Homocysteine, Cobalamin and Folate Status and their Relations to Neurocognitive and Psychological Markers in Elderly in Northeastern of Iran

Document Type : Original Article

Authors

1 Department of Laboratory Sciences Technology, School of Paramedical Sciences, Mashhad University of Medical Sciences, Mashhad, Iran.

2 Department of Neurology and Physiology, School of Medicine, Mashhad University of Medical Sciences, Mashhad, Iran

3 Department of Biostatistics, School of Medicine, Shiraz University of Medical Sciences, Shiraz, Iran

4 Department of Emergency Medicine, School of Medicine, Mashhad University of Medical Sciences, Mashhad, Iran

5 Department of Internal Medicine, School of Medicine, Mashhad University of Medical Sciences, Mashhad, Iran

6 Department of Biochemistry, School of Medicine, Mashhad University of Medical Sciences, Mashhad, Iran

7 Birjand University of Medical Sciences, Birjand, Iran

Abstract

 
 
 

Objective(s): Incidence of neurocognitive and psychological disorders may be related to serum homocystein (Hcy), cobalamin (vitamin B12
) and folate levels in old people. The aim of this study was to assess the relation between Hcy, cobalamin, folate and neurocognitive and/or psychological disorders in the elderly.
 
Materials and Methods:
In this cross-sectional study, 280 subjects with ≥ 65 years old, were evaluated. The subjects were selected from 12 regions of Mashhad, Iran, over March to October 2009. After blood sampling, data were collected by questionnaire, face to face interview and performing neurocognitive and psychological tests. The sera of 250 persons were analyzed for cobalamin and folate by RIA method. Amongst the aforementioned samples, 78 cases with cobalamin
Results:
Amongst the people, 126 (45%) were male and 154 (55%) were female. The prevalence of hyperhomocysteinemia (HHcy) was 59.5% and 37.1% in male and female respectively (P -value =0.049). Hcy inversely correlated to cobalamin (r=-0.282, P=0.014) and to folate (r=-0.203, P=0.014). Hcy, cobalamin and folate correlations to neurocognitive and psychological impairments were not statically significant.
Conclusion:
Hyper Hcy or low cobalamin and folate in the elderly, are prevalent but their relationships with neurocognitive and psychological impairments is controversial. If these relationships had been confirmed, performing a single serum Hcy or cobalamin test would have been enough to diagnose and prevent neurocognitive impairments and inversely, neurocognitive-psychological sign and symptoms could have meant probable tissue vitamin deficiencies. However methods of assessing neurocognitive and psychological markers with validity and reliability of clinical and laboratory tests for finding aforementioned relationships should be revised.

 

Keywords

References

1. Snow CF. Laboratory diagnosis of vitamin B
12
and folate deficiency: a guide for the primary care physician. Arch Intern Med [Review] 1999; 159:1289-1298.
2. Lee G. Megaloblastic and nonmegaloblastic macrocytic anemias. Wintrobe's clinical hematology. 9th ed. Philadelphia: Lea and Febiger; 1993.p.745-790.
 
3. Healton EB, Savage DG, Brust J, Garrett T, Lindenbaum J. Neurologic aspects of cobalamin deficiency. Medicine 1991; 70:229.
 
4. Meertens L, Solano L. Vitamin B
 
 
12
, folic acid and mental function in the elderly. Invest Clin 2005; 46:53-63.
5. Clarke R, Evans JG, Schneede J, Nexo E, Bates C, Fletcher A,
 
 
et al. Vitamin B12
and folate deficiency in later life. Ag Ageing 2004; 33:34-41.
6. Bizheh N, Jaafari M. The effect of a single bout circuit resistance exercise on homocysteine, hs-CRP and fibrinogen in sedentary middle aged men. Iran J Basic Med Sci 2011; 4:568-573.
 
7. Nilsson K, Gustafson L, Hultberg B. Plasma homocysteine and cognition in elderly patients with dementia or other psychogeriatric diseases. Dement Geriatr Cogn Disord 2010; 30:198-204.
 
8. Agarwal R. Vitamin B
 
 
12
deficiency & cognitive impairment in elderly population. Ind J Med Res 2011 ; 134:410-412.
9. Hvas A-M, Juul S, Lauritzen L, Nexo E, Ellegaard J. No effect of vitamin B
 
 
12
treatment on cognitive function and depression: a randomized placebo controlled study. J Affect Disord 2004; 81:269-273.
10. Stabler SP, Allen RH. Vitamin B
 
 
12
deficiency as a worldwide problem. Annu Rev Nutr 2004; 24:299-326.
11. Björkegren K, Svärdsudd K. A population-based intervention study on elevated serum levels of methylmalonic acid and total homocysteine in elderly people: results after 36 months of follow-up. J Intern Med 2004; 256:446-452.
 
12. Fakhrzadeh H, Ghotbi S, Pourebrahim R, Nouri M, Heshmat R, Bandarian F,
 
 
et al. Total plasma homocysteine, folate, and vitamin B12 status in healthy Iranian adults: the Tehran homocysteine survey (2003–2004)/a cross–
sectional population based study. BMC Public Health 2006; 6:29.
13. Noorbala AA, Bagheri Yazdi SA, Yasamy MT, Mohammad K. Mental health survey of the adult population in Iran. Br J Psychiatry 2004; 184:70-73.
 
14. Mohammadi MR, Davidian H, Noorbala AA, Malekafzali H, Naghavi HR, Pouretemad HR,
 
 
et al
. An epidemiological survey of psychiatric disorders in Iran. Clin Pract Epidemiol Mental Health 2005; 1:16.
15. Mokhber N, Majdi M, Salek Haghighatpoor M. Prevalence of depression in an elderly population in Iran. Eur Psychiatry 2008; 23:S296.
 
16. Wolters M, Hermann S, Hahn A. Vitamin B status and concentrations of homocysteine and
 
 
Manavifar L et al Neurocognitive Impairments and vit B in the Elderly
Iran J Basic Med Sci, Vol. 16, No. 6, Jun 2013
778
methylmalonic acid in elderly German women. Am J Clin Nutr 2003; 78:765-772.
17. Brattstrom LE, Hultberg BL, Hardebo JE. Folic acid responsive postmenopausal homocysteinemia. Metabol Clin Exp 1985; 34:1073-1077.
18. Vogel T, Dali-Youcef N, Kaltenbach G, Andres E. Homocysteine, vitamin B
12
, folate and cognitive functions: a systematic and critical review of the literature. Int J Clin Pract 2009; 63:1061-1067.
19. Shahar A, Feiglin L, Shahar DR, Levy S, Seligsohn U. High prevalence and impact of subnormal serum vitamin B
 
 
12
levels in Israeli elders admitted to a geriatric hospital. J Nutr Health Aging 2001; 5:124-127.
20. Gharaibeh MY, Gahtan RA, Khabour OF, Alomari MA. Hyperhomocysteinemia, Low Folate, and vitamin B
 
 
12
Deficiency in Elderly Living at Home and Care Residences: A Comparative Study. Lab Med 2010; 41:410-414.
21. Shirdel A, Manavifar L, Njat Shokohi A, Shakeri MT, Mahjoub M. A study of folate and cobalamin deficiency in elderly by determining a cut-off point with laboratory markers. Med J Mashhad Univ Med Sci 2009; 52:74.
 
22. Malouf R, Grimley Evans J. Folic acid with or without vitamin B
 
 
12
for the prevention and treatment of healthy elderly and demented people. Cochrane Database Syst Rev 2008:CD004514.
23. Papakostas GI, Petersen T, Mischoulon D, Ryan JL, Nierenberg AA, Bottiglieri T,
 
 
et al. Serum folate, vitamin B12
, and homocysteine in major depressive disorder, Part 1: predictors of clinical response in fluoxetine-resistant depression. J Clin Psychiatr 2004; 65:1090.
24. Oh R, Brown DL. Vitamin B
 
 
12
deficiency. Am Fam Physician 2003; 67:979-986.
25. Nagga K, Rajani R, Mardh E, Borch K, Mardh S, Marcusson J. Cobalamin, folate, methylmalonic acid, homocysteine, and gastritis markers in dementia. Dement Geriatr Cogn Dis 2003; 16:269-275.
 
26. Selhub J, Jacques PF, Wilson PW, Rush D, Rosenberg IH. Vitamin status and intake as primary determinants of homocysteinemia in an elderly population. JAMA 1993; 270:2693-2698.
 
27. Hvas AM, Ellegaard J, Nexo E. Increased plasma methylmalonic acid level does not predict clinical manifestations of vitamin B
 
 
12
deficiency. Arch Internal Med 2001; 161:1534-1541.
28. Lildballe DL, Fedosov S, Sherliker P, Hin H, Clarke R, Nexo E. Association of cognitive impairment with combinations of vitamin B
 
 
12
-related parameters. Clin Chem 2011; 57:1436-1443.
29.Carmel R, Green R, Jacobsen D, Rasmussen K, FloreaM, Azen C. Serum cobalamin, homocysteine, and methylmalonic acid concentrations in a multiethnic elderly population: ethnic and sex differences in cobalamin and metabolite abnormalities. Am J Clin Nutr 1999; 70:904-910.
 
30. Figlin E, Chetrit A, Shahar A, Shpilberg O, Zivelin A, Rosenberg N,
 
 
et al. High prevalences of vitamin B12
and folic acid deficiency in elderly subjects in Israel. Br J Haematol 2003; 123:696-701.
31. Rajan S, Wallace JI, Beresford SA, Brodkin KI, Allen RA, Stabler SP. Screening for cobalamin deficiency in geriatric outpatients: prevalence and influence of synthetic cobalamin intake. Journal of the Am Geriatr Soc 2002; 50:624-630.
 
32. Kado DM, Karlamangla AS, Huang M-H, Troen A, Rowe JW, Selhub J,
 
 
et al. Homocysteine versus the vitamins folate, B6, and B12
as predictors of cognitive function and decline in older high-functioning adults: MacArthur Studies of Successful Aging. Am J Med 2005; 118:161-167.
33. Nilsson K, Gustafson L, Hultberg B. Plasma homocysteine is elevated in elderly patients with memory complaints and vascular disease. Dement Geriatr Cogn Dis 2007; 23:321-326.
 
34. Stabler SP, Lindenbaum J, Allen RH. The use of homocysteine and other metabolites in the specific diagnosis of vitamin B
 
 
12
deficiency. J Nutr 1996; 126:1266S-1272S.
35. Ellinson M, Thomas J, Patterson A. A critical evaluation of the relationship between serum vitamin B, folate and total homocysteine with cognitive impairment in the elderly. J Hum Nutr Diet 2004; 17:371-383.
 
36. Bailey RL, Carmel R, Green R, Pfeiffer CM, Cogswell ME, Osterloh J,
 
 
et al. Monitoring of vitamin B12 nutritional status in the United States by using plasma methylmalonic acid and serum vitamin B12
. Am J Clin Nutr 2011; 94:552-561.
37. Lewerin C, Matousek M, Steen G, Johansson B, Steen B, Nilsson-Ehle H. Significant correlations of plasma homocysteine and serum methylmalonic acid with movement and cognitive performance in elderly subjects but no improvement from short-term vitamin therapy: a placebo-controlled randomized study. Am J Clin Nutr 2005; 81:1155-1162.
 
38. Khorram Khorshid MR, Manoochehri M, Nasehi L, Ohadi M, Rahgozar M. Ccr2-
 
 
64 a C r5 Δ3 polymorphisms in patients with late-onseta zhe er’s disease;a study from Iran (Ccr2-64 C r5 Δ3 y r h s s a zhe er’s sease
Iran J Basic Med Sci 2012; 15:937-944
 

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