Homocysteine, B Vitamins, and Cognitive Impairment

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-...

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Bibliographic Details
Published in:Annual review of nutrition Vol. 36; pp. 211 - 239
Main Authors: Smith, A David, Refsum, Helga
Format: Journal Article
Language:English
Published: United States 17.07.2016
Subjects:
Aging
Animals
Biomarkers
Cerebrovascular Circulation
Cognition Disorders - epidemiology
Cognition Disorders - etiology
Cognition Disorders - prevention & control
Cognitive Dysfunction - epidemiology
Cognitive Dysfunction - etiology
Cognitive Dysfunction - prevention & control
Dietary Supplements - adverse effects
Evidence-Based Medicine
Folic Acid - adverse effects
Folic Acid - metabolism
Folic Acid - therapeutic use
Homocysteine - blood
Homocysteine - metabolism
Humans
Hyperhomocysteinemia - diet therapy
Hyperhomocysteinemia - epidemiology
Hyperhomocysteinemia - metabolism
Hyperhomocysteinemia - physiopathology
Neurodegenerative Diseases - epidemiology
Neurodegenerative Diseases - etiology
Neurodegenerative Diseases - physiopathology
Neurodegenerative Diseases - prevention & control
Nootropic Agents - adverse effects
Nootropic Agents - metabolism
Nootropic Agents - therapeutic use
Nutritional Status
Practice Guidelines as Topic
Risk Factors
Vitamin B 12 - adverse effects
Vitamin B 12 - metabolism
Vitamin B 12 - therapeutic use
Vitamin B 6 - adverse effects
Vitamin B 6 - metabolism
Vitamin B 6 - therapeutic use
clinical trial
dementia
folate
cobalamin (vitamin B12)
cognition
Alzheimer's disease
ISSN:1545-4312
Online Access:Get more information
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Summary: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.
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ISSN:1545-4312
DOI:10.1146/annurev-nutr-071715-050947