Plasma homocysteine and vascular disease in psychogeriatric patients.
BACKGROUND
There is a high frequency (40-50%) of elevated plasma total homocysteine (tHcy) concentrations in elderly patients with mental disorders, and patients with a history of vascular disease exhibit significantly higher plasma tHcy concentration than patients without vascular disease.


METHODS
The main objective of the present study was to further investigate the association between plasma tHcy concentration and vascular disease in psychogeriatric patients. We have therefore investigated 304 psychogeriatric patients and determined plasma tHcy and its most important determinants (folate and cobalamin status and renal function), and the natriuretic peptide N-terminal-pro brain natriuretic peptide (NT-proBNP). The patients were classified into several groups of vascular disease according to the findings of brain imaging and presence of a history/symptoms indicating manifest occlusive arteriosclerotic vascular disease.


RESULTS
Plasma tHcy concentration is associated with the presence of vascular disease in psychogeriatric patients. The presence of vascular disease is also associated with higher age, higher serum NT-proBNP, renal impairment and lower serum folate concentration than in patients without vascular disease. The significant association between plasma tHcy concentration and vascular disease remained after correction for age and for cystatin C differences between the groups of patients without and with vascular disease. In the present population with only 16% of the patients showing elevated plasma tHcy, renal function was a more important determinant for plasma tHcy concentration than folate status.


CONCLUSIONS
Plasma tHcy concentration is associated with vascular disease. In the present population of psychogeriatric patients renal function is associated with vascular disease and elevated plasma tHcy concentration. Thus, the association between plasma tHcy concentration and vascular disease might partially be explained by impairment of renal function.
Nilsson
Karin
K
Department of Psychogeriatrics, Clinical Science, Lund University Hospital, Lund, Sweden.
Gustafson
Lars
L
Hultberg
Björn
B
D000368:Aged; D000369:Aged, 80 and over; D000544:Alzheimer Disease / Q000097:blood*; D003072:Cognition Disorders / Q000097:blood; D003221:Confusion / Q000097:blood; D003704:Dementia / Q000097:blood*; D015140:Dementia, Vascular / Q000097:blood*; D003866:Depressive Disorder / Q000097:blood; D005260:Female; D005492:Folic Acid / Q000097:blood; D006710:Homocysteine / Q000097:blood*; D006801:Humans; D007677:Kidney Function Tests; D008297:Male; D008875:Middle Aged; D020097:Natriuretic Peptide, Brain / Q000097:blood; D009483:Neuropsychological Tests; D010446:Peptide Fragments / Q000097:blood; D012016:Reference Values; D012307:Risk Factors; D014805:Vitamin B 12 / Q000097:blood
D010446:Peptide Fragments; C109794:pro-brain natriuretic peptide (1-76); D006710:Homocysteine; D020097:Natriuretic Peptide, Brain; D005492:Folic Acid; D014805:Vitamin B 12