Identification of cognitive impairment in the elderly: Homocysteine is an early marker

In 336 consecutive patients attending a university-affiliated memory unit, clinical and psychological findings, neuroimaging and laboratory tests were analyzed. The patients were diagnosed with early Alzheimer's disease 3%, s enile dementia (SDAT) 16%, vascular dementia (VAD) 20%, other dementias 9%, minor cognitive impairment (dysmentia) 32% and subjective symptoms only 21 %. Increases in vascular risk factors, serum homocysteine, ApoE4 load and n euroimaging pathology were found in dementia but also in dysmentia and in p atients with subjective symptoms only. The homocysteine levels correlated i nversely with cognitive performance. The increases in serum homocysteine, w hich were pathological in VAD, Dysmentia and SDAT, may be indicative of a d isturbed cerebral one-carbon metabolism and signal-accelerated development of cognitive disease.