Is Hyperhomocysteinemia (HHcy) a nutritional marker of senile ementia ?

Introduction: Correlations between nutritional status and cognitive impairment still need to be defined. Mild hyperhomocysteinemia (Hcy>15 nmol/ml)) is a good marker of multiple (and often subclinical) vitamin (B12, B6 and folic acid) deficits, often associated with neurological disturbances and poor performance on neuropsychological tests. Several studies have shown cognitive impairment (spatial copying and memory tests) in elderly patients with normal values of blood folates and serum Vit. B12 levels but mild hyperhomocysteinemia. Aim of this study is to evaluate, in healthy elderly (HE) and in patients with senile dementia Alzheimer type (AD), the prevalence and the relevance of HHcy versus other common nutritional parameters Materials and methods: 108 patients affected by AD (DSM IV criteria) were compared with 64 age matched healthy elderly (HE). All subjects underwent a nutritional (biochemical and anthropometric parameters) and Hcy plasma level assessment. Statistical analysis were performed by standard methods. Results: The prevalence of HHcy is higher in the AD group (75%) with respect of HE group (45%). HHcy is an associated factor of AD, as suggested by an Odds Ratio value of 5.58 (2.71 11.48; 95% C.I.). A statistically significant (p<0.05, t test for independent samples) difference for all nutritional parameters and for Hcy plasma levels was found between AD and HE group. Entering these parameters into a multiple logistic regression analysis, taking the presence or absence of dementia as the dependent variable, we obtained a model predicting dementia with a likelihood of 78.5% based on the table parameters. ParameterBRSignificanceHHcy0.800.22p<0.01Albumin-1.20-0.14p<0.02Haemoglobin-0.65-0.19p<0.01Lymphocyte count-0.013-0.14p<0.02Folic acid-0.48-0.19p<0.01 Conclusions: Our data show a high prevalence of HHcy in elederly patients with AD, suggesting its importance as a nutritional risk factor for cognitive impairment.