title: Hyperhomocysteinemia is associated with volumetric white matter change in patients with small vessel disease.
abstract: BACKGROUND
  Hyperhomocysteinemia is associated with cerebral small vessel disease (SVD). We examined the relationship between homocysteine and 1) volumetric measure of white matter change (WMC), 2) silent brain infarcts, 3) cerebral atrophy on MRI and 4) cognition on a consecutive cohort of patients with stroke associated with SVD.
  
  
  METHODS
  Fifty-seven patients consecutively admitted to the Acute Stroke Unit in a university hospital due to stroke associated with SVD were recruited and assessed three months after the stroke. Non-fasting homocysteine was obtained. Using MRI, the number of infarcts, volume of WMC and cerebral atrophy were measured. General cognitive functions were assessed using the Mini Mental State Examination and Alzheimer's disease Assessment Scale. Mattis Dementia Rating Scale - Initiation/Perseveration subset was used to assess executive cognitive functions.
  
  
  RESULTS
  Hyperhomocysteinemia (> or = 14.88 micromol/L) significantly accounted for the volume of WMC on MRI in a multivariate stepwise regression model (adjusted R(2)=0.058, p <0.05) after adjustment for age and folate level. Patients in the highest quartile of WMC volume had significantly higher levels of homocysteine than those in lowest quartile (p <0.001). No significant relationship was found between homocysteine and silent brain infarcts, cerebral atrophy and performance on psychometric tests.
  
  
  CONCLUSIONS
  Hyperhomocysteinemia is associated with volumetric measure of WMC among patients with SVD. The role of homocysteine in the development of silent brain infarcts and cerebral atrophy as previously reported cannot be ascertained in this study. No direct relationship was found between homocysteine and cognitive functions.
authors.affiliation: Dept. of Medicine and Therapeutics Chinese, University of Hong Kong, Prince of Wales Hospital Shatin, New Territories, Hong Kong. ks-wong@cuhk.edu.hk
authors.forename: Adrian
authors.initials: A
authors.lastname: Wong
authors.forename: Vincent
authors.initials: V
authors.lastname: Mok
authors.forename: Yu Hua
authors.initials: YH
authors.lastname: Fan
authors.forename: Wynnie W M
authors.initials: WW
authors.lastname: Lam
authors.forename: K S
authors.initials: KS
authors.lastname: Liang
authors.forename: Ka Sing
authors.initials: KS
authors.lastname: Wong
mesh_terms: D000368:Aged; D001921:Brain / Q000473:pathology*; D002561:Cerebrovascular Disorders / Q000097:blood / Q000473:pathology* / Q000523:psychology; D003072:Cognition Disorders / Q000209:etiology; D015331:Cohort Studies; D003404:Creatinine / Q000097:blood; D005260:Female; D006710:Homocysteine / Q000097:blood; D006801:Humans; D020138:Hyperhomocysteinemia / Q000097:blood / Q000473:pathology* / Q000523:psychology; D008279:Magnetic Resonance Imaging; D008297:Male; D009483:Neuropsychological Tests; D011569:Psychiatric Status Rating Scales; D011594:Psychometrics; D012044:Regression Analysis; D012307:Risk Factors; D020521:Stroke / Q000209:etiology / Q000473:pathology; D014805:Vitamin B 12 / Q000097:blood
chemical_list: D006710:Homocysteine; D003404:Creatinine; D014805:Vitamin B 12