Ozer Feriha, Meral Hasan, Hanoglu Lutfu, Aydemir Tuba, Yilsen Meral, Cetin Sibel, Ozturk Oya, Seval Hatice, Koldas Macit
Department of Neurology, Haseki Educational and Research Hospital, Turkey.
Neurol Res. 2006 Dec;28(8):853-8. doi: 10.1179/016164106X110445.
The aim of this study was to determine whether hyperhomocysteinemia caused by levodopa used in idiopathic Parkinson's disease (IPD) is associated with cognitive or physical impairments. The role of folate and vitamin B12 levels in this context was also ascertained.
Thirty-nine patients who had been followed with the diagnosis of IPD in our clinic for > 2 years and 28 healthy control subjects with similar demographic features were included in the study. The homocysteine, folic acid and vitamin B12 levels and the results of the short test of mental status (STMS) and the clock drawing test of IPD patients were compared with those of the controls. Subsequently, the patients with a homocysteine level of >14 micromol/l were compared with those having a homocysteine level of <14 micromol/l by means of detailed neuropsychometric test batteries.
Homocysteine levels were significantly higher in the patient group in comparison with the controls. There was a negative correlation between hyperhomocysteinemia and the levels of vitamin B12 and folate. On the other hand, a positive correlation between hyperhomocysteinemia and the levodopa dose was detected. There was a positive correlation between hyperhomocysteinemia and unified Parkinson's disease rating scale (UPDRS) motor section. The critical dose of levodopa was observed to be 300 mg/d. In terms of cognitive and frontal functions, no significant difference was detected between the patients and control group. The subgroup with a homocysteine level of >14 micromol/l had a significantly poorer performance in frontal and memory tests.
In patients with IPD who are detected to have hyperhomocysteinemia, the assessment of the cognitive performance, folic acid and vitamin B12 levels and the supplementation of folic acid and vitamin B12 to the treatment regimen might be appropriate.
本研究旨在确定特发性帕金森病（IPD）患者使用左旋多巴引起的高同型半胱氨酸血症是否与认知或身体损伤有关。同时也确定了叶酸和维生素B12水平在此情况下的作用。
本研究纳入了39例在我们诊所诊断为IPD且随访超过2年的患者以及28例具有相似人口统计学特征的健康对照者。将IPD患者的同型半胱氨酸、叶酸和维生素B12水平以及简易精神状态检查（STMS）结果和画钟试验结果与对照组进行比较。随后，通过详细的神经心理测试电池，将同型半胱氨酸水平>14 μmol/L的患者与同型半胱氨酸水平<14 μmol/L的患者进行比较。
与对照组相比，患者组的同型半胱氨酸水平显著更高。高同型半胱氨酸血症与维生素B12和叶酸水平呈负相关。另一方面，检测到高同型半胱氨酸血症与左旋多巴剂量呈正相关。高同型半胱氨酸血症与统一帕金森病评定量表（UPDRS）运动部分呈正相关。左旋多巴的临界剂量为300 mg/d。在认知和额叶功能方面，患者组与对照组之间未检测到显著差异。同型半胱氨酸水平>14 μmol/L的亚组在额叶和记忆测试中的表现明显较差。
在检测到患有高同型半胱氨酸血症的IPD患者中，评估认知表现、叶酸和维生素B12水平，并在治疗方案中补充叶酸和维生素B12可能是合适的。
