Homocysteine in Cerebrovascular Disease: an Independent Risk Factor for Subcortical Vascular Encephalopathy

Abstract

Hyperhomocysteinemia is a risk factor for obstructive large-vessel disease. Here, we studied plasma concentrations of homocysteine and vitamins in patients suffering from subcortical vascular encephalopathy (SVE), a cerebral small-vessel disease leading to dementia. These results were compared to the homocysteine and vitamin plasma concentrations from patients with cerebral large vessel disease and healthy control subjects.Plasma concentrations of homocysteine, vascular risk factors and vitamin status (B 6 , B 12 , folate) were determined in 82 patients with subcortical vascular encephalopathy, in 144 patients with cerebral large-vessel disease and in 102 control subjects. Patients with SVE, but not those with cerebral large-vessel disease, exhibited pathologically increased homocysteine concentrations in comparison with control subjects without cerebrovascular disease. Patients with SVE also showed lower vitamin B 6 values in comparison to subjects without cerebrovascular disease. Logistic regression analysis showed that homocysteine is associated with the highest risk for SVE (odds ratio 5.7; CI 2.5-12.9) in comparison to other vascular risk factors such as hypertension, age and smoking.These observations indicate that hyperhomocysteinemia is a strong independent risk factor for SVE.

Recurrent Small-Artery Disease in Hyperhomocysteinemia: Widowers' Stroke Syndrome?

“…Among the three small-population studies regarding the positive association of hyper-Hcy with lacunar infarction (4-6), two indicated a weak association (4,6), while the other indicated that the association was a little stronger than that with large-artery atherosclerosis (5). In addition, hyper-Hcy has been suggested to associate with subcortical vascular encephalopathy (14,15). Although the pathology of deep perforating arteries and subcortical microvessels may differ, these findings suggest that hyper-Hcy contributes to small artery diseases in a fashion different from atherosclerosis, possibly including the formation of microatheroma.…”

Associations between white matter lesions, cerebrovascular risk factors, and low CSF Aβ42

“…Age, hypertension, and hyperhomocysteinemia are known risk factors for both arteriolosclerosis and WML (Bertsch et al, 2001;Breteler et al, 1994;Vermeer et al, 2002) and post mortem pathological associations between WML and arteriolosclerosis have been described (Awad et al, 1986;van Swieten et al, 1991).…”

Supratentorial Age-Related White Matter Changes Predict Outcome in Cerebellar Stroke

“…[7][8][9] Increasing age and vascular risk factors such as hypertension, diabetes, and hyperhomocysteinemia are related to the degree of WMLs. 10,11 The clinical relevance of WMLs is controversial; however, recent data confirm the coexistence of vascular dementia, gait unsteadiness, and urinary incontinence subsumed in the syndrome of subcortical vascular encephalopathy (SVE) with severe WMLs. 12 There is growing evidence that the progression of WMLs is associated with progressive functional deficits such as gait disturbance 13 and upper limb discoordination, 14 and a large ongoing European trial 15 intends to clarify the issue of increasing disability in the elderly on the basis of progressive WMLs.…”