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Homocysteine and cognitive tests as predictors of cognitive decline: A cohort study
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Abstracts / Journal of the Neurological Sciences 283 (2009) 240–320
Correlation of plasma homocysteine levels with common neurological diseases in the elderly
Al. Siannia, K. Kosmaa, K. Liatsosc, E. Laskosa, A. Ganotopouloub a Dromokaitio Psychiatric Hospital of Athens, Attiki, Greece b Health Center of Skiathos, General Prefectural Hospital of Volos, Magnissia, Greece c Mitera Maternity Hospital of Athens, Attiki, Greece Introduction: Elevated levels of homocysteine have been associated with a variety of atherosclerotic diseases and with an increased risk for Alzheimer's dementia. Methods: In total, 97 subjects were included. All were over 55 years-old and inpatients of the Psychiatric Hospital of Athens. Patients with a diagnosis of congenital hyperhomocysteinemia were excluded. Subjects were divided in three groups. Group A consisted of 35 patients, 16 men and 19 women with a diagnosis of Alzheimer's dementia at least one year before entering the study. Group B was comprised of 32 patients, 18 men and 14 women. Patients of this group had a positive history of stroke, or a diagnosis of vascular or mixed dementia. At last 30 subjects, 14 men and 16 women, non demented and free of atherosclerotic disease psychiatric patients constituted Group C. Results: 5 patients (14.3%) of Group A presented with high homocysteine levels > 15 μmol/l. The rest had normal homocysteine values. The percentage was higher for Group B in which 7 patients (21%) had elevated homocysteine levels and finally and lower for group C in which only 3 patients 8.5% presented hyperhomocysteinemia The differences between the three subpopulations did not reach a statistical significance(x2 = 1.64). Conclusions: No significant relationship was detected between high homocysteine levels and the presence of Alzheimer's dementia. On the other hand, elevated homocysteine levels were detected more often when vascular dementia or a positive history of stroke was presented.
Group A Homocysteine levels 5-15mmol/lt >5mmol/lt Group B Homocysteine levels 5-15mmol/lt >5mmol/lt Group C Homocysteine levels 5-15mmol/lt >5mmol/lt
Patients N = 35 30 5
Women N = 19 17 2
Men N = 16 13 3
Patients N = 32 25 7
Women N = 14 12 2
Men N = 18 13 5
Patients N = 30 27 3
Women N = 16 15 1
Men N = 14 12 2
doi:10.1016/j.jns.2009.02.213
Homocysteine and cognitive tests as predictors of cognitive decline: A cohort study A. Garciaa, A. Hemraja, S. Klara, T. Chestneya, L. Khojaa, A. Dayb Department of Medicine, Queen's University, Kingston, Ontario, Canada Clinical Research Centre, KGH, Queen's University, Kingston, Ontario, Canada Background and aim: Homocysteine (tHcy) is considered a vascular dementia risk factor. We have assessed the relative impact of tHcy and psychometric tests scores in the development of dementia in a cohort of older adults. Methods: Cohort (n = 281) of cognitively normal older adults (ages 65 to 89) at baseline. Follow-up was 8 years (median of 6.5 years) and 44 (15.7%) were lost to follow-up (or had < 4 years of follow-up). Tests at baseline and at follow-up included: Mini-Mental State Exam (MMSE), Mattis Dementia Rating Scale (DRS), California Verbal Learning Test (CVLT), Stroop test, and serum tHcy. Analysis of data included CVLT factor analysis, Cox proportional hazards and Receiver Operating Characteristics (ROC). Results: At baseline, mean (± SD) tHy was 10.0 ± 4.0 with 12% having high tHcy (≥ 13 mM). Baseline tHcy was positively correlated with age and female sex and negatively correlated with baseline Stroop and CVLT factor 1. There were no significant differences at baseline between subjects followed
and the ones lost to follow-up but for the DRS score. Cumulative incidence of dementia at 8 years was 21%. Participants diagnosed with dementia were: older, more likely to be female, had higher tHcy levels, and had lower baseline test scores. Cox proportional hazard models showed that all psychometric test scores significantly predicted dementia after adjustment for age and sex. tHcy as continuous variable was not independently associated with dementia diagnosis (p = 0.42), but was mildly suggestive when dichotomized as high/normal (p = 0.048). Only CVLT factor 1 and DRS showed significant hazard ratio (p < 0.001) in backwards selection. ROC analysis showed that all variables had an area under the curve significantly greater than 0.5 (all p < 0.005 but for tHcy p < 0.012). Conclusions: These results suggest that tHcy predicts dementia only marginally when levels are high and that psychometric tests scores at baseline are better predictors of dementia. doi:10.1016/j.jns.2009.02.214
Post-stroke depression after mild stroke D.C. Kuljic Obradovic, S. Medic, N. Ivanovic Basurovic Sveti Sava Hospital, Belgrade, Serbia Background and aims: Post-stroke depression is one of the most frequent complications of stroke. The prevalence rates range from 30% to 50%. Whether post-stroke depression is an emotional response to the independence or an organic consequence of the brain injury still remains to be resolve. The aim of the study was to investigate the prevalence of depression in mild stroke patients and relationship between the occurrence of depression and sex, age, type of stroke, size of the cerebral lesion and involvement of specific areas of the brain. Methods: We included patients with single, demarcated, unilateral stroke defined by brain CT and/or MRI examination. The neurological examination was performed and diagnosis made using the criteria established by National Institute of Neurological Disorders and Stroke NIH-NINDS. The patients were studied using a standard protocol including Mini-Mental State Examination (MMSE) and Hamilton Rating Scale for Depression (HRSD). The patients with previous psychiatric illness, severe stroke (HIH-NINDS > 20) and cognitive impairments (MMSE < 24) were excluded. Results: 56 patients were studied, 31 female, 25 male, mean age 66.5. Thirty percent of the stroke patients fit the criteria for minor (14) or major (3) depression. No significant differences in sex, age, type of stroke (hemorrhagic/ischemic), territory of the stroke (cortical vs. subcortical, anterior vs. posterior vs. nonclassifiable) were found between depressed and non-depressed patients. There was a higher frequency of left hemisphere lesions (50% vs. 23.5%) and brain lesions larger than 2 cm (50% vs. 23.5%) in patients who have developed depression. Conclusions: Among the patients with mild stroke, the frequency of the depression was 30%, and was higher in patients with large brain lesions (p < 0.05), located in the left hemisphere (p < 0.05). We found no significant differences in depression scores depending on sex, age, type of stroke and vascular territory of the stroke. doi:10.1016/j.jns.2009.02.215
The relationship between poststroke depression and cognitive impairment in the patients of subacute stroke
S.D. Yoo, Y.S. Jeong, D.H. Kim Department of Physical Medicine and Rehabilitation, Kyung Hee University, East-West Neo Medical Center, Seoul, South Korea Background and aims: The aim of this study was to understand the correlation between PSD and the cognitive function in the patients of subacute stroke. Methods: We studied stroke patients who did not have aphasia, hearing disturbance, and history of depression. The severity of PSD were evaluated by Beck depression inventory(BDI), Korean form of Geriatric depression scale
Abstracts / Journal of the Neurological Sciences 283 (2009) 240–320
Correlation of plasma homocysteine levels with common neurological diseases in the elderly
Al. Siannia, K. Kosmaa, K. Liatsosc, E. Laskosa, A. Ganotopouloub a Dromokaitio Psychiatric Hospital of Athens, Attiki, Greece b Health Center of Skiathos, General Prefectural Hospital of Volos, Magnissia, Greece c Mitera Maternity Hospital of Athens, Attiki, Greece Introduction: Elevated levels of homocysteine have been associated with a variety of atherosclerotic diseases and with an increased risk for Alzheimer's dementia. Methods: In total, 97 subjects were included. All were over 55 years-old and inpatients of the Psychiatric Hospital of Athens. Patients with a diagnosis of congenital hyperhomocysteinemia were excluded. Subjects were divided in three groups. Group A consisted of 35 patients, 16 men and 19 women with a diagnosis of Alzheimer's dementia at least one year before entering the study. Group B was comprised of 32 patients, 18 men and 14 women. Patients of this group had a positive history of stroke, or a diagnosis of vascular or mixed dementia. At last 30 subjects, 14 men and 16 women, non demented and free of atherosclerotic disease psychiatric patients constituted Group C. Results: 5 patients (14.3%) of Group A presented with high homocysteine levels > 15 μmol/l. The rest had normal homocysteine values. The percentage was higher for Group B in which 7 patients (21%) had elevated homocysteine levels and finally and lower for group C in which only 3 patients 8.5% presented hyperhomocysteinemia The differences between the three subpopulations did not reach a statistical significance(x2 = 1.64). Conclusions: No significant relationship was detected between high homocysteine levels and the presence of Alzheimer's dementia. On the other hand, elevated homocysteine levels were detected more often when vascular dementia or a positive history of stroke was presented.
Group A Homocysteine levels 5-15mmol/lt >5mmol/lt Group B Homocysteine levels 5-15mmol/lt >5mmol/lt Group C Homocysteine levels 5-15mmol/lt >5mmol/lt
Patients N = 35 30 5
Women N = 19 17 2
Men N = 16 13 3
Patients N = 32 25 7
Women N = 14 12 2
Men N = 18 13 5
Patients N = 30 27 3
Women N = 16 15 1
Men N = 14 12 2
doi:10.1016/j.jns.2009.02.213
Homocysteine and cognitive tests as predictors of cognitive decline: A cohort study A. Garciaa, A. Hemraja, S. Klara, T. Chestneya, L. Khojaa, A. Dayb Department of Medicine, Queen's University, Kingston, Ontario, Canada Clinical Research Centre, KGH, Queen's University, Kingston, Ontario, Canada Background and aim: Homocysteine (tHcy) is considered a vascular dementia risk factor. We have assessed the relative impact of tHcy and psychometric tests scores in the development of dementia in a cohort of older adults. Methods: Cohort (n = 281) of cognitively normal older adults (ages 65 to 89) at baseline. Follow-up was 8 years (median of 6.5 years) and 44 (15.7%) were lost to follow-up (or had < 4 years of follow-up). Tests at baseline and at follow-up included: Mini-Mental State Exam (MMSE), Mattis Dementia Rating Scale (DRS), California Verbal Learning Test (CVLT), Stroop test, and serum tHcy. Analysis of data included CVLT factor analysis, Cox proportional hazards and Receiver Operating Characteristics (ROC). Results: At baseline, mean (± SD) tHy was 10.0 ± 4.0 with 12% having high tHcy (≥ 13 mM). Baseline tHcy was positively correlated with age and female sex and negatively correlated with baseline Stroop and CVLT factor 1. There were no significant differences at baseline between subjects followed
and the ones lost to follow-up but for the DRS score. Cumulative incidence of dementia at 8 years was 21%. Participants diagnosed with dementia were: older, more likely to be female, had higher tHcy levels, and had lower baseline test scores. Cox proportional hazard models showed that all psychometric test scores significantly predicted dementia after adjustment for age and sex. tHcy as continuous variable was not independently associated with dementia diagnosis (p = 0.42), but was mildly suggestive when dichotomized as high/normal (p = 0.048). Only CVLT factor 1 and DRS showed significant hazard ratio (p < 0.001) in backwards selection. ROC analysis showed that all variables had an area under the curve significantly greater than 0.5 (all p < 0.005 but for tHcy p < 0.012). Conclusions: These results suggest that tHcy predicts dementia only marginally when levels are high and that psychometric tests scores at baseline are better predictors of dementia. doi:10.1016/j.jns.2009.02.214
Post-stroke depression after mild stroke D.C. Kuljic Obradovic, S. Medic, N. Ivanovic Basurovic Sveti Sava Hospital, Belgrade, Serbia Background and aims: Post-stroke depression is one of the most frequent complications of stroke. The prevalence rates range from 30% to 50%. Whether post-stroke depression is an emotional response to the independence or an organic consequence of the brain injury still remains to be resolve. The aim of the study was to investigate the prevalence of depression in mild stroke patients and relationship between the occurrence of depression and sex, age, type of stroke, size of the cerebral lesion and involvement of specific areas of the brain. Methods: We included patients with single, demarcated, unilateral stroke defined by brain CT and/or MRI examination. The neurological examination was performed and diagnosis made using the criteria established by National Institute of Neurological Disorders and Stroke NIH-NINDS. The patients were studied using a standard protocol including Mini-Mental State Examination (MMSE) and Hamilton Rating Scale for Depression (HRSD). The patients with previous psychiatric illness, severe stroke (HIH-NINDS > 20) and cognitive impairments (MMSE < 24) were excluded. Results: 56 patients were studied, 31 female, 25 male, mean age 66.5. Thirty percent of the stroke patients fit the criteria for minor (14) or major (3) depression. No significant differences in sex, age, type of stroke (hemorrhagic/ischemic), territory of the stroke (cortical vs. subcortical, anterior vs. posterior vs. nonclassifiable) were found between depressed and non-depressed patients. There was a higher frequency of left hemisphere lesions (50% vs. 23.5%) and brain lesions larger than 2 cm (50% vs. 23.5%) in patients who have developed depression. Conclusions: Among the patients with mild stroke, the frequency of the depression was 30%, and was higher in patients with large brain lesions (p < 0.05), located in the left hemisphere (p < 0.05). We found no significant differences in depression scores depending on sex, age, type of stroke and vascular territory of the stroke. doi:10.1016/j.jns.2009.02.215
The relationship between poststroke depression and cognitive impairment in the patients of subacute stroke
S.D. Yoo, Y.S. Jeong, D.H. Kim Department of Physical Medicine and Rehabilitation, Kyung Hee University, East-West Neo Medical Center, Seoul, South Korea Background and aims: The aim of this study was to understand the correlation between PSD and the cognitive function in the patients of subacute stroke. Methods: We studied stroke patients who did not have aphasia, hearing disturbance, and history of depression. The severity of PSD were evaluated by Beck depression inventory(BDI), Korean form of Geriatric depression scale