Relationship Of Plasma Homocysteine And Cerbral Small Vessel Disease Cognitive Impairment

Objective:To investigate the relationship of plasma homocysteine(Hcy) concentrations in SVD, relevant cerebral MRI change and cognitive impairment.To explore new pathogenic factors for VCI and provide a theoretical basis for the early diagnosis and prevention of vascular dementia.Materials and Methods:Totally 69 patients with cerebral SVD confirmed by MRI or CT in the endoneural department from October 2005 to March 2007 were chosen for the study. They were divided into non cognitive impairment group and cognitive impairment group, and the latter were subsequently divided into vascular cognitive impairment, no dementia(VCIND) and VaD.Cerebral SVD patients were subtyped isolated lacunar infarction and ischaemic white matter letions according to their MRI scan appearances.69 control subjects with no neurological diseases were the out-patient examinationer in corresponding period.All cases underwent enzymatic cycling assay and electrochemilu-minescence immunoassay method were applied to detect their Hcy level.23 cases were applied to detect their serum folate and VitB12 level respectively. Comparative study was made on their biochemical indexes like blood lipid.The demographic and clinical data were recorded and compared between the two groups.To explore the relationship of Hcy and vascular cognition impairment in SVD.Results:1. Hcy and SVDMean homocysteine levels were higher in patients with SVD than in controls (P< 0.001). Hyperhomocysteinaemia is an independent risk factor for SVD after controlling for correlation confounding risk factors. Extent of SVD remained associated with homocysteine levels. 2.Hcy and SVD subtypeHyperhomocysteinaemia is a significant independent risk factor for SVD after controlling for correlation confounding risk factors. For isolated lacunar infarction, homocysteine was associated with an OR of 4.22 (P=0.02) per umol increase in log homocysteine concentration after adjustment for risk factors and creatinine.For ischaemic leukoaraiosis the adjusted OR was 8.92 (P<0.001).Homocysteine were correlated with PVHs and DWMHs.3. Hcy and cognitive impairment in SVDPlasma Hcy level of the cognitive impairment group was significantly higher than that of the non-cognitive impairment group and controls.Only the latter compairison is difference in statistics after controlling for correlation confounding risk factors (P< 0.05).After controlling for correlation confounding risk factors, plasma Hcy level of the dementia group was significantly higher than that of the VCIND group (P<0.05) Hyperhomocysteinaemia is an individual risk factor of cognitive impairment in elder SVD.Conclusions:Hyperhomocysteinaemia is an independent risk factor for SVD, particularly ischaemic leukoaraiosis. Hyperhomocysteinaemia is an individual risk factor of cognitive impairment in elder SVD.It is fairly apparent for mild poor measures of executive function in earlier period. Cognitive impairment is proved to be aggravating with the increase of plasma Hcy level only in older SVD. Folate and VitB12 deficiency is proved to be an important nutrition factor that might cause HHcy to lead to VCI.