The Journals of Gerontology Series A: Biological Sciences and Medical Sciences 58:M1135-M1136 (2003)
© 2003 The Gerontological Society of America
Association of Plasma Homocysteine in Elderly Persons With Atherosclerotic Vascular Disease and Dementia, Atherosclerotic Vascular Disease Without Dementia, Dementia Without Atherosclerotic Vascular Disease, and No Dementia or Atherosclerotic Vascular Disease
Samantha G. Storey1,
Vana Suryadevara1,
Wilbert S. Aronow1,2 and
Chul Ahn3
1 Division of Geriatrics
2 Division of Cardiology, Department of Medicine, Westchester Medical Center/New York Medical College, Valhalla.
3 Department of Medicine, University of Texas School of Medicine at Houston.
 |
Abstract
|
|---|
Background. Increased plasma homocysteine has been associated with atherosclerotic vascular disease in elderly persons. The Framingham Study found that plasma homocysteine was a risk factor for dementia and Alzheimer's disease.
Methods. We investigated in an academic nursing home the association of plasma homocysteine with atherosclerotic vascular disease plus dementia (group 1), atherosclerotic vascular disease without dementia (group 2), dementia without atherosclerotic vascular disease (group 3), and no dementia or atherosclerotic vascular disease (group 4).
Results. The mean plasma homocysteine level was 15.3 ± 3.0 µmol/L in 50 group 1 patients, 15.1 ± 2.7 µmol/L in 50 group 2 patients, 14.4 ± 2.7 µmol/L in 50 group 3 patients, and 10.6 ± 3.2 µmol/L in 50 group 4 patients (p <.0001 for group 1 vs group 4, for group 2 vs group 4, and for group 3 vs group 4).
Conclusions. The mean plasma homocysteine level was significantly higher in elderly patients with atherosclerotic vascular disease plus dementia, atherosclerotic vascular disease without dementia, and dementia without atherosclerotic vascular disease than in patients with no dementia or atherosclerotic vascular disease.
INCREASED plasma homocysteine is present in elderly patients with atherosclerotic vascular disease (1–7). The Framingham Study found that plasma homocysteine was a risk factor for dementia and for Alzheimer's disease (8). We are reporting data from a cross-sectional study of elderly patients in an academic nursing home showing the association of increased plasma homocysteine with atherosclerotic vascular disease plus dementia, atherosclerotic vascular disease without dementia, dementia without atherosclerotic vascular disease, and no dementia or atherosclerotic vascular disease.
|
METHODS
|
|---|
The study population included 200 patients, mean age 78 ± 9 years (range, 59–99 years), in an academic nursing home affiliated with New York Medical College (9). Atherosclerotic vascular disease was diagnosed if the patient had either coronary artery disease, prior stroke, or peripheral arterial disease as previously described (10). Dementia was diagnosed as previously described (11).
The 4 study groups included 50 patients with atherosclerotic vascular disease plus dementia, 50 patients with atherosclerotic vascular disease without dementia, 50 patients with dementia without atherosclerotic vascular disease, and 50 patients with no dementia or atherosclerotic vascular disease. Fasting plasma homocysteine levels were obtained in all 200 patients. Normal plasma homocysteine levels in our laboratory are 5–15 µmol/L.
Chi-square tests were used for comparisons of dichotomous variables among groups. Analysis of variance tests were used for comparison of continuous variables among the 4 groups. Pair-wise comparisons were made using Student's t tests for continuous variables.
|
RESULTS
|
|---|
Table 1 shows the prevalence of women and men, the mean age, and the mean plasma homocysteine level in 50 patients with atherosclerotic vascular disease plus dementia, in 50 patients with atherosclerotic vascular disease without dementia, in 50 patients with dementia without atherosclerotic vascular disease, and in 50 patients with no dementia or atherosclerotic vascular disease. Table 1 also shows levels of statistical significance.
View this table:
[in this window]
[in a new window]
|
Table 1. Prevalence of Women and Men, Mean Age, and Mean Plasma Homocysteine in Elderly Patients With Atherosclerotic Vascular Disease Plus Dementia, Atherosclerotic Vascular Disease Without Dementia, Dementia Without Atherosclerotic Vascular Disease, and No Dementia or Atherosclerotic Vascular Disease.
|
|
|
DISCUSSION
|
|---|
Increased plasma homocysteine is present in elderly patients with atherosclerotic vascular disease (1–7). In the present study, elderly patients with atherosclerotic vascular disease with and without dementia had a significantly higher mean plasma homocysteine level than in elderly patients with no atherosclerotic vascular disease or dementia.
The Framingham Study reported in 1092 persons, mean age 76 years, without dementia, that at 8-year follow-up, dementia developed in 111 persons, including 83 with the diagnosis of Alzheimer's disease (8). In this study, an increased plasma homocysteine level was found to be a strong, independent risk factor for the development of dementia and Alzheimer's disease (8).
Joosten and colleagues (12) reported that the mean plasma homocysteine level was significantly higher in 52 elderly patients with Alzheimer's disease than in 50 nondemented elderly hospitalized control patients and in 49 healthy elderly persons living at home. Reynish and colleagues (13) explored the potential role of vitamin B12 and folate, with the production of hyperhomocysteinemia, in the pathophysiology of Alzheimer's disease.
In the present study, elderly patients with dementia with and without atherosclerotic vascular disease had a significantly higher mean plasma homocysteine level than elderly patients with no atherosclerotic vascular disease or dementia. However, prospective, randomized, double-blind, placebo-controlled trials need to be performed to investigate the effect of lowering increased plasma homocysteine levels by folic acid in combination with vitamins B6 and B12 on the development and progression of vascular dementia and of Alzheimer's disease.
|
Acknowledgments
|
|---|
Address correspondence to Wilbert S. Aronow, MD, FGSA, Cardiology Division, New York Medical College, Macy Pavilion, Rm. 138, Valhalla, NY 10595. E-mail: wsaronow{at}aol.com
Received December 18, 2002
Accepted January 23, 2003
|
References
|
|---|
- Selhub J, Jacques PF, Bostom AG, et al. Association between plasma homocysteine concentrations and extracranial carotid-artery stenosis. N Engl J Med.. 1995;332:286-291.[Abstract/Free Full Text]
- Bostom AG, Rosenberg IH, Silvershatz H, et al. Nonfasting plasma total homocysteine levels and stroke incidence in elderly persons: the Framingham study. Ann Intern Med.. 1999;131:352-355.[Abstract/Free Full Text]
- Ridker PM, Manson JE, Buring JE, Shih J, Matias M, Hennekens CH. Homocysteine and risk of cardiovascular disease among postmenopausal women. JAMA.. 1999;281:1817-1821.[Abstract/Free Full Text]
- Aronow WS, Ahn C, Schoenfeld MR. Association between plasma homocysteine and extracranial carotid arterial disease in older persons. Am J Cardiol.. 1997;79:1432-1433.[Medline]
- Aronow WS, Ahn C. Increased plasma homocysteine is an independent predictor of new coronary events in older persons. Am J Cardiol.. 2000;86:346-347.[Medline]
- Aronow WS, Ahn C, Gutstein H. Increased plasma homocysteine is an independent predictor of new atherothrombotic brain infarction in older persons. Am J Cardiol.. 2000;86:585-586.[Medline]
- Aronow WS, Ahn C. Association between plasma homocysteine and peripheral arterial disease in older persons. Coronary Artery Dis.. 1998;9:49-50.[Medline]
- Seshadri S, Beiser A, Selhub J, et al. Plasma homocysteine as a risk factor for dementia and Alzheimer's disease. N Engl J Med.. 2002;346:476-483.[Abstract/Free Full Text]
- Suryadevara V, Storey SG, Aronow WS, Ahn C. Association of abnormal serum lipids in elderly persons with atherosclerotic vascular disease and dementia, atherosclerotic vascular disease without dementia, dementia without atherosclerotic vascular disease, and no dementia or atherosclerotic vascular disease. J Gerontol Med Sci.. 2003;58A:859-861.
- Aronow WS, Ahn C, Gutstein H. Prevalence and incidence of cardiovascular disease in 1160 older men and 2464 older women in a long-term health care facility. J Gerontol Med Sci.. 2002;57A:M45-M46.
- Folstein M, Folstein SE, McHugh PR. "Mini-Mental State." A practical method of grading the cognitive state of patients for the clinician. J Psychiatr Res.. 1975;12:189-198.[Medline]
- Joosten E, Lesaffre E, Riezler R, et al. Is metabolic evidence for vitamin B-12 and folate deficiency more frequent in elderly patients with Alzheimer's disease? J Gerontol Med Sci.. 1997;52A:M76-M79.
- Reynish W, Andrieu S, Nourhashemi F, Vellas B. Nutritional factors and Alzheimer's disease. J Gerontol Med Sci.. 2001;56A:M675-M680.
This article has been cited by other articles:
|
|
|
|
 
G. Ravaglia, P. Forti, F. Maioli, M. Martelli, L. Servadei, N. Brunetti, E. Porcellini, and F. Licastro
Homocysteine and folate as risk factors for dementia and Alzheimer disease
Am. J. Clinical Nutrition,
September 1, 2005;
82(3):
636 - 643.
[Abstract]
[Full Text]
[PDF]
|
|
|
Top
Abstract
Methods
