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Plasma Homocysteine and Risk of Coexisting Silent Brain Infarction in Alzheimer’s DiseaseMatsui T.a · Nemoto M.a · Maruyama M.a · Yuzuriha T.b · Yao H.c · Tanji H.a · Ootsuki M.a · Tomita N.a · Matsushita S.d · Higuchi S.d · Yoshida Y.e · Seki T.f · Iwasaki K.f · Furukawa K.f · Arai H.f
aDepartment of Geriatric and Respiratory Medicine, Tohoku University Graduate School of Medicine, Sendai, bCenter for Emotional and Behavioral Disorders, National Hospital Organization, Hizen Psychiatric Center, Saga, cDepartment of Medicine and Clinical Science, Graduate School of Medical Sciences, Kyushu University, Fukuoka, dNational Hospital Organization, Kurihama Alcoholism Center, Yokosuka, eOnagawa Municipal Hospital, Onagawa, and fCenter for Asian Traditional Medicine Research, Department of Geriatric and Complementary Medicine, Tohoku University Graduate School of Medicine, Sendai, Japan
Background: Cerebrovascular disease is common in Alzheimer’s disease (AD). Elevated plasma homocysteine (pHcy) levels are reported to be associated with an increased risk of poor cognition and dementia. Objective: To determine whether high pHcy levels are associated with an increased risk of coexisting silent brain infarctions (SBIs) in AD. Methods: Study population comprising 143 outpatients with clinical diagnosis of probable AD (73.3 ± 7.0 years) were classified into 2 groups according to the presence or absence of SBIs on magnetic resonance imaging. Results: SBIs were noted in 32.9% (47/143) of the AD patients. The pHcy levels in the AD with SBIs (14.0 ± 4.5 µmol/l) were significant ly elevated compared with the AD without SBIs (11.7 ± 4.7 µmol/l, p = 0.007). After adjusting for age and gender, high pHcy (>12.4 µmol/l), but not hypertension, was associated with an increased risk of developing SBIs in AD (OR = 4.61, 95% CI = 1.74–12.2, p = 0.002). However, age at onset, cognitive function, cerebrospinal tau or amyloid β-peptide1–42 levels were not significantly correlated with pHcy levels in AD. Conclusion: SBIs commonly coexist with AD, and may be a unique vascular condition in which homocysteine plays an important role. Homocysteine-lowering therapy rather than antihypertensive medication might be an appropriate strategy to prevent stroke associated with AD.
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