Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht, The Netherlands.
Alzheimers Dement. 2013 May;9(3):302-9. doi: 10.1016/j.jalz.2011.11.008. Epub 2012 Aug 3.
Homocysteine may be a modifiable risk factor for cognitive decline and brain atrophy, particularly in older persons. We examined whether homocysteine increased the risk for cognitive decline and brain atrophy, and evaluated the modifying effect of age.
Within the Second Manifestations of ARTerial disease-Magnetic Resonance study-a prospective cohort study among patients with atherosclerotic disease-longitudinal analyses were performed in 663 patients (mean age: 57 ± 9 years; follow-up: 3.9 ± 0.4 years). At baseline and follow-up, brain segmentation on magnetic resonance imaging was used to quantify relative (%) cortical, ventricular, and global brain volumes, and z-scores of memory and executive functioning were calculated. Linear regression analysis was used to estimate associations of homocysteine (per standard deviation increase) and hyperhomocysteinemia (HHCY) with brain volumes, memory, and executive functioning at follow-up, adjusted for baseline brain volume, memory, and executive functioning, respectively, and age, sex, and vascular risk factors. Furthermore, interaction terms between homocysteine and age (continuous) were added.
Significant interactions were observed between total plasma homocysteine (tHcy) and age with cortical, ventricular, and global brain volume (for all three measures: P < .05), and between HHCY and age with executive functioning (P = .04), and results were stratified by age. In patients aged ≥65 years, increasing tHcy level and HHCY were significantly associated with progression of ventricular enlargement (B = 0.07%, 95% confidence interval [CI]: 0.01% to 0.13% and B = 0.16%, 95% CI: 0.01% to 0.31%, respectively) and with a decline in executive function (B = -0.29, 95% CI: -0.54 to -0.04 and B = -0.84, 95% CI: -1.37 to -0.32, respectively).
Elevated tHcy was related to progression of ventricular enlargement and increased the risk for a decline in executive functioning in older persons.
同型半胱氨酸可能是认知能力下降和脑萎缩的一个可改变的危险因素，尤其是在老年人中。我们研究了同型半胱氨酸是否会增加认知能力下降和脑萎缩的风险，并评估了年龄的修饰作用。
在动脉粥样硬化疾病第二次表现的磁共振研究（Second Manifestations of ARTerial disease-Magnetic Resonance study）中，这是一项针对动脉粥样硬化疾病患者的前瞻性队列研究，对 663 名患者（平均年龄：57 ± 9 岁；随访：3.9 ± 0.4 年）进行了纵向分析。在基线和随访时，使用磁共振成像脑分割来量化相对（%）皮质、脑室和全脑体积，并计算记忆和执行功能的 z 分数。线性回归分析用于估计同型半胱氨酸（每标准偏差增加）和高同型半胱氨酸血症（HHCY）与随访时脑体积、记忆和执行功能的关联，分别调整基线脑体积、记忆和执行功能以及年龄、性别和血管危险因素。此外，还添加了同型半胱氨酸与年龄（连续变量）之间的交互项。
总血浆同型半胱氨酸（tHcy）和年龄与皮质、脑室和全脑体积之间存在显著的交互作用（所有三个指标：P <.05），HHCY 与年龄之间与执行功能之间存在显著的交互作用（P =.04），结果按年龄分层。在年龄≥65 岁的患者中，tHcy 水平升高和 HHCY 与脑室扩大的进展显著相关（B = 0.07%，95%置信区间[CI]：0.01%至 0.13%和 B = 0.16%，95% CI：0.01%至 0.31%），与执行功能下降相关（B = -0.29，95% CI：-0.54 至 -0.04 和 B = -0.84，95% CI：-1.37 至 -0.32）。
高同型半胱氨酸与脑室扩大的进展有关，并增加了老年人执行功能下降的风险。
