Zeitschrift für Gerontologie und Geriatrie

, Volume 42, Issue 2, pp 131–136

Besteht auch bei multimorbiden geriatrischen Patienten ein Zusammenhang zwischen erhöhten Homocysteinspiegeln und kognitiven Defiziten?

  • Susanne Hengstermann
  • Anja Hanemann
  • Rolf Nieczaj
  • Nadia Abdollahnia
  • Antje Schweter
  • Elisabeth Steinhagen-Thiessen
  • Andreas Lun
  • Gernot Lämmler
  • Ralf-Joachim Schulz
ORIGINALARBEIT

Zusammenfassung

Hintergrund

Der Zusammenhang zwischen Homocystein (Hcys)- bzw. Folsäurespiegeln im Blut und kognitiven Defiziten wurde bisher bei gesunden, nicht aber bei multimorbiden Senioren beschrieben. Die aktuelle Fragestellung ist daher, ob sich dieser Zusammenhang bei multimorbiden geriatrischen Patienten bestätigt.

Methodik

Der kognitive Status wurde von 189 (131 f/58 m) multimorbiden geriatrischen Patienten im Alter von 78,6 ± 7,3 Jahren mittels Syndrom-Kurztest (SKT) in einer Querschnittserhebung untersucht. Neben biochemischen Parametern (Plasma-Hcys, Serum-Folsäure, Vitamin B12, Blutbild), Ernährungsstatus (BMI, Mini Nutritional Assessment) wurde die Selbstständigkeit der Patienten erfasst. Die Bestimmung der Vitaminzufuhr erfolgte anhand des 3-Tage- Ernährungsprotokolls.

Ergebnisse

Nach SKT zeigten 25,4% keine kognitive Leistungsstörungen, bei 21,2% lag ein Verdacht auf leichte kognitive Defizite vor, 12,7% hatten leichte, 9,0% mäßige und 31,7% schwere kognitive Defizite. Plasma Hcys-Spiegel waren unabhängig von kognitiven Defiziten um 20% erhöht. Folsäure und Vitamin B12 im Serum lagen im Normbereich, obwohl die Folsäurezufuhr um 75% vermindert war. Unterschiede zwischen SKT-Gruppen waren weder hinsichtlich Ernährungsstatus, Selbständigkeit, Anzahl der Diagnosen oder Medikation noch hinsichtlich biochemischer Parameter signifikant.

Schlussfolgerungen

Es wurden erhöhte Hcys-Spiegel bei multimorbiden geriatrischen Patienten mit kognitiven Defiziten und normalen Folsäure- und Vitamin B12- Konzentrationen analysiert. Hcys im Plasma erscheint als kein geeigneter biologischer Risikofaktor für kognitive Defizite bei multimorbiden geriatrischen Patienten.

Schlüsselwörter

Homocystein Folsäure kognitive Defizite multimorbide Senioren 

Does an association between increased homocystein levels and cognitive dysfunction also exist in multimorbid geriatric patients?

Abstract

Background

Total blood homocysteine (Hcys) and folate have been investigated in association with cognitive dysfunction (CD) in healthy but not in multimorbid elderly patients. We hypothesized that total Hcys and folate are adequate markers to identify multimorbid elderly patients with CD.

Methods

According to the Short Performance Cognitive Test (SKT) CD was determined in a cross-sectional study with 189 (131 f/58 m) multimorbid elderly patients with a mean age of 78.6 ± 7.3 yrs. Besides the analyses of biochemical parameters (Hcys, folate, vitamin B12, hemogram) nutritional status (BMI, Mini Nutritional Assessment) as well as activities of daily living were assessed. Daily nutritional intake was measured with a 3-day nutrition diary. For analysis, we used the nutritional software program DGE-PC professional.

Results

According to SKT 25.4% showed no cerebral cognitive dysfunction, 21.2% had a suspicion about incipient cognitive dysfunction, 12.7% showed mild, 9.0% moderate, 31.7% of patients severe cognitive deficits. Median plasma Hcys was about 20% elevated in multimorbid elderly patients independent of CD. Serum folate and vitamin B12 levels were within range, though dietary folate intake (97 [80–128] µg/d) was reduced about 75% (recommendation 400 µg/d). Significant correlations between vitamin intake and plasma/serum levels of Hcys, folate and vitamin B12 were not present. We did not find significant differences between SKT groups of nutritional status, activities of daily living, index of diseases, medications, or selected biochemical parameters.

Conclusion

We analysed elevated serum Hcys levels in multimorbid elderly patients with normal plasma folate and vitamin B12 concentration and CD. Plasma Hcys or serum folate did not appear as an important biological risk factor on CD in multimorbid elderly patients.

Key words

homocysteine folate cognitive dysfunction multimorbidity elderly 

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Copyright information

© Spinger 2008

Authors and Affiliations

  • Susanne Hengstermann
    • 1
  • Anja Hanemann
    • 1
  • Rolf Nieczaj
    • 1
  • Nadia Abdollahnia
    • 1
  • Antje Schweter
    • 1
  • Elisabeth Steinhagen-Thiessen
    • 1
  • Andreas Lun
    • 2
  • Gernot Lämmler
    • 1
  • Ralf-Joachim Schulz
    • 1
  1. 1.Charité – Universitätsmedizin Berlin, Campus Virchow-KlinikumForschungsgruppe Geriatrie am „Evangelischen Geriatriezentrum Berlin“BerlinGermany
  2. 2.Charité – Universitätsmedizin Berlin, Campus Virchow-KlinikumZentralinstitut für Laboratoriumsmedizin und PathobiochemieBerlinGermany

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