Cognitive and clinical outcomes of homocysteine-lowering B-vitamin treatment in mild cognitive impairment: a randomized controlled trial

Background Homocysteine is a risk factor for Alzheimer's disease. In the first report on the VITACOG trial, we showed that homocysteine‐lowering treatment with B vitamins slows the rate of brain atrophy in mild cognitive impairment (MCI). Here we report the effect of B vitamins on cognitive and...

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Published in:	International journal of geriatric psychiatry Vol. 27; no. 6; pp. 592 - 600
Main Authors:	de Jager, Celeste A., Oulhaj, Abderrahim, Jacoby, Robin, Refsum, Helga, Smith, A. David
Format:	Journal Article
Language:	English
Published:	Chichester, UK John Wiley & Sons, Ltd 01.06.2012 Psychology Press Wiley Subscription Services, Inc
Subjects:	Aged Aged, 80 and over Alzheimer's disease Biological and medical sciences Brain clinical dementia rating Clinical outcomes Clinical trials cobalamin Cognition - drug effects Cognition Disorders - blood Cognition Disorders - drug therapy Cognition Disorders - physiopathology cognitive decline Degenerative and inherited degenerative diseases of the nervous system. Leukodystrophies. Prion diseases Double-Blind Method Executive Function - drug effects Female folate Folic Acid - blood Folic Acid - therapeutic use General aspects Geriatric psychiatry Geriatrics Homocysteine Homocysteine - blood Humans Linear Models Male Medical sciences Memory - drug effects mild cognitive impairment Neurology Psychology. Psychoanalysis. Psychiatry Psychopathology. Psychiatry pyridoxine Risk factors Vitamin B Vitamin B 12 - blood Vitamin B 12 - therapeutic use Vitamin B 6 - blood Vitamin B 6 - therapeutic use Vitamin B Complex - blood Vitamin B Complex - therapeutic use Prognosis Cognitive disorder Cognition B-Vitamins cognitive decline Folic acid Folate Intellectual deterioration Randomization cobalamin Homocystein Clinical trial Evolution Degenerative disease Human homocysteine Thiol Controlled therapeutic trial Pyridoxine Sulfur containing aminoacid Gerontology Treatment clinical dementia rating Cobalamine mild cognitive impairment Elderly Psychiatry Dementia Geriatrics
ISSN:	0885-6230, 1099-1166, 1099-1166
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Summary:	Background Homocysteine is a risk factor for Alzheimer's disease. In the first report on the VITACOG trial, we showed that homocysteine‐lowering treatment with B vitamins slows the rate of brain atrophy in mild cognitive impairment (MCI). Here we report the effect of B vitamins on cognitive and clinical decline (secondary outcomes) in the same study. Methods This was a double‐blind, single‐centre study, which included participants with MCI, aged ≥70 y, randomly assigned to receive a daily dose of 0.8 mg folic acid, 0.5 mg vitamin B12 and 20 mg vitamin B6 (133 participants) or placebo (133 participants) for 2 y. Changes in cognitive or clinical function were analysed by generalized linear models or mixed‐effects models. Results The mean plasma total homocysteine was 30% lower in those treated with B vitamins relative to placebo. B vitamins stabilized executive function (CLOX) relative to placebo (P = 0.015). There was significant benefit of B‐vitamin treatment among participants with baseline homocysteine above the median (11.3 µmol/L) in global cognition (Mini Mental State Examination, P < 0.001), episodic memory (Hopkins Verbal Learning Test–delayed recall, P = 0.001) and semantic memory (category fluency, P = 0.037). Clinical benefit occurred in the B‐vitamin group for those in the upper quartile of homocysteine at baseline in global clinical dementia rating score (P = 0.02) and IQCODE score (P = 0.01). Conclusion In this small intervention trial, B vitamins appear to slow cognitive and clinical decline in people with MCI, in particular in those with elevated homocysteine. Further trials are needed to see if this treatment will slow or prevent conversion from MCI to dementia. Copyright © 2011 John Wiley & Sons, Ltd.
Bibliography:	istex:50547BCFE12B6F381B78411E21EF877B8A06C573 ArticleID:GPS2758 ark:/67375/WNG-S9DV16ZW-N These authors contributed equally to the research. SourceType-Scholarly Journals-1 ObjectType-Feature-1 content type line 14 ObjectType-Article-1 ObjectType-Feature-2 content type line 23 ObjectType-Undefined-3
ISSN:	0885-6230 1099-1166 1099-1166
DOI:	10.1002/gps.2758