Homocysteine and cognitive decline in healthy elderly

Serum homocysteine is increased, and correlates inversely with cognitive sc ores, in Alzheimer's disease (AD), vascular dementia and 'age-associated me mory impairment'. Elevated levels might signal accelerated cognitive declin e, although this remains to be established. We therefore repeated Mini-Ment al State Examinations, together with additional ADAS-Cog assessments, in 32 healthy elderly individuals to determine whether prior homocysteine levels predicted cognitive changes over a 5-year period. Homocysteine predicted f ollow-up cognitive scores and rate of decline in cognitive performance inde pendently of age, sex, education, renal function, vitamin B status, smoking and hypertension (p < 0.001). Homocysteine predicted word recall (p = 0.01 ), orientation (p = 0.02) and constructional praxis scores (p < 0.0001). On e subject, with the second highest initial homocysteine, had developed prob able AD at follow-up. Fasting total serum homocysteine appears to be an ind ependent predictor of cognitive decline in healthy elderly and exerts a max imal effect on spatial copying skills. Copyright (C) 2001 S. Karger AG, Basel.