Schulz Ralf-Joachim
Charité - Universitätsmedizin Berlin, Campus Virchow-Klinikum, Research Group on Geriatrics at 'Ev. Geriatriezentrum Berlin', Berlin, Germany.
Curr Opin Clin Nutr Metab Care. 2007 Nov;10(6):718-23. doi: 10.1097/MCO.0b013e3282f0cfe3.
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.
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.
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.
已对同型半胱氨酸和B族维生素与健康及多病共存老年患者认知功能障碍的关系进行了研究。降低高同型半胱氨酸血症是否能降低痴呆或阿尔茨海默病的风险仍在研究中。
高同型半胱氨酸浓度与较差的认知功能相关，但会受到多种因素的影响。流行病学研究结果在显示同型半胱氨酸水平升高与痴呆或阿尔茨海默病之间的关联方面并不一致。尽管前瞻性研究显示了同型半胱氨酸相关B族维生素替代有益的趋势，但预计即将开展的临床干预试验会提供一致的数据。近期临床随机试验的数据，包括各种认知测试、不同年龄组以及不同剂量的补充剂，不足以支持推荐用叶酸或维生素B12替代疗法来降低同型半胱氨酸。根据已发表的数据，同型半胱氨酸降低是否会改善认知表现仍有待证实。
同型半胱氨酸本身并非筛查认知功能减退或阿尔茨海默病的有用标志物，但可作为认知功能减退患者营养不良和器官功能不全的替代参数。
