Gofir Abdul, Wibowo Samekto, Hakimi Muhammad, Putera David Dwi, Satriotomo Irawan, Mustofa Mustofa
Department of Neurology, Faculty of Medicine, Public Health, and Nursing (FKKMK) Universitas Gadjah Mada, Yogyakarta, Indonesia.
Department of Neurology, Dr. Sardjito Hospital, Yogyakarta, Indonesia.
Int J Neuropsychopharmacol. 2021 Nov 15;25(2):136-43. doi: 10.1093/ijnp/pyab076.
As the life expectancy of elderly people has drastically increased, the incidence of cardiovascular and cerebrovascular diseases in this population has proportionally grown. Vascular cognitive impairment (VCI) refers to all forms of cognitive disorder associated with cerebrovascular disease. Homocysteine has recently been recognized as a contributor to the pathomechanisms involved in cognitive impairment. B vitamins, such as folic acid, are known to be effective in lowering homocysteine levels.
To evaluate the efficacy of folic acid in patients with VCI.
We conducted a systematic review and meta-analysis of research on folic acid treatments for VCI. Only randomized controlled trials studies that compared the efficacy of folic acid to placebo or other interventions were considered, irrespective of publication status, year of publication, and languages. Two independent reviewers searched the Medline via Ovid, EMBASE and Cochrane Central Register of Controlled Trials (Central) journal databases up to July 2021 and independently appraised the included studies. We used mean difference outcome with 95% confidence intervals (CI) to calculate the change of Mini-Mental State Examination (MMSE), cognitive function domain, and concentration of homocysteine.
We found three studies comparing folic acid with placebo and one study comparing folic acid with other interventions. There is only slight evidence that the MMSE score in patients who received Folic Acid increased 0.3 point higher compared to the placebo group after 24 months (95% CI:-0.12-0.37; p=0.31). There is very strong evidence that the concentration of Homocysteine in the Folic Acid group became 6.16 μmol/L lower compared to the placebo group after 6 months (95% CI:2.32-8.21 lower; p<0.001).
Our review shows the effectiveness of folic acid in lowering plasma homocysteine concentration after 6 months period compared to placebo. However, this effect is not accompanied by improvement in cognitive function.
随着老年人预期寿命的大幅提高，该人群中心血管和脑血管疾病的发病率也相应增加。血管性认知障碍（VCI）是指与脑血管疾病相关的所有形式的认知障碍。同型半胱氨酸最近被认为是参与认知障碍发病机制的一个因素。已知维生素B，如叶酸，可有效降低同型半胱氨酸水平。
评估叶酸对血管性认知障碍患者的疗效。
我们对叶酸治疗血管性认知障碍的研究进行了系统评价和荟萃分析。仅纳入比较叶酸与安慰剂或其他干预措施疗效的随机对照试验研究，不考虑发表状态、发表年份和语言。两名独立评审员通过Ovid检索了截至2021年7月的Medline、EMBASE和Cochrane对照试验中央注册库（Central）期刊数据库，并独立评估了纳入的研究。我们使用95%置信区间（CI）的平均差值结果来计算简易精神状态检查表（MMSE）、认知功能领域和同型半胱氨酸浓度的变化。
我们发现三项比较叶酸与安慰剂的研究和一项比较叶酸与其他干预措施的研究。仅有微弱证据表明，接受叶酸治疗的患者在24个月后MMSE评分比安慰剂组高0.3分（95%CI：-0.12-0.37；p=0.31）。有非常有力的证据表明，叶酸组的同型半胱氨酸浓度在6个月后比安慰剂组低6.16μmol/L（95%CI：低2.32-8.21；p<0.001）。
我们的综述表明，与安慰剂相比，叶酸在6个月后可有效降低血浆同型半胱氨酸浓度。然而，这种效果并未伴随着认知功能的改善。
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