Plasma homocysteine and risk of coexisting silent brain infarction in Alzheimer's disease.
BACKGROUND
Cerebrovascular disease is common in Alzheimer's disease (AD). Elevated plasma homocysteine (pHcy) levels are reported to be associated with an increased risk of poor cognition and dementia.


OBJECTIVE
To determine whether high pHcy levels are associated with an increased risk of coexisting silent brain infarctions (SBIs) in AD.


METHODS
Study population comprising 143 outpatients with clinical diagnosis of probable AD (73.3 +/- 7.0 years) were classified into 2 groups according to the presence or absence of SBIs on magnetic resonance imaging.


RESULTS
SBIs were noted in 32.9% (47/143) of the AD patients. The pHcy levels in the AD with SBIs (14.0 +/- 4.5 micromol/l) were significant ly elevated compared with the AD without SBIs (11.7 +/- 4.7 micromol/l, p = 0.007). After adjusting for age and gender, high pHcy (>12.4 micromol/l), but not hypertension, was associated with an increased risk of developing SBIs in AD (OR = 4.61, 95% CI = 1.74-12.2, p = 0.002). However, age at onset, cognitive function, cerebrospinal tau or amyloid beta-peptide(1-42) levels were not significantly correlated with pHcy levels in AD.


CONCLUSIONS
SBIs commonly coexist with AD, and may be a unique vascular condition in which homocysteine plays an important role. Homocysteine-lowering therapy rather than antihypertensive medication might be an appropriate strategy to prevent stroke associated with AD.
Matsui
Toshifumi
T
Department of Geriatric and Respiratory Medicine, Tohoku University Graduate School of Medicine, Sendai, Japan.
Nemoto
Miyako
M
Maruyama
Masahiro
M
Yuzuriha
Takefumi
T
Yao
Hiroshi
H
Tanji
Haruko
H
Ootsuki
Mari
M
Tomita
Naoki
N
Matsushita
Sachio
S
Higuchi
Susumu
S
Yoshida
Yo-ichi
Y
Seki
Takashi
T
Iwasaki
Koh
K
Furukawa
Katsutoshi
K
Arai
Hiroyuki
H
D000368:Aged; D000483:Alleles; D000544:Alzheimer Disease / Q000150:complications* / Q000453:epidemiology*; D016229:Amyloid beta-Peptides / Q000134:cerebrospinal fluid; D001057:Apolipoproteins E / Q000235:genetics; D016923:Cell Death / Q000502:physiology; D002544:Cerebral Infarction / Q000453:epidemiology* / Q000209:etiology*; D004797:Enzyme-Linked Immunosorbent Assay; D005260:Female; D005492:Folic Acid / Q000097:blood; D005838:Genotype; D006710:Homocysteine / Q000097:blood*; D006801:Humans; D008279:Magnetic Resonance Imaging; D008297:Male; D009474:Neurons; D010446:Peptide Fragments / Q000134:cerebrospinal fluid; D012307:Risk Factors; D014805:Vitamin B 12 / Q000097:blood; D016875:tau Proteins / Q000134:cerebrospinal fluid
D016229:Amyloid beta-Peptides; D001057:Apolipoproteins E; D010446:Peptide Fragments; C075222:amyloid beta-protein (1-42); D016875:tau Proteins; D006710:Homocysteine; D005492:Folic Acid; D014805:Vitamin B 12