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Evaluation of the Cognitive Performance of Hypertensive Patients with Silent Cerebrovascular Lesions
Published on: April 23, 2021
Homocysteinemia is Associated with the Presence of Microbleeds in Cognitively Impaired Patients
Jun Sang Yoo1, Chang-Hwan Ryu1, Young Seo Kim1
1Department of Neurology, College of Medicine, Hanyang University, Seoul, Republic of Korea.
Background & Objective:
Homocysteine is possibly associated with cerebral small vessel diseases such as leukoaraiosis, silent brain infarction and cerebral microbleeds, which are in turn associated with cognitive dysfunction. We aimed to examine the relationships between cerebral microbleeds (CMBs) and plasma total homocysteine (tHcy) level, methylenetetrahydrofolate reductase (MTHFR) C677T polymorphism and cognitive function.
Methods:
A total of 819 patients with memory disturbance who visited a dementia clinic consecutively were included in this study. We retrospectively collected demographic, clinical and laboratory data including tHcy level, MTHFR C677T polymorphism and Mini-Mental State Examination (MMSE). All patients underwent brain MRI including fluid attenuated inversion recovery (FLAIR) image and T2*-weighed gradient-echo (GRE) image. Logistic regression analysis was performed to test the association between risk factors and the presence of microbleeds.
Results:
One hundred and sixty-one (19.7%) patients had CMBs, of whom 88 (54.7%) had CMBs in the lobar region. CMBs were more common in older hypertensive male patients with hyperhomocysteinemia. In multivariable analysis, plasma tHcy remained an independent predictor of the presence of CMBs after adjusting other confounders (OR: 1.035, 95% CI: 1.009-1.062, p = 0.009). Higher plasma tHcy level was also associated with number of CMBs, TT MTHFR genotype, and lower MMSE scores.
Conclusions:
Elevated plasma tHcy level is related to high prevalence of CMBs and cognitive dysfunction. Lowering plasma tHcy could be helpful in cognitively impaired patients who have CMBs or the MTHFR TT genotype.
Insights
Elevated homocysteine levels are linked to cerebral microbleeds and cognitive decline. Lowering homocysteine may benefit patients with microbleeds or specific MTHFR gene variants.
Area of Science:
- Neurology
- Neuroimaging
- Genetics
Background:
- Cerebral small vessel diseases, including cerebral microbleeds (CMBs), are associated with cognitive dysfunction.
- Homocysteine is a potential risk factor for these cerebrovascular conditions.
Purpose of the Study:
- To investigate the relationship between plasma total homocysteine (tHcy) levels, methylenetetrahydrofolate reductase (MTHFR) C677T polymorphism, and the presence of CMBs.
- To assess the association of these factors with cognitive function in patients with memory disturbance.
Main Methods:
- Retrospective analysis of 819 patients with memory disturbance.
- Data collection included plasma tHcy, MTHFR C677T genotype, Mini-Mental State Examination (MMSE) scores, and brain MRI.
- Logistic regression analysis was used to determine risk factors for CMBs.
Main Results:
- Cerebral microbleeds (CMBs) were present in 19.7% of patients, more common in older, hypertensive males with hyperhomocysteinemia.
- Plasma tHcy was an independent predictor of CMBs (OR: 1.035, p=0.009).
- Higher tHcy levels correlated with increased CMBs, the MTHFR TT genotype, and lower MMSE scores.
Conclusions:
- Elevated plasma tHcy is associated with a higher prevalence of CMBs and cognitive impairment.
- Reducing plasma tHcy may be a therapeutic strategy for patients with CMBs or the MTHFR TT genotype and cognitive issues.
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