1.
Hultberg, Björn, et al.
(författare)
Homocystein--markör för kärlsjukdom hos aldre med psykisk sjukdom.
2008
Ingår i: Läkartidningen. - 0023-7205. ; 105:38, s. 2576-2578
Forskningsöversikt (refereegranskat) abstract
Many studies have reported higher total plasma homocysteine (tHcy) in elderly patients with mental illness than in control subjects. There are many different determinants of plasma tHcy concentration, including age, cobalamin/folate status, renal function and the presence of vascular disease. The presence of vascular disease may contribute to cognitive impairment. We have investigated elderly patients with regard to plasma tHcy and the presence of vascular disease. Clarification of the role of vascular risk factors in mental illness is important because most are modifiable, in contrast to other risk factors such as age and genetics. The main findings in our studies imply that elevated plasma tHcy concentration in elderly patients with mental illness is mainly associated with the presence of vascular disease and is not related to the specific psychogeriatric diagnosis. Furthermore, it seems possible that the control of conventional vascular risk factors could be guided by the level of plasma tHcy, serum cystatin C, and serum N-terminal pro-brain natriuretic peptide. Patients with an elevation of any of these parameters could be selected for a lower target level of vascular risk factors such as blood pressure cholesterol etc. than conventional target levels.
2.
3.
Nilsson, Anna-Karin, et al.
(författare)
C-reactive protein: vascular risk marker in elderly patients with mental illness.
2008
Ingår i: Dementia and Geriatric Cognitive Disorders. - : S. Karger AG. - 1420-8008 .- 1421-9824. ; 26:3, s. 251-256
Tidskriftsartikel (refereegranskat) abstract
BACKGROUND: There is increasing evidence that vascular disease contributes to cognitive impairment and dementia. Clarification of the role of vascular risk factors in dementia is important because most are modifiable, in contrast to other risk factors such as age and genetics. METHODS: In 428 patients with mental illness we have investigated the relation of vascular disease to diagnoses, and a biochemical parameter, C-reactive protein (CRP), which is associated with inflammation and vascular disease. RESULTS: Patients with vascular disease showed higher CRP levels than patients without vascular disease. Furthermore, patients with Alzheimer's disease showed lower CRP levels than patients with vascular dementia, mild cognitive impairment or depression. There is no obvious reason for this finding, since it could not be attributed to drug treatment. CONCLUSION: The findings indicate that the control of conventional vascular risk factors and therapy could be guided by the level of CRP.
4.
Nilsson, Karin, et al.
(författare)
Association between plasma homocysteine levels and mortality in elderly patients with mental illness.
2009
Ingår i: Dementia and Geriatric Cognitive Disorders. - : S. Karger AG. - 1420-8008 .- 1421-9824. ; 27:6, s. 579-583
Tidskriftsartikel (refereegranskat) abstract
BACKGROUND/METHOD: Total plasma homocysteine (tHcy) concentration is elevated in elderly patients with mental illness. Plasma tHcy is known to be associated with cardiovascular disease, renal impairment and negative lifestyle factors, and has been shown to predict mortality in human subjects. Epidemiological data on this topic in elderly patients with mental illness are missing. We therefore investigated the association between plasma tHcy levels and mortality in these patients. RESULTS: The group of deceased patients showed higher age, higher plasma tHcy, lower renal function and lower serum folate than patients who were still alive. Only age, plasma tHcy and the presence of vascular disease significantly influenced mortality. CONCLUSION: The association between plasma tHcy level and mortality risk was probably explained in part by the two plasma tHcy determinants age and presence of vascular disease. The determination of plasma tHcy in elderly patients with mental illness may help to identify patients in need of more intensive treatment.
5.
Nilsson, Karin, et al.
(författare)
Elevated plasma homocysteine concentration in elderly patients with mental illness is mainly related to the presence of vascular disease and not the diagnosis
2007
Ingår i: Dementia and Geriatric Cognitive Disorders. - : S. Karger AG. - 1420-8008 .- 1421-9824. ; 24:3, s. 162-168
Tidskriftsartikel (refereegranskat) abstract
Background: Plasma total homocysteine (tHcy) is often elevated in patients with mental illness. Since patients with mental illness and vascular disease exhibit a higher plasma tHcy concentration than patients without vascular disease, it is possible that elevated plasma tHcy in mental illness is mainly due to concomitant vascular disease. Methods: We have investigated plasma tHcy, cobalamin/folate status, renal function and the presence of vascular disease in patients with vascular dementia (VaD, n = 501), Alzheimer's disease ( AD, n = 300), depression ( n = 259) and in healthy subjects ( n = 144) stratified according to age ( below and above 75 years). Results: Plasma tHcy concentration showed the highest increase in patients with VaD compared to patients with AD or depression. After the exclusion of patients with cobalamin/ folate deficiencies and increased serum creatinine, patients with AD or depression above 75 years with vascular disease showed a similar elevation of plasma tHcy concentration as patients with VaD. Furthermore, patients with AD and depression without vascular disease showed a similar plasma tHcy concentration to healthy subjects. Conclusion: The findings imply that elevated plasma tHcy concentration in elderly patients with mental illness is mainly associated with the presence of vascular disease and is not related to the specific psychogeriatric diagnosis.
6.
Nilsson, Karin, et al.
(författare)
Homocysteine, cystatin C and N-terminal-pro brain natriuretic Peptide. Vascular risk markers in elderly patients with mental illness.
2008
Ingår i: Dementia and Geriatric Cognitive Disorders. - : S. Karger AG. - 1420-8008 .- 1421-9824. ; 25:1, s. 88-96
Tidskriftsartikel (refereegranskat) abstract
BACKGROUND: There is increasing evidence that vascular disease contributes to cognitive impairment and dementia. Clarification of the role of vascular risk factors in dementia is important because most are modifiable, in contrast to other risk factors such as age and genetics. METHODS: In 451 patients with mental illness we have investigated three biochemical markers related to vascular disease, total plasma homocysteine (tHcy), cystatin C, and N-terminal-pro brain natriuretic peptide (NT-proBNP), and their association with vascular disease, diagnoses, and brain imaging findings (CT). RESULTS: Plasma tHcy, serum cystatin C, and serum NT-proBNP showed significantly increased frequencies of elevated levels in patients with vascular disease, in patients with a pathological CT finding indicating cerebrovascular disease, and in patients above 75 years of age. CONCLUSION: It is possible that the control of conventional vascular risk factors and therapy could be guided by the level of plasma tHcy, serum cystatin C, and serum NT-proBNP. Patients with an elevation of any of these three parameters could be selected for a lower target level of risk factors such as blood pressure, hyperlipidemia etc. than conventional target levels.
7.
Nilsson, K, et al.
(författare)
Lack of association between plasma homocysteine and inflammation in psychogeriatric patients
2002
Ingår i: Dementia and Geriatric Cognitive Disorders. - 1420-8008. ; 14:3, s. 151-155
Tidskriftsartikel (refereegranskat) abstract
Background/Objectives: In previous studies we observed a high incidence of elevated plasma homocysteine (tHcy) concentrations in psychogeriatric patients. Plasma tHcy is increased in folate deficiency. Folates are sensitive to oxidative stress. Oxidative stress, caused by inflammatory processes, could represent an endogenous reason for folate deficiency, even when the dietary intake of the vitamin is within the recommended range. It has been suggested that oxidative stress rather than insufficient folate intake causes hyperhomocysteinemia in different forms of psychogeriatric diseases. In the present study we investigated the association between plasma tHcy and C-reactive protein (CRP), a sensitive marker for inflammation, in psychogeriatric patients. Methods: Plasma tHcy, its main determinants, and CRP were measured in plasma and serum of 132 psychogeriatric patients (53 males and 79 females, mean age 75 12 years). Results. In the psychogeriatric patients, plasma tHcy was elevated and blood folate and serum creatinine were lower than in control subjects, whereas serum CRP concentrations did not differ significantly. We also subdivided the psychogeriatric patients into different diagnosis groups, yet there were no differences in serum CRP concentrations in these groups compared with age-matched control groups. There was a significant correlation between plasma tHcy and serum CRP (rho = 0.19, p < 0.05). A stepwise multiple regression analysis including serum CRP, age, blood folate, serum cobalamin, serum methylmalonic acid and serum creatinine showed that only blood folate (p < 0.001), age (p < 0.001), serum creatinine (p < 0.001), serum cobalamin (p < 0.001), and serum methylmalonic acid (p < 0.001) independently predicted plasma tHcy concentration. Thus CRP concentration was not an independent predictor of plasma tHcy. Conclusion: The present study did not show any association between inflammatory status and plasma tHcy concentration in psychogeriatric patients.
8.
9.
Nilsson, Karin, et al.
(författare)
Plasma Homocysteine and Vascular Disease in Psychogeriatric Patients.
2006
Ingår i: Dementia and Geriatric Cognitive Disorders. - : S. Karger AG. - 1420-8008 .- 1421-9824. ; 21:3, s. 148-154
Tidskriftsartikel (refereegranskat) abstract
<i>Background:</i> There is a high frequency (40–50%) of elevated plasma total homocysteine (tHcy) concentrations in elderly patients with mental disorders, and patients with a history of vascular disease exhibit significantly higher plasma tHcy concentration than patients without vascular disease. <i>Method:</i> The main objective of the present study was to further investigate the association between plasma tHcy concentration and vascular disease in psychogeriatric patients. We have therefore investigated 304 psychogeriatric patients and determined plasma tHcy and its most important determinants (folate and cobalamin status and renal function), and the natriuretic peptide N-terminal-pro brain natriuretic peptide (NT-proBNP). The patients were classified into several groups of vascular disease according to the findings of brain imaging and presence of a history/symptoms indicating manifest occlusive arteriosclerotic vascular disease. <i>Results:</i> Plasma tHcy concentration is associated with the presence of vascular disease in psychogeriatric patients. The presence of vascular disease is also associated with higher age, higher serum NT-proBNP, renal impairment and lower serum folate concentration than in patients without vascular disease. The significant association between plasma tHcy concentration and vascular disease remained after correction for age and for cystatin C differences between the groups of patients without and with vascular disease. In the present population with only 16% of the patients showing elevated plasma tHcy, renal function was a more important determinant for plasma tHcy concentration than folate status. <i>Conclusion:</i> Plasma tHcy concentration is associated with vascular disease. In the present population of psychogeriatric patients renal function is associated with vascular disease and elevated plasma tHcy concentration. Thus, the association between plasma tHcy concentration and vascular disease might partially be explained by impairment of renal function.
10.
Nilsson, Karin, et al.
(författare)
Plasma Homocysteine, Cobalamin/Folate Status, and Vascular Disease in a Large Population of Psychogeriatric Patients.
2006
Ingår i: Dementia and Geriatric Cognitive Disorders. - : S. Karger AG. - 1420-8008 .- 1421-9824. ; 22:4, s. 358-366
Tidskriftsartikel (refereegranskat) abstract
<i>Background:</i> Cobalamin/folate deficiency and vascular disease are prevalent in elderly subjects and may lead to mental symptoms, but may even more often influence the severity of other organic and non-organic mental diseases. In the present study, we have evaluated cobalamin–folate status and the presence of vascular disease in 1,982 psychogeriatric patients investigated and diagnosed in a psychogeriatric clinic. The objective of the present study is to obtain information on the role of cobalamin/folate status and vascular disease in different diagnoses of psychogeriatric patients and their association with plasma homocysteine (tHcy). <i>Methods:</i> We have measured serum cobalamin, blood/serum folate, serum creatinine, plasma tHcy and evaluated the presence of vascular disease in 1,982 well-defined psychogeriatric patients. <i>Results and Conclusions:</i> The present study indicates that cobalamin/folate deficiencies do not play an important role in cognitive dysfunction in psychogeriatric patients, since only about 7% of the study population had metabolic cobalamin/folate deficiencies. Furthermore, cobalamin/folate deficiencies were rare in younger patients (below 70 years of age). We were also able to confirm our previous finding that there was no association between dementia of Alzheimer type (AD) and plasma tHcy level or metabolic cobalamin/folate deficiencies. Furthermore, we observed a low proportion of vascular disease in patients with AD, which does not give support for an association between well-defined AD and the presence of vascular disease. The presence of vascular disease was higher and of similar degree in patients with mild cognitive impairment and depression, which indicates an association between these diagnoses and the presence of vascular disease. The present study also shows that at plasma tHcy levels below 14 µmol/l, the likelihood of cobalamin/folate deficiency is small and further investigation of cobalamin/folate status could be omitted.
