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Homocysteine, B Vitamins, and Cognitive Impairment.
Annu Rev Nutr. 2016 07 17; 36:211-39.AR

Abstract

Moderately elevated plasma total homocysteine (tHcy) is a strong modifiable risk factor for vascular dementia and Alzheimer's disease. Prospectively, elevated tHcy is associated with cognitive decline, white matter damage, brain atrophy, neurofibrillary tangles, and dementia. Most homocysteine-lowering trials with folate and vitamins B6 and/or B12 tested as protective agents against cognitive decline were poorly designed by including subjects unlikely to benefit during the trial period. In contrast, trials in high-risk subjects, which have taken into account the baseline B vitamin status, show a slowing of cognitive decline and of atrophy in critical brain regions, results that are consistent with modification of the Alzheimer's disease process. Homocysteine may interact with both risk factors and protective factors, thereby identifying people at risk but also providing potential strategies for early intervention. Public health steps to slow cognitive decline should be promoted in individuals who are at risk of dementia, and more trials are needed to see if simple interventions with nutrients can prevent progression to dementia.

Authors+Show Affiliations

OPTIMA, Department of Pharmacology, University of Oxford, Oxford OX1 3QT, United Kingdom; email: david.smith@pharm.ox.ac.uk.OPTIMA, Department of Pharmacology, University of Oxford, Oxford OX1 3QT, United Kingdom; email: david.smith@pharm.ox.ac.uk. Department of Nutrition, Institute of Basic Medical Sciences, University of Oslo, 0316 Oslo, Norway; email: helga.refsum@medisin.uio.no.

Pub Type(s)

Journal Article
Review

Language

eng

PubMed ID

27431367

Citation

Smith, A David, and Helga Refsum. "Homocysteine, B Vitamins, and Cognitive Impairment." Annual Review of Nutrition, vol. 36, 2016, pp. 211-39.
Smith AD, Refsum H. Homocysteine, B Vitamins, and Cognitive Impairment. Annu Rev Nutr. 2016;36:211-39.
Smith, A. D., & Refsum, H. (2016). Homocysteine, B Vitamins, and Cognitive Impairment. Annual Review of Nutrition, 36, 211-39. https://doi.org/10.1146/annurev-nutr-071715-050947
Smith AD, Refsum H. Homocysteine, B Vitamins, and Cognitive Impairment. Annu Rev Nutr. 2016 07 17;36:211-39. PubMed PMID: 27431367.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Homocysteine, B Vitamins, and Cognitive Impairment. AU - Smith,A David, AU - Refsum,Helga, PY - 2016/7/20/entrez PY - 2016/7/20/pubmed PY - 2017/7/21/medline KW - Alzheimer's disease KW - clinical trial KW - cobalamin (vitamin B12) KW - cognition KW - dementia KW - folate SP - 211 EP - 39 JF - Annual review of nutrition JO - Annu Rev Nutr VL - 36 N2 - Moderately elevated plasma total homocysteine (tHcy) is a strong modifiable risk factor for vascular dementia and Alzheimer's disease. Prospectively, elevated tHcy is associated with cognitive decline, white matter damage, brain atrophy, neurofibrillary tangles, and dementia. Most homocysteine-lowering trials with folate and vitamins B6 and/or B12 tested as protective agents against cognitive decline were poorly designed by including subjects unlikely to benefit during the trial period. In contrast, trials in high-risk subjects, which have taken into account the baseline B vitamin status, show a slowing of cognitive decline and of atrophy in critical brain regions, results that are consistent with modification of the Alzheimer's disease process. Homocysteine may interact with both risk factors and protective factors, thereby identifying people at risk but also providing potential strategies for early intervention. Public health steps to slow cognitive decline should be promoted in individuals who are at risk of dementia, and more trials are needed to see if simple interventions with nutrients can prevent progression to dementia. SN - 1545-4312 UR - https://www.unboundmedicine.com/medline/citation/27431367/Homocysteine_B_Vitamins_and_Cognitive_Impairment_ DB - PRIME DP - Unbound Medicine ER -