Department of Neurology, University of California San Francisco, San Francisco, CA, USA.
Department of Neurology, Center for Health and Technology, University of Rochester, Rochester, NY, USA.
J Parkinsons Dis. 2024;14(6):1243-1255. doi: 10.3233/JPD-240035.
DATATOP was a study of early Parkinson's disease (PD) conducted in the 1980 s, before mandatory folic acid fortification in the United States. Our analysis of its baseline serum samples revealed a geometric mean vitamin B12 of 369 pg/mL and homocysteine (tHcy) of 9.5μmol/l. We also found that low B12 predicted greater worsening of ambulatory capacity (AC) and elevated tHcy (>15μmol/L) predicted greater declines in cognitive function.
We sought to measure B12 and tHcy in contemporary trial participants with early PD who had not started dopaminergic treatment and to determine whether these analytes were associated with clinical progression.
We measured B12 and tHcy from baseline and end-of-study blood samples from three recent clinical trials.
Baseline geometric mean B12 levels for these studies ranged from 484- 618 pg/ml and for tHcy ranged from 7.4- 10μmol/L. Use of B12-containing supplements ranged from 41- 61%, and those taking supplements had higher B12 and lower tHcy. Those who began levodopa, but were not taking B12-supplements, had greater end-of-study tHcy. There was no association of baseline tHcy > 15μmol/L with annualized change in Montreal Cognitive Assessment and no association of baseline B12 tertiles with change in AC.
In these longitudinal trials, B12 levels were higher than for DATATOP, due in large part to increased B12-supplement intake, while tHcy levels were similar. Initiation of levodopa was associated with increases of tHcy in those not taking a B12-containing supplement. These smaller studies did not replicate prior findings of low B12 and elevated tHcy with features of progression, possibly due to higher baseline B12.
DATATOP 是一项 20 世纪 80 年代在美国强制叶酸强化之前进行的早期帕金森病 (PD) 研究。我们对其基线血清样本的分析显示，维生素 B12 的几何平均值为 369pg/mL，同型半胱氨酸 (tHcy) 为 9.5μmol/L。我们还发现，低 B12 预示着步行能力 (AC) 恶化更大，而高 tHcy (>15μmol/L) 预示着认知功能下降更大。
我们试图测量早期 PD 且尚未开始多巴胺能治疗的当代试验参与者的 B12 和 tHcy，并确定这些分析物是否与临床进展相关。
我们从最近三项临床试验的基线和研究结束时的血液样本中测量了 B12 和 tHcy。
这些研究的基线几何平均 B12 水平范围为 484-618pg/ml，tHcy 水平范围为 7.4-10μmol/L。B12 补充剂的使用率为 41-61%，服用补充剂的人 B12 更高，tHcy 更低。那些开始服用左旋多巴但未服用 B12 补充剂的人在研究结束时 tHcy 更高。基线 tHcy>15μmol/L 与蒙特利尔认知评估的年变化率之间没有关联，基线 B12 三分位数与 AC 变化之间也没有关联。
在这些纵向试验中，B12 水平高于 DATATOP，这主要是由于 B12 补充剂摄入量的增加，而 tHcy 水平相似。在未服用含 B12 补充剂的患者中，左旋多巴的使用与 tHcy 的增加有关。这些较小的研究没有复制先前发现的低 B12 和高 tHcy 与进展特征相关的结果，这可能是由于基线 B12 较高。
