Scott Tammy Maria, Tucker Katherine L, Bhadelia Afsan, Benjamin Batia, Patz Samuel, Bhadelia Rafeeque, Liebson Elizabeth, Price Lori Lyn, Griffith John, Rosenberg Irwin, Folstein Marshal F
Department of Psychiatry, Tufts-New England Medical Center, and Tufts University School of Medicine, Boston, MA 02446, USA.
Am J Geriatr Psychiatry. 2004 Nov-Dec;12(6):631-8. doi: 10.1176/appi.ajgp.12.6.631.
There is a growing literature on the relationship between low serum B-vitamins, elevated homocysteine, and cognitive impairment; however, few studies have examined radiological markers of associated neuropathology in geropsychiatry inpatients. The authors examined the relationship of homocysteine, folate, and vitamin B12 with magnetic resonance imaging (MRI) markers of neuropathology.
In this archival study, authors reviewed the MRIs and medical records of 34 inpatients in a geriatric psychiatry unit. Patients were selected if folate, B12, and/or homocysteine levels had been assessed and if the appropriate clinical MRIs were performed (19 men; mean age, 75 years). Patients with schizophrenia or current substance dependence were excluded. The relationships between MRI volume measures, white-matter hyperintensity (WMH) grade, and serum concentrations of folate, B12, and homocysteine were analyzed, using age-adjusted Pearson correlations.
Homocysteine was related to WMH grade, but not brain-volume measures. Folate was associated with hippocampus and amygdala, and negatively associated with WMH. B12 level was not statistically associated with any brain measure.
Elevated homocysteine and low folate were associated with radiological markers of neuropathology. Since no patient had clinically deficient folate, it may be important to rethink what defines functionally significant micronutrient deficiency and explore what this means in different age- and health-status groups. Larger samples will be needed to assess interactions between homocysteine, micronutrients, and other neuropathology risk factors.
关于低血清B族维生素、高同型半胱氨酸与认知障碍之间关系的文献越来越多；然而，很少有研究在老年精神科住院患者中检查相关神经病理学的影像学标志物。作者研究了同型半胱氨酸、叶酸和维生素B12与神经病理学磁共振成像（MRI）标志物之间的关系。
在这项档案研究中，作者回顾了老年精神科病房34名住院患者的MRI和病历。如果患者的叶酸、B12和/或同型半胱氨酸水平已被评估且进行了适当的临床MRI检查，则被纳入研究（19名男性；平均年龄75岁）。排除患有精神分裂症或当前存在物质依赖的患者。使用年龄校正的Pearson相关性分析MRI体积测量、白质高信号（WMH）分级与叶酸、B12和同型半胱氨酸血清浓度之间的关系。
同型半胱氨酸与WMH分级相关，但与脑体积测量无关。叶酸与海马体和杏仁核相关，与WMH呈负相关。B12水平与任何脑测量指标均无统计学关联。
高同型半胱氨酸和低叶酸与神经病理学的影像学标志物相关。由于没有患者临床上存在叶酸缺乏，因此可能有必要重新思考什么定义了具有功能意义的微量营养素缺乏，并探索这在不同年龄和健康状况群体中的意义。需要更大的样本量来评估同型半胱氨酸、微量营养素和其他神经病理学危险因素之间的相互作用。
