Hengstermann S, Hanemann A, Nieczaj R, Abdollahnia N, Schweter A, Steinhagen-Thiessen E, Lun A, Lämmler G, Schulz R-J
Charité - Universitätsmedizin Berlin, Campus Virchow-Klinikum, Forschungsgruppe Geriatrie am Evangelischen Geriatriezentrum Berlin, Berlin, Germany.
Z Gerontol Geriatr. 2009 Apr;42(2):131-6. doi: 10.1007/s00391-008-0551-x. Epub 2008 Jun 13.
Total blood homocysteine (Hcys) and folate have been investigated in association with cognitive dysfunction (CD) in healthy but not in multimorbid elderly patients. We hypothesized that total Hcys and folate are adequate markers to identify multimorbid elderly patients with CD.
According to the Short Performance Cognitive Test (SKT) CD was determined in a cross-sectional study with 189 (131 f/58 m) multimorbid elderly patients with a mean age of 78.6 +/- 7.3 yrs. Besides the analyses of biochemical parameters (Hcys, folate, vitamin B(12), hemogram) nutritional status (BMI, Mini Nutritional Assessment) as well as activities of daily living were assessed. Daily nutritional intake was measured with a 3-day nutrition diary. For analysis, we used the nutritional software program DGE-PC professional.
According to SKT 25.4% showed no cerebral cognitive dysfunction, 21.2% had a suspicion about incipient cognitive dysfunction, 12.7% showed mild, 9.0% moderate, 31.7% of patients severe cognitive deficits. Median plasma Hcys was about 20% elevated in multimorbid elderly patients independent of CD. Serum folate and vitamin B(12) levels were within range, though dietary folate intake (97 [80-128] microg/d) was reduced about 75% (recommendation 400 microg/d). Significant correlations between vitamin intake and plasma/serum levels of Hcys, folate and vitamin B(12) were not present. We did not find significant differences between SKT groups of nutritional status, activities of daily living, index of diseases, medications, or selected biochemical parameters.
We analysed elevated serum Hcys levels in multimorbid elderly patients with normal plasma folate and vitamin B(12) concentration and CD. Plasma Hcys or serum folate did not appear as an important biological risk factor on CD in multimorbid elderly patients.
总血同型半胱氨酸（Hcys）和叶酸已被研究与健康人群认知功能障碍（CD）的关系，但尚未在多病共存的老年患者中进行研究。我们假设总Hcys和叶酸是识别患有CD的多病共存老年患者的合适标志物。
在一项横断面研究中，根据简易认知功能测试（SKT）对189例（131例女性/58例男性）平均年龄为78.6±7.3岁的多病共存老年患者进行CD测定。除了分析生化参数（Hcys、叶酸、维生素B12、血常规）外，还评估了营养状况（BMI、微型营养评定）以及日常生活活动能力。通过3天的营养日记测量每日营养摄入量。分析时，我们使用了营养软件程序DGE-PC专业版。
根据SKT，25.4%的患者未表现出脑认知功能障碍，21.2%的患者疑似存在早期认知功能障碍，12.7%的患者表现为轻度认知功能障碍，9.0%的患者为中度认知功能障碍，31.7%的患者存在严重认知缺陷。多病共存老年患者的血浆Hcys中位数升高约20%，与CD无关。血清叶酸和维生素B12水平在正常范围内，尽管膳食叶酸摄入量（97[80-128]μg/d）降低了约75%（推荐摄入量为400μg/d）。维生素摄入量与血浆/血清Hcys、叶酸和维生素B12水平之间无显著相关性。我们未发现SKT组在营养状况、日常生活活动能力、疾病指数、药物治疗或选定的生化参数方面存在显著差异。
我们分析了血浆叶酸和维生素B12浓度正常且患有CD的多病共存老年患者血清Hcys水平升高的情况。血浆Hcys或血清叶酸似乎不是多病共存老年患者CD的重要生物学危险因素。
