Soni Ravi M, Tiwari Sarvada C, Mahdi Abbas A, Kohli Neera
Department of Geriatric Mnetal Health, King George's Medical University, Lucknow, India.
Department of Bichemistry, King George's Medical University, Lucknow, India.
Ann Neurosci. 2019 Jan;25(3):152-159. doi: 10.1159/000487068. Epub 2018 May 30.
There are studies showing the relation between serum B12, folate and Behavioral and Psychological symptoms of Dementia (BPSD) in Alzheimer's disease (AD). Serum levels of these vitamins do not reflect actual disease status and therefore checking the serum Homocysteine level is considered a better test. Homocysteine has been found to be associated with cognitive impairment and various psychiatric disorders.
This study was planned to identify the correlation between serum homocysteine levels and BPSD in AD patients.
AD patients ( = 18) and healthy controls ( = 18) were included in the study. Diagnosis of AD was confirmed using International Classification Disease-10. AD patients were assessed using Mini Mental Status Examination (MMSE), Clinical Dementia Rating scale (CDR), Global Deterioration scale (GDS), and Neuropsychiatric inventory (NPI). Healthy controls were assessed on MMSE and Mini International Neuropsychiatric Interview. Serum homocysteine, vitamin B12, and folate levels were measured in all study subjects.
Patients with AD had statistically significant higher serum levels of homocysteine as compared to the control group, while the levels of vitamin B12 and folate did not differ significantly. There was statistically significant positive correlation of serum homocysteine levels with total NPI score as well as with NPI sub-domains particularly delusion, agitation/aggression, and depression/dysphoria. Serum homocysteine levels did not correlate significantly with MMSE, CDR, and GDS scores.
Correlation was observed between serum homocysteine levels and behavioral and psychological symptoms of AD. There is a possibility of etiological role, but the underlying pathophysiological mechanisms need to be elucidated. Whether patients will benefit or not with supplements of vitamin B12 and folate requires further research. This was a cross-sectional study and findings should not be generalized. Further prospective longitudinal studies with a large number of patients are needed.
有研究表明血清维生素B12、叶酸与阿尔茨海默病（AD）中的痴呆行为和心理症状（BPSD）之间存在关联。这些维生素的血清水平并不能反映实际疾病状态，因此检测血清同型半胱氨酸水平被认为是一项更好的检测方法。已发现同型半胱氨酸与认知障碍和各种精神疾病有关。
本研究旨在确定AD患者血清同型半胱氨酸水平与BPSD之间的相关性。
本研究纳入了18例AD患者和18例健康对照者。AD的诊断采用国际疾病分类第10版进行确认。AD患者采用简易精神状态检查表（MMSE）、临床痴呆评定量表（CDR）、总体衰退量表（GDS）和神经精神科问卷（NPI）进行评估。健康对照者采用MMSE和迷你国际神经精神访谈进行评估。对所有研究对象测定血清同型半胱氨酸、维生素B12和叶酸水平。
与对照组相比，AD患者血清同型半胱氨酸水平在统计学上显著更高，而维生素B12和叶酸水平无显著差异。血清同型半胱氨酸水平与NPI总分以及NPI子领域尤其是妄想、激越/攻击和抑郁/烦躁不安在统计学上呈显著正相关。血清同型半胱氨酸水平与MMSE、CDR和GDS评分无显著相关性。
观察到血清同型半胱氨酸水平与AD的行为和心理症状之间存在相关性。有可能存在病因学作用，但潜在的病理生理机制需要阐明。补充维生素B12和叶酸患者是否会受益需要进一步研究。这是一项横断面研究，研究结果不应一概而论。需要对大量患者进行进一步的前瞻性纵向研究。
