Relation of serum levels of homocysteine, vitamin B12 and folate to cognitive functions in multiple sclerosis patients

ABSTRACT Background: Hyperhomocysteinemia, vitamin B12 and folate deficiency have been linked to cognitive dysfunction in multiple sclerosis (MS) patients. Objective: This study aimed to investigate the relation of serum homocysteine (Hcy), vitamin B12 and folate to cognitive functions in MS patients. Subjects and Methods: Forty-five MS patients and twenty matched healthy controls were included. Subjects were submitted to cognitive assessment using a selected psychometric battery and measurement of serum levels of homocysteine, B12 and folic acid. Results: MS patients showed significant worse performance in cognitive scales compared to controls (P ≤ 0.05). Serum homocysteine, vitamin B12 and folate showed no significant difference between patients and controls (P > 0.05). Serum homocysteine was negatively correlated with total score of Addenbrooke's Cognitive Examination (ACE), paced auditory serial addition test and controlled oral word association test scores. Serum vitamin B12 was positively correlated with ACE language, visuospatial and total scores and negatively correlated with trail making B score. Serum folate was significantly positively correlated with ACE language and total scores. Homocysteine was the only significant predictor for cognitive impairment in MS patients. Conclusion: Serum homocysteine may play a role in cognitive dysfunction in MS patients.

[1]  A. Abdelalim,et al.  Primary fatigue contributes to cognitive dysfunction in patients with multiple sclerosis , 2016 .

[2]  S. Lautenbacher,et al.  Cognitive screening tools in multiple sclerosis revisited: sensitivity and specificity of a short version of Rao’s Brief Repeatable Battery , 2015, BMC Neurology.

[3]  Tamer H. Emara,et al.  Normative data for healthy adult performance on the Egyptian–Arabic Addenbrooke’s Cognitive Examination III , 2015 .

[4]  M. Sá,et al.  Cognitive Dysfunction in Multiple Sclerosis , 2012, Front. Neur..

[5]  Ponnada A Narayana,et al.  Intracortical lesions by 3T magnetic resonance imaging and correlation with cognitive impairment in multiple sclerosis , 2011, Multiple sclerosis.

[6]  Jeffrey A. Cohen,et al.  Diagnostic criteria for multiple sclerosis: 2010 Revisions to the McDonald criteria , 2011, Annals of neurology.

[7]  C. Pozzilli,et al.  Cognitive and psychosocial features in childhood and juvenile MS , 2010, Neurology.

[8]  H. Blom,et al.  Overview of homocysteine and folate metabolism. With special references to cardiovascular disease and neural tube defects , 2010, Journal of Inherited Metabolic Disease.

[9]  Mohamed S Khalil.  Preliminary Arabic normative data of neuropsychological tests: The verbal and design fluency , 2010, Journal of clinical and experimental neuropsychology.

[10]  K. Koivisto,et al.  The reliability of the MSFC and its components , 2007, Acta neurologica Scandinavica.

[11]  R. Erasmus,et al.  Iron and the folate-vitamin B12-methylation pathway in multiple sclerosis , 2006, Metabolic Brain Disease.

[12]  J. De Keyser,et al.  Plasma homocysteine levels in multiple sclerosis , 2006, Journal of Neurology, Neurosurgery & Psychiatry.

[13]  Stephen M. Rao.  Cognitive Function in Patients with Multiple Sclerosis: Impairment and Treatment , 2004 .

[14]  R. Benedict,et al.  Working memory and processing speed deficits in systemic lupus erythematosus as measured by the paced auditory serial addition test , 2004, Journal of the International Neuropsychological Society.

[15]  Y. Liaw,et al.  Homocysteine and risk of coronary artery disease: Folate is the important determinant of plasma homocysteine concentration. , 2003, Nutrition.

[16]  A. Smith,et al.  Total Plasma Homocysteine, Age, Systolic Blood Pressure, and Cognitive Performance in Older People , 2002, Journal of the American Geriatrics Society.

[17]  P. Sachdev,et al.  Relationship between plasma homocysteine levels and brain atrophy in healthy elderly individuals , 2002, Neurology.

[18]  Sudha Seshadri,et al.  Plasma Homocysteine as a Risk Factor for Dementia and Alzheimer's Disease , 2002 .

[19]  A. McCaddon,et al.  Homocysteine and Cognitive Decline in Healthy Elderly , 2001, Dementia and Geriatric Cognitive Disorders.

[20]  A. Thompson.  The effectiveness of neurological rehabilitation in multiple sclerosis. , 2000, Journal of rehabilitation research and development.

[21]  Michael D. Franzen,et al.  Reliability of alternate forms of the trail making test , 1996 .

[22]  M. Tintoré,et al.  Serum homocysteine levels in multiple sclerosis. , 1994, Archives of neurology.

[23]  J. Pacala.  Vitamin B12 deficiency. , 1993, The Journal of family practice.

[24]  J. Kurtzke.  Rating neurologic impairment in multiple sclerosis , 1983, Neurology.

[25]  R. Reitan.  Validity of the Trail Making Test as an Indicator of Organic Brain Damage , 1958 .

[26]  Robert Zivadinov,et al.  Basal ganglia, thalamus and neocortical atrophy predicting slowed cognitive processing in multiple sclerosis , 2011, Journal of Neurology.

[27]  D. Auer,et al.  Disconnection as a mechanism for cognitive dysfunction in multiple sclerosis. , 2009, Brain : a journal of neurology.

[28]  A. Quattrone,et al.  Hyperhomocysteinemia is associated with cognitive impairment in multiple sclerosis , 2007, Journal of Neurology.

[29]  J. Jolles,et al.  Homocysteine in relation to cognitive performance in pathological and non-pathological conditions , 2005, Clinical chemistry and laboratory medicine.

[30]  M. Franzen.  Cross-validation of the alternate forms reliability of the trailmaking test , 1996 .

[31]  R. Charter,et al.  Reliability of the WAIS, WMS, and reitan battery: raw scores and standardized scores corrected for age and education , 1987 .