Objective: To analyze the association between dementia and lysate homocysteine (Hcy) level.
Design: The study refers to 272 members of a female Catholic order at the age of 65 years or above.
Materials and Methods: Clinical diagnosis was based on cognitive evaluation (CERAD-NP neuropsychological battery) and informant interview (IQCODE, BAYER ADL). The severity of dementia was assessed using the CDR (Clinical Dementia Rating). Of the subjects, 169 were cognitively intact (CDR=0), 26 had questionable dementia (CDR = 0.5), and 77 showed mild to severe dementia (CDR 1 - 3). Hcy was measured in lysed whole blood. Using this procedure, the cut-off concentration for females is 8 µmol/L (Brandl et al. Clinical chemistry 45, No. 5,1999).
Results: The percentage of subjects with elevated Hcy levels was 35% (cognitively intact), 73% (questionable dementia), 69% (mild dementia), 81% (moderate dementia), and 100% (severe dementia). The mean Hcy levels were 7,9 µmol/L (cognitively intact), 9,8 µmol/L (questionable dementia), 10,3 µmol/L (mild dementia), 11,2 µmol/L (moderate dementia), and 16,3 µmol/L (severe dementia). Multiple logistic regression controlling for age showed that increased Hcy concentration (OR = 2.7; 95 % CI 1.27-5.79) was a significant risk factor for dementia in this group of elderly Catholic nuns.
Conclusion: We found a significant relationship between the presence of dementia and Hcy level. Elevated Hcy is a well-known risk factor for vascular diseases and may promote the development or manifestation of dementia by increasing the likelihood of cerebrovascular damage. To determine whether increased Hcy is a cause or a consequence of dementia the present sample of elderly Catholic nuns will be followed up prospectively. The homogeneous lifestyle within a religious order reduces the potential influence of confounding factors (e.g. nutrition, drinking, or smoking). This work was supported by Deutsche Forschungsgemeinschaft (Grant # Ku 585/3-1)
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