Levels of Vitamins and Homocysteine in Older Adults with Alzheimer Disease or Mild Cognitive Impairment in Cuba.

Abstract

INTRODUCTION Age-related cognitive disorders, including Alzheimer disease, are among the main causes of disability and dependence in older adults worldwide. High blood homocysteine levels (hyperhomocysteinemia) are a risk factor for diseases whose metabolism involves different B vitamins. Antioxidant vitamins provide a protective effect by mitigating oxidative stress generated by these diseases. Epidemiological studies have presented varying results on the relationships between blood levels of these vitamins and such cognitive disorders. OBJECTIVE Evaluate the association of vitamin and homocysteine levels with mild cognitive impairment and Alzheimer disease in a group of Cuban older adults. METHODS A cross-sectional study was conducted in Havana, Cuba, of 424 persons aged ≥65 years: 43 with Alzheimer disease, 131 with mild cognitive impairment, and 250 with no signs of cognitive impairment. Dementia was diagnosed using criteria of the International 10/66 Dementia Research Group and Diagnostic and Statistical Manual of Mental Disorders (DSM IV), and mild cognitive impairment was diagnosed using Petersen's criteria. Blood levels of vitamins (thiamine, B-2, folate, B-12, C and A) and homocysteine were measured by standard procedures. Analysis of variance for continuous variables and percentage comparison tests for dichotomous variables were used to compare groups. RESULTS Persons with Alzheimer disease presented signifi cantly lower levels of vitamins B-2, C and A than healthy participants (p <0.05). Homocysteine levels were signifi cantly higher in those with Alzheimer disease and mild cognitive impairment than in participants with no cognitive impairment (p <0.05). Statistically, levels of thiamine, folic acid, and vitamin B-12 were not signifi cantly different across groups. Compared with those without cognitive impairment, prevalence rates (PR) in the Alzheimer group were signifi cantly higher for hyperhomocysteinemia (PR = 3.26; 1.84-5.80) and defi - ciency of all B vitamins: thiamine (PR = 1.89; 1.04-3.43), B-2 (PR = 2.85; 1.54-5.26), folate (PR = 3.02; 1.53-5.95), B-12 (PR = 2.21; 1.17-4.19), vitamin C (PR = 3.88; 2.12-7.10) and A (PR = 5.47; 3.26-9.17). In mild cognitive impairment, prevalence rates were signifi cantly higher for hyperhomocysteinemia (PR = 1.42; 1.08-1.87), vitamin B-2 defi ciency (PR = 1.70; 1.24-2.32) and vitamin A defi - ciency (PR =1.88; 1.05-3.38). CONCLUSIONS Hyperhomocysteinemia and various vitamin defi ciencies are related to Alzheimer disease and mild cognitive impairment. Longitudinal studies are needed to further elucidate the relationship between different nutritional biomarkers and dementia. A better understanding of this relationship could provide a basis for therapeutic and preventive strategies. KEYWORDS Vitamins, homocysteine, geriatrics, Alzheimer disease, cognitive impairment, Cuba.