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Plasma homocysteine and cognitive decline in older hypertensive subjects

Published online by Cambridge University Press:  06 May 2011

Sunil K. Narayan ,
Brian K. Saxby ,
Michael J. Firbank ,
John T. O'Brien ,
Frances Harrington ,
Ian G. McKeith ,
Monica Hansrani ,
Gerard Stansby  and
Gary A. Ford
Sunil K. Narayan
Affiliation:
Institute for Ageing and Health, Newcastle University, Campus for Ageing and Vitality, Newcastle upon Tyne, UK
Brian K. Saxby
Affiliation:
Institute for Ageing and Health, Newcastle University, Campus for Ageing and Vitality, Newcastle upon Tyne, UK
Michael J. Firbank
Affiliation:
Institute for Ageing and Health, Newcastle University, Campus for Ageing and Vitality, Newcastle upon Tyne, UK
John T. O'Brien
Affiliation:
Institute for Ageing and Health, Newcastle University, Campus for Ageing and Vitality, Newcastle upon Tyne, UK
Frances Harrington
Affiliation:
Institute for Ageing and Health, Newcastle University, Campus for Ageing and Vitality, Newcastle upon Tyne, UK
Ian G. McKeith
Affiliation:
Institute for Ageing and Health, Newcastle University, Campus for Ageing and Vitality, Newcastle upon Tyne, UK
Monica Hansrani
Affiliation:
Department of Surgery, Newcastle upon Tyne Hospitals NHS Foundation Trust, Royal Victoria Infirmary, Newcastle upon Tyne, UK
Gerard Stansby
Affiliation:
Institute of Cellular Medicine, Newcastle University, Newcastle upon Tyne, UK
Gary A. Ford*
Affiliation:
Institute for Ageing and Health, Newcastle University, Campus for Ageing and Vitality, Newcastle upon Tyne, UK
*
Correspondence should be addressed to: Professor Gary A. Ford, Level 6 Leazes Wing, Royal Victoria Infirmary, Newcastle upon Tyne, NE1 4LP, UK. Phone: +44–191-222-7744; Fax: +44-191-282-0288. Email: g.a.ford@ncl.ac.uk.
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Abstract

Background: Elevated plasma homocysteine concentrations have been associated with both cognitive impairment and dementia. However, it is unclear whether some cognitive domains are more affected than others, or if this relationship is independent of B12 and folate levels, which can also affect cognition. We examined the relationship between plasma homocysteine and cognitive decline in an older hypertensive population.

Methods: 182 older people (mean age 80 years) with hypertension and without dementia, were studied at one center participating in the Study on COgnition and Prognosis in the Elderly (SCOPE). Annual cognitive assessments were performed using a computerized assessment battery and executive function tests, over a 3–5 year period (mean 44 months). Individual rates of decline on five cognitive domains were calculated for each patient. End of study plasma homocysteine, folate and B12 concentrations were measured. The relationship between homocysteine levels and cognitive decline was studied using multivariate regression models, and by comparing high versus low homocysteine quartile groups.

Results: Higher homocysteine showed an independent association with greater cognitive decline in three domains: speed of cognition (β = −27.33, p = 0.001), episodic memory (β = −1.25, p = 0.02) and executive function (β = −0.05, p = 0.04). The association with executive function was no longer significant after inclusion of folate in the regression model (β = −0.032, p = 0.22). Change in working memory and attention were not associated with plasma homocysteine, folate or B12. High homocysteine was associated with greater decline with a Cohen's d effect size of approximately 0.7 compared to low homocysteine.

Conclusions: In a population of older hypertensive patients, higher plasma homocysteine was associated with cognitive decline.

Keywords

vitamin B12folatecognitionimmunoassaycerebrovascular disease
Type
Research Article
Information
International Psychogeriatrics , Volume 23 , Issue 10 , December 2011 , pp. 1607 - 1615
Copyright
Copyright © International Psychogeriatric Association 2011

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