Homocysteine as a Risk Factor for Cognitive Impairment in Stroke Patients

• Published in: Dementia and geriatric cognitive disorders Vol. 15; no. 3; pp. 155 - 162
• Main Authors: Sachdev, Perminder S., Valenzuela, Michael J., Brodaty, Henry, Wang, Xing Li, Looi, Jeffrey, Lorentz, Lisa, Howard, Lesley, Jones, Megan, Zagami, Alessandro S., Gillies, David, Wilcken, David E.L.
• Format: Journal Article
• Language: English
• Published: Basel, Switzerland Karger 01.01.2003; S. Karger AG
• Subjects: Aged; Aged, 80 and over; Biological and medical sciences; Case-Control Studies; Cognition Disorders - blood; Cognition Disorders - diagnosis; Cognition Disorders - etiology; Female; Homocysteine - blood; Humans; Magnetic Resonance Imaging; Male; Medical sciences; Middle Aged; Neurology; Neuropsychological Tests; Original Research Article; Risk Factors; Stroke - blood; Stroke - complications; Stroke - pathology; Vascular diseases and vascular malformations of the nervous system; Total homocysteine; Brain scans; Homocysteine; MRI; Cognitive impairment; Human; Nervous system diseases; Stroke; Thiol; Cognitive disorder; Cardiovascular disease; Psychometrics; Increase; Cerebral disorder; Vascular disease; Sulfur containing aminoacid; Homocystein; Central nervous system disease; Risk factor; Complication; Cerebrovascular disease
• ISSN: 1420-8008; 1421-9824
• DOI: 10.1159/000068481

Background: Elevated total homocysteine (tHcy) levels are associated with an increased risk of cerebrovascular disease. It is uncertain whether tHcy is also an independent risk factor for cognitive impairment. Methods: We examined 95 stroke subjects 3 months after their strokes, and 55 healthy comparison subjects, with a detailed neuropsychological assessment, and MRI brain scans in a proportion (n = 97). Baseline measurements of tHcy, serum folate and B 12 , creatinine and plasma fibrinogen levels were obtained. Results: tHcy levels were higher in the stroke subjects by a mean 34%. These levels were significantly correlated with the first factor of a principal component analysis of the neuropsychological data, after controlling for age, folate, B 12 and creatinine levels. The correlation of Hcy levels was particularly significant with frontal-executive functioning and attention. tHcy levels were significantly correlated with number of infarcts and total stroke volume in the stroke group, but not with T 2 -weighted deep white matter hyperintensity scores, after correction for age. In the control group, tHcy levels were significantly correlated with ventricle-to-brain ratios as measures of brain atrophy. Conclusion: This study provides evidence that high tHcy levels are associated with cognitive impairment, in particular that of frontal-executive function. The major component of this association is accounted for by small and large strokes, but non-vascular neurotoxic effects of tHcy also appear to play a role. tHcy must receive greater attention as a risk factor for cognitive impairment.