The results of this trial do not support the hypothesis that homocysteine lowering with B vitamins improves cognitive performance. (Australian Clinical Trials registry number, ACTR NO 12605000030673.).

The significant correlations between the predictor variables and test scores justified computing a set of equations for use in interpreting data from older persons. The abnormality of the difference between predicted and obtained scores provides a convenient index of an individual's current level of neuropsychological functioning.

Supplementation with folate and vitamins B-6 and B-12 lowered plasma homocysteine but had no beneficial effect on bone turnover at the end of 2 y, as assessed by biomarkers of bone formation and resorption.

An elevated circulating homocysteine concentration is associated with the risk of cardiovascular disease. The mechanism by which an elevated homocysteine increases cardiovascular risk is unclear but may be mediated in part by elevating blood pressure. It is well established that supplements containing folate, vitamins B-12, and B-6 lower homocysteine concentrations. However, the effect of homocysteine-lowering vitamins on blood pressure has not been well studied. We sought to determine whether lowering homocysteine with B vitamins lowers blood pressure in healthy older people with elevated homocysteine concentrations. Two hundred seventy-six healthy older participants (> or = 65 y) with a homocysteine > or = 13 micromol/L were randomized to receive a daily supplement containing folate (1 mg), vitamin B-12 (500 microg), and vitamin B-6 (10 mg), or a placebo, for 2 y. Plasma homocysteine was lower in the Vitamins group than the Placebo group at both 1 [-4.3 micromol/L (95% CI; -4.9, -3.7)] and 2 y [-4.4 micromol/L (95% CI: -5.3, -3.6)]. Systolic and diastolic blood pressures as well as pulse pressure in the Vitamins group did not differ from the Placebo group over the duration of the trial. The mean differences in blood pressures, adjusted for baseline values, did not exceed 1 mm Hg. Supplemental B-vitamins lowered plasma homocysteine but had no effect on blood pressure in older people with elevated baseline homocysteine concentrations.

An issue that often confronts the clinician referred an elderly person for neuropsychological assessment is how to interpret the significance of changes in test scores over time. In this report, data useful for estimating the statistical significance of changes on the Rey Auditory Verbal Learning Test (AVLT) are presented. The sample tested comprised 253 healthy persons aged 65 and over taking part in a randomized double-blind trial of the effect on cognitive performance of lowering homocysteine using dietary supplements. Results were based on the full sample because of the absence of any treatment effects. Test-retest data with a 1-year interval were used to estimate reliability coefficients and to calculate reliable change indices. The magnitude of a change necessary for a deterioration or improvement in scores at the two-tailed 90% confidence interval is given for the full sample, and persons above and below the age of 75.

No abstract

Elevated plasma total homocysteine (tHcy) is a risk factor for vascular disease but lowering tHcy with B-vitamins, including folate, has generally not reduced vascular events in secondary prevention trials. Elevated plasma S-adenosylhomocysteine (AdoHcy) concentration may be a more sensitive indicator of vascular disease than plasma tHcy. However, unlike tHcy, plasma AdoHcy did not correlate with folate concentration in one study indicating that folate supplementation may not lower AdoHcy. Our aim was to determine whether providing B-vitamin supplements to healthy older people with elevated tHcy (. 13 mmol/l) affects plasma AdoHcy and S-adenosylmethionine (AdoMet) concentrations. Healthy older participants (n 276; $65 years) were randomised to receive a daily supplement containing folate (1 mg), vitamin B 12 (500 mg) and vitamin B 6 (10 mg), or placebo, for 2 years. Of these participants, we selected the first fifty participants in each treatment group and measured plasma AdoHcy and AdoMet. Plasma tHcy was 4·4 (95 % CI 3·2, 5·6; P,0·001) mmol/l lower at 2 years in the vitamins group compared with the placebo group. At 2 years, there were no significant differences in plasma AdoMet (þ 4 % (95 % CI 2 2, 11); P¼ 0·19), AdoHcy (21 % (95 % CI 2 10, 8); P¼ 0·61) or the AdoMet:AdoHcy ratio (0·22 (95 % CI 2 0·04, 0·49); P¼0·10) between the two groups. In conclusion, B-vitamin supplementation of older people lowered plasma tHcy but had no effect on plasma AdoMet or AdoHcy concentration. If elevated plasma AdoHcy is detrimental, this may explain why B-vitamins have generally failed to reduce vascular events in clinical trials.

Background Globally, suicide is the fourth highest cause of adolescent mortality (Suicide: https://www.who.int/news-room/fact-sheets/detail/suicide). The effects of post‐primary school‐based suicide prevention (PSSP) on adolescent suicidal thoughts and behaviours (STBs) have not been comprehensively synthesised. We aim to estimate the population effect for PSSP interventions on adolescent STBs and explore how intervention effects vary based on intervention and contextual moderators. Methods Searches of PsycINFO, Medline, Education Source, ERIC, Web of Science, and the Cochrane Central Register of Controlled Trials identified cluster randomised trials examining the effectiveness of PSSP on adolescent STBs. The Cochrane Risk of Bias tool assessed bias. Crude and adjusted back‐transformed odds ratios (ORs) were calculated. Multilevel random‐effects models accounted for dependencies of effects. Univariate meta‐regression explored variability of intervention and contextual moderators on pooled effects. Results There were 19 and 12 effects for suicidal ideation (SI) and suicide attempts (SA). Compared with controls, interventions were associated with 13% (OR = 0.87, 95%CI [0.78, 0.96]) and 34% (OR = 0.66, 95%CI [0.47, 0.91]) lower crude odds reductions for SI and SA, respectively. Effects were similar for adjusted SI (OR = 0.85, 95%CI [0.75, 0.95]) and SA (OR = 0.72, 95%CI [0.59, 0.87]) models. Within‐study (0.20–9.10%) and between‐study (0–51.20%) heterogeneity ranged for crude and adjusted SA models and SI heterogeneity was 0%. Moderator analyses did not vary SA effects (ps > .05). Conclusions This meta‐analysis contributes to the PSSP evidence‐base by demonstrating that PSSP targeting STBs as both primary intervention outcomes and with other health and well‐being outcomes reduced SI and SA among 33,155 adolescents attending 329 schools, compared to controls. The number needed to treat estimates suggests the potential of reducing the incidence of SA and SI in one adolescent by implementing PSSP in 1–2 classrooms, supporting PSSP as a clinically relevant suicide prevention strategy. Although moderator analyses were nonsignificant and contained a small number of trials, larger SA effect sizes support particular effectiveness for interventions of a duration of ≤1 week, involving multiple stakeholders and with a 12‐month follow‐up.