Total serum homocysteine in senile dementia of Alzheimer type
A. McCaddon
Bok Engelsk 1998
| Utgitt | 1998
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| Omfang | Side 235- 239
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| Opplysninger | Objective. The main hypothesis was that subtle vitamin B12deficiencies occur more commonly in senile dementia of Alzheimer type(SDAT) than in healthy elderly individuals, and may be revealed byelevated total serum homocysteine (tHcy). A subsidiary hypothesis wasthat such deficiencies would be nutritionally independent asdetermined by retinol binding protein (RBP).Design. A prospective case-controlled survey.Setting. A Welsh urban psychogeriatric assessment centre and localgeneral practice.Patients. Thirty patients, aged 65 or over, seen consecutively in1994 with features compatible with DSM-III-R criteria for primarydegenerative dementia of Alzheimer type and 30 cognitively intact age-matched control subjects.Measures. Diagnosis was assessed using the CAMDEX. Cognitive scoreswere evaluated with the CAMCOG scale for patients and MMSE scores forcontrol subjects. THcy was measured using high performance liquidchromatography (HPLC), and REP assayed by a radial immunodiffusionmethod.Results. Patients had a highly significant elevation of tHcy comparedwith controls (p < 0.0001). Multiple regression highlighted theinterrelated effects of tHcy and total serum cobalamin on cognitivescores. REP did not differ between groups. Macrocytosis was absent,and neutrophil hypersegmentation uncommon, in hyperhomocysteinaemicpatients.Conclusions. SDAT patients have significantly elevated tHcy. This isindependent of REP determined nutritional status. 'Classical'haematological changes of cobalamin or folate deficiency are poorpredictors of tHcy in these patients. Aberrant cobalamin tissuedelivery appears to contribute to SDAT cognitive decline. Relativecontributions of other tHcy determinants require furtherinvestigation. (C) 1998 John Wiley & Sons, Ltd.
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