title: Increased total homocysteine level is associated with clinical status and severity of white matter changes in symptomatic patients with subcortical small vessel disease.
abstract: OBJECTIVE
  Elevated plasma total homocysteine (tHcy) is an independent risk factor for ischemic stroke and has been linked to cerebral small vessel disease (SVD), in particular. Controversy persists as to whether increased tHcy is associated with functional status and cognitive decline in these patients.
  
  
  METHODS
  Plasma tHcy, MTHFR polymorphism, vascular risk factors, functional and cognitive status and severity of lesions on MRI, assessed with the Age-Related White Matter Changes (ARWMC) visual grading scale, were analyzed in 95 patients with SVD and 41 healthy control subjects.
  
  
  RESULTS
  Plasma tHcy levels were higher in patients with SVD (14.4±5.0 μmol/L) compared to healthy SVD-free controls (8.9±3.9 μmol/L). In SVD patients, tHcy levels strongly correlated with cognitive status (age-adjusted risk 5.8, 95% CI 1.3-25.3, p=0.015), functional status (age-adjusted risk 3.2, 95% CI 1.2-8.8, p=0.022) and severity of MRI lesions (age-adjusted risk 1.2, 95% CI 1.1-1.4; p=0.004). Only total ARWMC score was independently associated with increased tHcy levels (OR 1.2, 95%CI 1.1-1.4, p=0.004). Independent predictors of WMC occurrence were tHcy levels (OR 1.2, 95%CI 1.1-1.3, p=0.003) and mRS score (OR 2.2, 95%CI 1.2-4.1, p=0.017).
  
  
  CONCLUSIONS
  In patients with cerebral SVD there is a positive association of increased plasma tHcy levels with clinical status and severity of WMC.
authors.affiliation: Clinic for Neurology, Clinical Center of Serbia, Faculty of Medicine, University of Belgrade, Dr Subotica 6, Belgrade 11000, Serbia. aleksandrapavlovic@hotmail.com
authors.forename: A M
authors.initials: AM
authors.lastname: Pavlovic
authors.forename: T
authors.initials: T
authors.lastname: Pekmezovic
authors.forename: R
authors.initials: R
authors.lastname: Obrenovic
authors.forename: I
authors.initials: I
authors.lastname: Novakovic
authors.forename: G
authors.initials: G
authors.lastname: Tomic
authors.forename: M
authors.initials: M
authors.lastname: Mijajlovic
authors.forename: N
authors.initials: N
authors.lastname: Sternic
mesh_terms: D000367:Age Factors; D000368:Aged; D015415:Biomarkers; D001921:Brain / Q000473:pathology*; D059345:Cerebral Small Vessel Diseases / Q000097:blood* / Q000453:epidemiology / Q000523:psychology; D003071:Cognition / Q000502:physiology; D003863:Depression / Q000150:complications / Q000523:psychology; D005260:Female; D005838:Genotype; D006710:Homocysteine / Q000097:blood* / Q000235:genetics; D006801:Humans; D007091:Image Processing, Computer-Assisted; D008279:Magnetic Resonance Imaging; D008297:Male; D045102:Methylenetetrahydrofolate Dehydrogenase (NAD+) / Q000235:genetics; D008875:Middle Aged; D009483:Neuropsychological Tests; D016017:Odds Ratio; D011569:Psychiatric Status Rating Scales; D055771:Serbia / Q000453:epidemiology; D012737:Sex Factors
chemical_list: D015415:Biomarkers; D006710:Homocysteine; D045102:Methylenetetrahydrofolate Dehydrogenase (NAD+)