Press Release; Kwangju, South Korea, Feb. 7 — Folate deficiency was associated with a threefold increased risk of developing dementia and Alzheimer’s disease in individuals 65 or older.
by Judith Groch, Senior Writer, MedPage Today
Press Release: Kwangju, South Korea, Feb. 7 — Folate deficiency was associated with a threefold increased risk of developing dementia and Alzheimer’s disease in individuals 65 or older.
People who were folate deficient at the study’s start were 3.5 times more likely to develop dementia over a 2.4 year follow-up, Jin-Sang Yoon, M.D., of Chonnam National University here, and colleagues reported online in the Journal of Neurology, Neurosurgery, & Psychiatry.
The researchers tracked the development of dementia from 2001 through 2003 in 625 people, mean age 71.6, without dementia at baseline. Of these, 518 (83%) were clinically assessed for incident dementia and Alzheimer’s disease. Serum levels of folate, vitamin B12, and homocysteine were measured at baseline and at follow-up assessments.
At baseline, 3.5% of individuals were folate deficient, 19.7% had high levels of homocysteine, while 17.4% had low vitamin B12 levels.
Only lower folate concentrations at baseline (OR 3.20, 95% CI 1.01 to 10.17) predicted dementia, the researchers said.
No associations were found with baseline vitamin B12, or homocysteine concentrations at the outset, the researchers said.
By the end of the study, there were 45 cases (8.7%) of dementia. Of these, 34 (6.6%) had Alzheimer’s disease, seven (1.4%) had vascular dementia, and four (0.8%) had “other” dementias.
Covariates included age, sex, education, disability, depression, alcohol consumption, physical activity, vascular risk factors, serum creatinine concentration, vitamin intake, and weight change, the researchers said.
Incident dementia was significantly predicted by older age, lower education, more severe cognitive impairment and disability, lower physical activity, and presence of apolipoprotein e4 allele, the researchers said.
Over the course of the follow-up period, dementia occurred more commonly in those with a relative decline in folate, weaker vitamin B12 concentrations, and a relative increase in homocysteine concentrations.
However, the relationship between dementia and a change in homocysteine did not withstand adjustments for weight change, the researchers said.
In this study, the researchers said, dementia was more strongly associated with changes in these factors than with baseline concentrations. Although these changes may have an effect on neurodegenerative processes during stages of mild cognitive impairment, the opposite may be true, the researchers said.
There is growing evidence that somatic changes associated with dementia start to occur before the onset of the clinical syndrome. These include weight loss and blood pressure decline, and may also include changes in micronutrient concentrations.
Although weight loss is unlikely to cause changes in micronutrients directly, it might be a manifestation of changes in dietary intake, either quantity or quality, the researchers suggested.
It is also possible that vitamin supplementation might be the cause. Most supplements in Korea contain vitamin B12, but not folate. However, the researchers said, they did not believe this was likely to have been the sole cause.
Study limitations included the fact that dementia was evaluated over a relatively short period and accurate timing of the onset was not possible. Furthermore, data on vitamin supplementation was not available.
Further research is required to clarify these complex longitudinal inter-relationships, the researchers said.
In the meantime, attention should be paid to the nutritional status of people with dementia from the time of diagnosis onward, regardless of whether this is a cause or effect of their condition.
In addition, the investigators said, there may be good arguments for focusing interventions for the prevention of dementia on nutritionally deficient frail populations.
This study was supported by a grant from the Korea Health 21 R&D, Ministry of Health and Welfare, Republic of Korea.
No competing interests were reported.
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Published: February 07, 2008
Reviewed by Zalman S. Agus, MD; Emeritus Professor, University of Pennsylvania School of Medicine
Kim J-M, et al “Changes in folate, vitamin B12 and homocysteine associated with incident dementia” J Neurol Neurosurg Psychiatry 2008: DOI: 10.1136/jnnp.2007.131482.
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