies reported a significant association between low baseline blood folate concentrations and subsequent poor test performance in the global cognitive domain, and 4 of 9 folate studies found associations between low blood folate concentrations and increased prevalence of Alzheimer's disease. Studies did not reveal an association of vitamin B-6 and vitamin B-12 blood concentrations with cognitive-test performance or Alzheimer's disease, nor was B-vitamin dietary intake associated with cognitive function. Higher plasma homocysteine concentrations were associated with poorer cognitive function. Although the majority of studies indicated that low blood folate concentrations predicted poorer cognitive function, data supporting this association were limited because of the heterogeneity in cognition-assessment methodology, and scarcity of good quality studies and standardized threshold levels for categorizing low B-vitamin status.
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Affiliation(s)
- Gowri Raman
- Tufts-New England Medical Center Evidence-based Practice Center, Institute for Clinical Research and Health Policy Studies, Tufts-New England Medical Center, Boston, MA 02111, USA
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Eussen SJPM, Ueland PM, Clarke R, Blom HJ, Hoefnagels WHL, van Staveren WA, de Groot LCPGM. The association of betaine, homocysteine and related metabolites with cognitive function in Dutch elderly people. Br J Nutr 2007; 98:960-8. [PMID: 17537289 DOI: 10.1017/s0007114507750912] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
Abstract
The importance of the one-carbon metabolites, choline and homocysteine, to brain function is well known. However, the associations between the one-carbon metabolites choline, betaine, methionine and dimethylglycine with cognition in elderly are unclear. We therefore examined the associations of these metabolites with cognition in a double-blind, placebo-controlled trial. Individuals (n 195) were randomized to receive daily oral capsules with either 1000 microg cobalamin (vitamin B12), or 1000 microg cobalamin plus 400 microg folic acid, or placebo for 24 weeks. Concentrations of homocysteine, methionine, choline, betaine and dimethylglycine were assessed before and after 12 and 24 weeks of treatment. Cognitive function, including domains of attention, construction, sensomotor speed, memory and executive function, was assessed before and after 24 weeks of treatment. At baseline, elevated plasma homocysteine was associated with lower performance of attention, construction, sensomotor speed and executive function. In addition, betaine was positively associated with better performance of construction, sensomotor speed and executive function, whereas elevated concentrations of methionine were positively associated with sensomotor speed. Daily combined supplementation with cobalamin plus folic acid decreased total homocysteine concentrations by 36%, and increased betaine concentrations by 38%. Participants with the largest increases in betaine concentrations showed a borderline significant (P = 0.07) higher memory performance compared to those without it. Although this trial observed associations of homocysteine and betaine with cognitive domains prior to supplementation, decreased concentrations of homocysteine were not related to improved cognitive performance. There was a tendency of participants with the largest increases in betaine concentrations to show the greatest improvement in memory function.
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Affiliation(s)
- Simone J P M Eussen
- Division of Human Nutrition, Wageningen University, P.O. Box 8129 6700 EV Wageningen, The Netherlands.
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Zana M, Janka Z, Kálmán J. Oxidative stress: A bridge between Down's syndrome and Alzheimer's disease. Neurobiol Aging 2007; 28:648-76. [PMID: 16624449 DOI: 10.1016/j.neurobiolaging.2006.03.008] [Citation(s) in RCA: 75] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/30/2005] [Revised: 02/23/2006] [Accepted: 03/16/2006] [Indexed: 12/20/2022]
Abstract
Besides the genetic, biochemical and neuropathological analogies between Down's syndrome (DS) and Alzheimer's disease (AD), there is ample evidence of the involvement of oxidative stress (OS) in the pathogenesis of both disorders. The present paper reviews the publications on DS and AD in the past 10 years in light of the "gene dosage" and "two-hit" hypotheses, with regard to the alterations caused by OS in both the central nervous system and the periphery, and the main pipeline of antioxidant therapeutic strategies. OS occurs decades prior to the signature pathology and manifests as lipid, protein and DNA oxidation, and mitochondrial abnormalities. In clinical settings, the assessment of OS has traditionally been hampered by the use of assays that suffer from inherent problems related to specificity and/or sensitivity, which explains some of the conflicting results presented in this work. For DS, no scientifically proven diet or drug is yet available, and AD trials have not provided a satisfactory approach for the prevention of and therapy against OS, although most of them still need evidence-based confirmation. In the future, a balanced up-regulation of endogenous antioxidants, together with multiple exogenous antioxidant supplementation, may be expected to be one of the most promising treatment methods.
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Affiliation(s)
- Marianna Zana
- Department of Psychiatry, Faculty of Medicine, Albert Szent-Györgyi Center for Medical and Pharmaceutical Sciences, University of Szeged, 6 Semmelweis St, Szeged H-6725, Hungary.
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Di Bonito P, Di Fraia L, Di Gennaro L, Vitale A, Lapenta M, Scala A, Iardino MR, Cusati B, Attino L, Capaldo B. Impact of impaired fasting glucose and other metabolic factors on cognitive function in elderly people. Nutr Metab Cardiovasc Dis 2007; 17:203-208. [PMID: 17367706 DOI: 10.1016/j.numecd.2005.07.011] [Citation(s) in RCA: 14] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/20/2005] [Revised: 07/06/2005] [Accepted: 07/06/2005] [Indexed: 11/22/2022]
Abstract
AIM The present study was undertaken to evaluate the impact of impaired fasting glucose (IFG), insulin resistance (IR) and hyperhomocysteinaemia (Hhcy) on cognitive function (CF) in a sample of non-diabetic elderly subjects. METHODS AND RESULTS One hundred and eighty-two non-diabetic subjects, aged > or = 65 years, without signs of previous stroke were included in the study. CF was evaluated by the Mini Mental State Examination (MMSE) score, corrected for age and education. Since diagnostic criteria for IFG have been recently lowered from 110 to 100 mg/dl, subjects were categorized according to old (IFG1997) and new (IFG2003) criteria. IR and Hhcy were defined by the upper quartile of insulin (11.0 UI/L) and Hcy (18.6 micromol/L) distribution, respectively. The frequency of IFG1997, Hhcy, and IR, but not of IFG2003, showed a linear trend across tertiles of MMSE (p<0.001). The odds ratio (95% CI) for impaired CF (MMSE<24.3) was 9.08 (2.97-27.74) for IFG1997, 3.66 (1.28-10.45) for Hhcy, 2.83 (1.25-6.37) for IR and 1.32 (0.61-2.89) for IFG2003. CONCLUSIONS Our study shows that IFG1997, Hhcy and IR are powerful metabolic markers of impaired CF among elderly people.
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Affiliation(s)
- P Di Bonito
- Department of Internal Medicine, S. Maria delle Grazie Pozzuoli Hospital, Via Domitiana Loc. La Schiana, 80078 Pozzuoli, Naples, Italy.
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Obeid R, Kostopoulos P, Knapp JP, Kasoha M, Becker G, Fassbender K, Herrmann W. Biomarkers of folate and vitamin B12 are related in blood and cerebrospinal fluid. Clin Chem 2007; 53:326-33. [PMID: 17200133 DOI: 10.1373/clinchem.2006.076448] [Citation(s) in RCA: 46] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/30/2022]
Abstract
BACKGROUND B-vitamins (folate, B(12)) are important micronutrients for brain function and essential cofactors for homocysteine (HCY) metabolism. Increased HCY has been related to neurological and psychiatric disorders. We studied the role of the B-vitamins in HCY metabolism in the brain. METHODS We studied blood and cerebrospinal fluid (CSF) samples from 72 patients who underwent lumbar puncture. We measured HCY, methylmalonic acid (MMA), and cystathionine by gas chromatography-mass spectrometry; S-adenosylmethionine (SAM) and S-adenosylhomocysteine (SAH) by liquid chromatography-tandem mass spectrometry; and the B-vitamins by HPLC or immunoassays. RESULTS Concentrations were lower in CSF than serum or plasma for HCY (0.09 vs 9.4 micromol/L), SAH (13.2 vs 16.8 nmol/L), cystathionine (54 vs 329 nmol/L), and holotranscobalamin (16 vs 63 pmol/L), whereas concentrations in CSF were higher for MMA (359 vs 186 nmol/L) and SAM (270 vs 113 nmol/L; all P <0.05). CSF concentrations of HCY correlated significantly with CSF folate (r = -0.46), CSF SAH (r = 0.48), CSF-albumin (r = 0.31), and age (r = 0.32). Aging was also associated with lower concentrations of CSF-folate and higher CSF-SAH. The relationship between serum and CSF folate depended on serum folate: the correlation (r) of serum and CSF-folate was 0.69 at serum folate <15.7 nmol/L. CSF concentrations of MMA and holotranscobalamin were not significantly correlated. CONCLUSIONS CSF and serum/plasma concentrations of vitamin biomarkers are significantly correlated. Older age is associated with higher CSF-HCY and CSF-SAH and lower CSF-folate. These metabolic alterations may be important indicators of low folate status, hyperhomocysteinemia, and neurodegenerative diseases.
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Affiliation(s)
- Rima Obeid
- Department of Clinical Chemistry and Laboratory Medicine, Faculty of Medicine, University Hospital of Saarland, Homburg/Saar, Germany
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Morris MS, Jacques PF, Rosenberg IH, Selhub J. Folate and vitamin B-12 status in relation to anemia, macrocytosis, and cognitive impairment in older Americans in the age of folic acid fortification. Am J Clin Nutr 2007; 85:193-200. [PMID: 17209196 PMCID: PMC1828842 DOI: 10.1093/ajcn/85.1.193] [Citation(s) in RCA: 405] [Impact Index Per Article: 23.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/21/2023] Open
Abstract
BACKGROUND Historic reports on the treatment of pernicious anemia with folic acid suggest that high-level folic acid fortification delays the diagnosis of or exacerbates the effects of vitamin B-12 deficiency, which affects many seniors. This idea is controversial, however, because observational data are few and inconclusive. Furthermore, experimental investigation is unethical. OBJECTIVE We examined the relations between serum folate and vitamin B-12 status relative to anemia, macrocytosis, and cognitive impairment (ie, Digit Symbol-Coding score < 34) in senior participants in the 1999-2002 US National Health and Nutrition Examination Survey. DESIGN The subjects had normal serum creatinine concentrations and reported no history of stroke, alcoholism, recent anemia therapy, or diseases of the liver, thyroid, or coronary arteries (n = 1459). We defined low vitamin B-12 status as a serum vitamin B-12 concentration < 148 pmol/L or a serum methylmalonic acid concentration > 210 nmol/L-the maximum of the reference range for serum vitamin B-12-replete participants with normal creatinine. RESULTS After control for demographic characteristics, cancer, smoking, alcohol intake, serum ferritin, and serum creatinine, low versus normal vitamin B-12 status was associated with anemia [odds ratio (OR): 2.7; 95% CI: 1.7, 4.2], macrocytosis (OR: 1.8; 95% CI: 1.01, 3.3), and cognitive impairment (OR: 2.5; 95% CI: 1.6, 3.8). In the group with a low vitamin B-12 status, serum folate > 59 nmol/L (80th percentile), as opposed to < or = 59 nmol/L, was associated with anemia (OR: 3.1; 95% CI: 1.5, 6.6) and cognitive impairment (OR: 2.6; 95% CI: 1.1, 6.1). In the normal vitamin B-12 group, ORs relating high versus normal serum folate to these outcomes were < 1.0 (P(interaction) < 0.05), but significantly < 1.0 only for cognitive impairment (0.4; 95% CI: 0.2, 0.9). CONCLUSION In seniors with low vitamin B-12 status, high serum folate was associated with anemia and cognitive impairment. When vitamin B-12 status was normal, however, high serum folate was associated with protection against cognitive impairment.
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Affiliation(s)
- Martha Savaria Morris
- Jean Mayer US Department of Agriculture Human Nutrition Research Center on Aging, Tufts University, Boston, MA 02111, USA.
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Chou YC, Lee MS, Wu MH, Shih HL, Yang T, Yu CP, Yu JC, Sun CA. Plasma homocysteine as a metabolic risk factor for breast cancer: findings from a case-control study in Taiwan. Breast Cancer Res Treat 2006; 101:199-205. [PMID: 16850249 DOI: 10.1007/s10549-006-9278-9] [Citation(s) in RCA: 24] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/08/2006] [Accepted: 05/17/2006] [Indexed: 10/24/2022]
Abstract
Homocysteine (Hcy) is an intermediary product in methionine metabolism and an elevation in plasma Hcy is a sensitive biomarker for an imbalance in the integrated pathways of one-carbon metabolism. More recently, there has been interest in the potential links between total Hcy, folate and cancer. In this study, the association of plasma Hcy levels with the breast cancer risk was investigated. Questionnaire information and blood samples were taken before treatment from 146 women with newly diagnosed, histologically confirmed breast cancer and 285 age-matched control women who were admitted for health examination. Plasma levels of Hcy and folate were measured by enzyme conversion immunoassay and radioassay, respectively. Dietary intake of B-group vitamins was estimated using a semi-quantitative dietary questionnaire. Logistic regression was used to calculate odds ratios (ORs) and their 95% confidence intervals (CIs). Elevated plasma Hcy levels were significantly linked to increased risk of breast cancer (adjusted OR = 2.89, 95% CI = 1.70-4.92 for the highest tertile as compared with the lowest tertile). Moreover, a similar pattern of enhanced breast cancer risk at higher plasma Hcy levels was observed in both pre-menopausal and post-menopausal women. And this consistent pattern did not differ substantially by level of dietary intake of B-group vitamins. The current study results seem to suggest a possibility that the plasma Hcy levels could be a metabolic risk factor for breast cancer. Future studies are needed to prove causality and provide insight on the mechanism of action of Hcy in breast tumorigenesis.
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Affiliation(s)
- Yu-Ching Chou
- Graduate Institute of Medical Sciences, National Defense Medical Center, Taipei, Taiwan, Republic of China
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71
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Abstract
Despite worldwide public-health campaigns recommending periconceptional daily supplementation of synthetic folic acid to reduce the risk of neural tube defects, many women are not following these recommendations. At the same time, in most European countries no decline in defects has been recorded in recent years. Vulnerable groups are those with a low standard of education, young people, and women with unplanned pregnancies. Furthermore, in most countries without mandatory fortification, the general population is not consuming the recommended 0.4 mg of food folate per day. Voluntary fortification improves the situation, but does not reach all parts of the population. In the USA, Canada, and Chile, mandatory fortification of flour substantially improved folate and homocysteine status, and neural tube defects rates fell by between 31% and 78%. Nevertheless, many countries do not choose mandatory folic acid fortification, in part because expected additional health benefits are not yet scientifically proven in clinical trials, in part because of feared health risks, and because of the issue of freedom of choice. Thus, additional creative public-health approaches need to be developed to prevent neural tube defects and improve the folate status of the general population.
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Affiliation(s)
- Monika Eichholzer
- Institute of Social and Preventive Medicine, University of Zurich, Hirschengraben 84, 8001 Zurich, Switzerland.
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72
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van Uffelen JGZ, Hopman-Rock M, Chin A Paw MJM, van Mechelen W. Protocol for Project FACT: a randomised controlled trial on the effect of a walking program and vitamin B supplementation on the rate of cognitive decline and psychosocial wellbeing in older adults with mild cognitive impairment [ISRCTN19227688]. BMC Geriatr 2005; 5:18. [PMID: 16375760 PMCID: PMC1361795 DOI: 10.1186/1471-2318-5-18] [Citation(s) in RCA: 15] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/05/2005] [Accepted: 12/23/2005] [Indexed: 12/05/2022] Open
Abstract
Background the prevalence of individuals with cognitive decline is increasing since the number of elderly adults is growing considerably. The literature provides promising results on the beneficial effect of exercise and vitamin supplementation on cognitive function both in cognitively healthy as well as in the demented elderly. Methods/Design the design is a two-by-two factorial randomised controlled trial. The study population consists of independently living elderly, between 70 and 80 years old, with mild cognitive impairment (MCI). In the RCT the effect of two interventions, a walking program and vitamin supplementation, is examined. The walking program (WP) is a group-based program aimed at improving cardiovascular endurance; frequency two lessons a week; lesson duration one hour; program duration one year. Non-walking groups receive a placebo activity program (PAP) (i.e. low intensive non-aerobic group exercises, like stretching) with the same frequency, lesson and program duration. Vitamin supplementation consists of a single daily vitamin supplement containing 50 mg B6, 5 mg folic acid and 0,4 mg B12 for one year. Subjects not receiving vitamin supplements are daily taking an identically looking placebo pill, also for a year. Participants are randomised to four groups 1) WP and vitamin supplements; 2) WP and placebo supplements; 3) PAP and vitamin supplements; 4) PAP and placebo supplements. Primary outcome measures are measures of cognitive function. Secondary outcomes include psychosocial wellbeing, physical activity, cardiovascular endurance and blood vitamin levels. Discussion no large intervention study has been conducted yet on the effect of physical activity and vitamin supplementation in a population-based sample of adults with MCI. The objective of the present article is to describe the design of a randomised controlled trial examining the effect of a walking program and vitamin B supplementation on the rate of cognitive decline in older adults with MCI.
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Affiliation(s)
- Jannique GZ van Uffelen
- Body@Work, Research Center Physical Activity, Work and Health, TNO-VU University Medical Center, Amsterdam, The Netherlands
- Department of Public and Occupational Health, EMGO Institute/VU University Medical Center, Amsterdam, The Netherlands
- Dep. of Physical Activity and Health, TNO Quality of Life, Leiden, The Netherlands
| | - Marijke Hopman-Rock
- Body@Work, Research Center Physical Activity, Work and Health, TNO-VU University Medical Center, Amsterdam, The Netherlands
- Dep. of Physical Activity and Health, TNO Quality of Life, Leiden, The Netherlands
| | - Marijke JM Chin A Paw
- Body@Work, Research Center Physical Activity, Work and Health, TNO-VU University Medical Center, Amsterdam, The Netherlands
- Department of Public and Occupational Health, EMGO Institute/VU University Medical Center, Amsterdam, The Netherlands
| | - Willem van Mechelen
- Body@Work, Research Center Physical Activity, Work and Health, TNO-VU University Medical Center, Amsterdam, The Netherlands
- Department of Public and Occupational Health, EMGO Institute/VU University Medical Center, Amsterdam, The Netherlands
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73
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Wong A, Mok V, Fan YH, Lam WWM, Liang KS, Wong KS. Hyperhomocysteinemia is associated with volumetric white matter change in patients with small vessel disease. J Neurol 2005; 253:441-7. [PMID: 16267639 DOI: 10.1007/s00415-005-0022-x] [Citation(s) in RCA: 44] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/08/2005] [Revised: 08/03/2005] [Accepted: 08/11/2005] [Indexed: 11/26/2022]
Abstract
BACKGROUND Hyperhomocysteinemia is associated with cerebral small vessel disease (SVD). We examined the relationship between homocysteine and 1) volumetric measure of white matter change (WMC), 2) silent brain infarcts, 3) cerebral atrophy on MRI and 4) cognition on a consecutive cohort of patients with stroke associated with SVD. SUBJECTS AND METHODS Fifty-seven patients consecutively admitted to the Acute Stroke Unit in a university hospital due to stroke associated with SVD were recruited and assessed three months after the stroke. Non-fasting homocysteine was obtained. Using MRI, the number of infarcts, volume of WMC and cerebral atrophy were measured. General cognitive functions were assessed using the Mini Mental State Examination and Alzheimer's disease Assessment Scale. Mattis Dementia Rating Scale - Initiation/Perseveration subset was used to assess executive cognitive functions. RESULTS Hyperhomocysteinemia (> or = 14.88 micromol/L) significantly accounted for the volume of WMC on MRI in a multivariate stepwise regression model (adjusted R(2)=0.058, p <0.05) after adjustment for age and folate level. Patients in the highest quartile of WMC volume had significantly higher levels of homocysteine than those in lowest quartile (p <0.001). No significant relationship was found between homocysteine and silent brain infarcts, cerebral atrophy and performance on psychometric tests. CONCLUSION Hyperhomocysteinemia is associated with volumetric measure of WMC among patients with SVD. The role of homocysteine in the development of silent brain infarcts and cerebral atrophy as previously reported cannot be ascertained in this study. No direct relationship was found between homocysteine and cognitive functions.
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Affiliation(s)
- Adrian Wong
- Dept. of Medicine and Therapeutics Chinese, University of Hong Kong, Prince of Wales Hospital Shatin, New Territories, Hong Kong.
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74
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Domínguez RO, Marschoff ER, Guareschi EM, Famulari AL, Pagano MA, Serra JA. Homocysteine, vitamin B 12 and folate in Alzheimer's and vascular dementias: The paradoxical effect of the superimposed type II diabetes mellitus condition. Clin Chim Acta 2005; 359:163-70. [PMID: 15935339 DOI: 10.1016/j.cccn.2005.03.049] [Citation(s) in RCA: 16] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/02/2005] [Revised: 03/18/2005] [Accepted: 03/24/2005] [Indexed: 10/25/2022]
Abstract
BACKGROUND Increased concentration of plasmatic homocysteine (tHcy) and decreased vitamin B 12 (B12) and folate (FOL) are associated with Alzheimer's (AD) and vascular (VaD) dementias, with type II diabetes mellitus (DM), and reported as risk factors of these diseases. METHODS The sample (n=122; males=60; mean age=73+/-7 years) comprised AD and VaD patients without DM, with a concomitant DM (AD+DM, VaD+DM), DM alone and controls (CTR), resulting in 6 groups. tHcy, B12 and FOL were determined in duplicate. RESULTS The one-way ANOVA yielded significant differences between groups for all variables: tHcy p<10(-12); B12 p<10(-3); FOL p<10(-4). Significance for comparisons between groups was set at alpha=0.05, using the Bonferroni's statistic. The comparisons: DM vs. CTR, AD+DM vs. AD, VaD+DM vs. VaD, and DM demented vs. DM non-demented resulted significant for all variables, except for B12 in 2 comparisons. CONCLUSIONS In demented and control subjects, tHcy and FOL exhibit extreme differences, not so marked between DM and controls. Demented patients with concomitant diabetes are closer to controls than their non-diabetic counterparts. Diabetes affects tHcy and FOL values, which are changed with opposite sign to non-demented. These results suggests a paradoxical phenomenon when diabetes is superimposed to dementias.
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Affiliation(s)
- Raúl O Domínguez
- Facultad de Medicina, Hospital Sirio-Libanés-UBA, FACENE, Buenos Aires, Argentina
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75
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Vollset SE, Ueland PM. B vitamins and cognitive function: do we need more and larger trials? Am J Clin Nutr 2005; 81:951-2. [PMID: 15883414 DOI: 10.1093/ajcn/81.5.951] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/31/2022] Open
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