Correlations of plasma homocysteine with cerebral white matter lesion severity and cognitive impairment in elderly patients with hypertension

Abstract

Objective To investigate the correlations of plasma homocysteine(Hcy)levels with cerebral white matter lesion(WML)severity and cognitive impairment in elderly hypertension patients. Methods A retrospective case-control study was conducted.Ninty-eight elderly patients with hypertension were enrolled.Based on the presence or absence of hyperhomocysteinemia(hypertension with plasma Hcy levels ≥10 μmol/L was defined as H-type hypertension), patients were divided into two groups: a control group(n=48)and an H-type hypertension group(n=50). The degree of WML was rated by the Fazekas scale using magnetic resonance imaging(MRI)analysis.Neuropsychological examinations including mini-mental state examination(MMSE)and Montreal cognitive assessment(MoCA)were taken to assess cognitive function.The degree of WML and cognitive impairment were compared between the two groups.Correlations of plasma Hcy levels with the degree of WML and cognitive impairment were analyzed. Results Compared with the control group, scores of the Fazekas scale(3.2±1.0 vs.2.5±1.0, P<0.05)and deep white matter hyperintensity on MRI(1.7±0.8 vs.1.3±0.7, P<0.05)increased, and scores of MMSE(24.9±3.3 vs.27.7±1.8, P<0.05)and MoCA(18.6±3.9 vs.25.0±3.0, P<0.05)decreased in the H-type hypertension group.Plasma Hcy levels were positively correlated with the degree of WML(r=0.430, P<0.01)and negatively correlated with cognitive function(r=-0.406 in MMSE and-0.663 in MoCA, P<0.01). Multivariate logistic regression showed that Hcy, fasting blood-glucose, deep WML, low-density lipoprotein cholesterolin, age and systolic pressure were influencing factors for cognitive impairment(P<0.01). Conclusions WML and cognitive function are worse in elderly H-type hypertension patients than in hypertension patients with normal Hcy levels.WML and cognitive impairment are aggravated with increased plasma Hcy levels.The plasma Hcy level may be an effective clinical indicator of cognitive function in elderly people with hypertension. Key words: Hypertension; Cysteine; Leukoencephalopathies; Cognitive disorders