Homocysteine and nutritional biomarkers in cognitive impairment

Abstract

Background: Cognitive impairment is a progressive disorder that affects the aging population. With the increase in the mean age of our population, it is becoming a public health problem. Homocysteinemia has been implicated in cognitive impairment. While it is modulated by vitamins B12 and folate, it acts through MMPs 2 and 9.Objectives: To assesses the relationship of cognitive impairment with homocysteine, B12, folate, and MMPs 2 and 9, with the intention of detecting cases of mild cognitive impairment which are potentially reversible.Materials and Methods: Blood samples were drawn from 73 enrolled subjects, with and without cognitive impairment on basis of Montreal cognitive assessment (MoCA) score <25 or >25, respectively. Homocysteine, B12, folate, and MMPs2 and 9 were estimated. Correlation between MoCA score and these parameters was elucidated.Results: After adjusting for age and sex, homocysteine was the only signi cant independent predictor of MoCA score.Cut off of homocysteine for prediction of MoCA <25 was derived at 13.5 µmol/L (PPV=59.6%; NPV=79.2%; Sensitivity=84.8%; Speci city=50%). The equation derived for calculation of MoCA score from homocysteine is:MoCA score = 32.893 + [(-0.223)(homocysteine in mmol/L)] Conclusions: Homocysteine >13.5mmol/L predicts low MoCA (<25) with 84.8% sensitivity and 50% speci city. So patients with a Hcy >13.5mmol/L should be carefully evaluated for the presence/progression of dementia and administered vitamins of the B group as a measure towards amelioration of the modi able risk factor of cognitive decline, i.e. homocysteinemia.Author Contributions: Seema Bhargava conceptualized the study, reviewed literature, formulated the design of the study, performed biochemical analyses for estimation of homocysteine, vitamin B12 and folate, compiled the data, participated in analysis of the data, participated in writing and editing the manuscript and formulated the hypothesis.Prahlad K Sethi helped in formulation of the design of the study, identi ed subjects, assessed their cognitive abilities, reviewed and edited the manuscript.Anuradha Batra helped in formulation of the design of the study, identi ed subjects, assessed their cognitive abilities, reviewed and edited the manuscript. Sangeeta Choudhury helped in formulation of the design of the study, performed analyses of samples for MMPs 2 and 9, helped in statistical analysis, helped in editing the manuscript.Parul Takkar helped in compilation of data and performed statistical analyses Anjali Manocha, Mamta Kankra and Parul Singla helped in review of literature, formulation of the design of the study, performing biochemical analyses for estimation of homocysteine, vitamin B12 and folate, compilation of data, editing of manuscript. Ethics approval:This study was approved by the institutional ethics committee under no: EC/01/16/925. Consent to participate: Informed consent was obtained from all individual subjects included for participating in the study and publishing of the data as per the consent form approved by the ethics...