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From the Division of Stroke and Critical Care (Drs. Wright and Sacco), Department of Neurology, College of Physicians and Surgeons of Columbia University; Departments of Biostatistics (H.-S. Lee and Dr. Paik) and Epidemiology (Dr. Sacco), Mailman School of Public Health, Columbia University, New York, NY; and Department of Medicine (Drs. Stabler and Allen), University of Colorado Health Sciences Center, Denver.
Address correspondence and reprint requests to Dr. Clinton Wright, Division of Stroke and Critical Care, College of Physicians and Surgeons of Columbia University, NI-Room 640, 710 W168th Street, New York, NY 10032; e-mail: cbw7{at}columbia.edu
Objective: Several studies implicate elevated homocysteine as a risk factor for dementia and cognitive decline, but most studies have involved subjects older than 55 years from homogeneous populations. The authors examined homocysteine and cognition in a tri-ethnic community sample 40 years and older.
Method: The Northern Manhattan Study includes 3,298 stroke-free subjects. Of these 2,871 had baseline fasting total homocysteine (tHcy) levels and Mini-Mental State Examination (MMSE) scores available. The authors used multiple linear regression to examine the cross-sectional association between baseline tHcy levels and mean MMSE scores adjusting for sociodemographic and vascular risk factors.
Results: Homocysteine levels were related to age, renal function, and B12 deficiency. Those with B12 deficiency had tHcy levels five points higher (9.4 vs 14.4 nmol/L). Mean MMSE scores differed by age, sex, and race-ethnic group. Those with hypertension, diabetes, cardiac disease, and B12 deficiency had lower MMSE scores. In multivariate analyses, elevated tHcy was associated with lower mean MMSE scores for those older than 65 but not for those 40 to 64. Adjusting for B12 deficiency and sociodemographic factors the mean MMSE was 2.2 points lower for each unit increase in the log tHcy level (95% CI –3.6, –0.9). Adding vascular risk factors to the model did not attenuate this effect (mean MMSE –2.2 points; 95% CI –3.5, –0.9).
Conclusions: Elevated homocysteine was independently associated with decreased cognition in subjects older than 65 in this tri-ethnic cohort, adjusting for sociodemographic and vascular risk factors.
Received December 13, 2003. Accepted in final form March 23, 2004.
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