Impact of homocysteine on cortical perfusion and cognitive decline in mild Alzheimer's dementia
Version of Record online: 14 APR 2013
© 2013 The Author(s) European Journal of Neurology © 2013 EFNS
European Journal of Neurology
Volume 20, Issue 8, pages 1191–1197, August 2013
How to Cite
Huang, C.-W., Chang, W.-N., Huang, S.-H., Lui, C.-C., Chen, N.-C., Chang, Y.-T., Lee, C.-C., Chang, C.-C. and Chang, A. Y. W. (2013), Impact of homocysteine on cortical perfusion and cognitive decline in mild Alzheimer's dementia. European Journal of Neurology, 20: 1191–1197. doi: 10.1111/ene.12159
- Issue online: 5 JUL 2013
- Version of Record online: 14 APR 2013
- Manuscript Accepted: 28 FEB 2013
- Manuscript Received: 12 NOV 2012
- Chang Gung Memorial Hospital. Grant Numbers: 880951, 8A0511
- Alzheimer's disease;
- cortical perfusion;
- longitudinal decline;
- single photon emission computed tomography
Background and purpose
Elevated plasma total homocysteine level (tHcy) is associated with increased risk of dementia via increased white matter changes or reduction in cortical volume. Whether tHcy has an independent impact on regional perfusion and if it can predict a more rapid cognitive decline in mild Alzheimer dementia (AD) warrants investigation.
Eighty AD patients with a clinical dementia rating of 1 were enrolled. Their Cognitive Ability Screening Instrument (CASI) scores on enrolment and after 1 year of follow-up as well as their perfusion index (PI) from single photon emission computed tomography upon enrolment were analyzed.
In cross-sectional analysis, elevated tHcy was associated with lower frontal PI independent of cerebrovascular risk factors (β = −0.35, P = 0.009). The CASI scores correlated with temporo-parietal PI (Pearson r range 0.3–0.39, P < 0.01) but not with tHcy or frontal PI. By longitudinal analysis, only tHcy level was related to a more rapid cognitive decline (odds ratio for executive function score 1.82; odds ratio for total CASI score 1.74).
Cognitive performance in mild AD can be reflected by hypo-perfusion of the temporo-parietal region while frontal hypo-perfusion may be mediated by tHcy. tHcy level is an independent risk factor for rapid cognitive decline, especially in the executive function.