Omega-3 Fatty Acid Status Enhances the Prevention of Cognitive Decline by B Vitamins in Mild Cognitive Impairment.
Omega-3 Fatty Acid Status Enhances the Prevention of Cognitive Decline by B Vitamins in Mild Cognitive Impairment.
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DOI：
10.3233/jad-150777
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发表时间：
2016
期刊：
影响因子：
--
通讯作者：
de Jager CA
中科院分区：
文献类型：
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作者：
Oulhaj A;Jernerén F;Refsum H;Smith AD;de Jager CA
一项针对轻度认知障碍（MCI）患者的随机试验（VITACOG）发现，用B族维生素治疗降低同型半胱氨酸可以减缓认知和临床衰退的速度。我们利用这项试验的数据来观察基线omega-3脂肪酸状态是否与B族维生素治疗的效果相互作用。266名年龄≥70岁的轻度认知损伤患者随机服用B族维生素（叶酸、维生素B6和B12）或安慰剂，为期2年。测量基线认知测试表现、临床痴呆评分（CDR）量表以及总同型半胱氨酸、总二十二碳六烯酸和二十碳五烯酸（omega-3脂肪酸）的血浆浓度。根据ω -3脂肪酸的基线浓度增加，服用B族维生素的组在言语延迟回忆、全局认知和CDR盒子和方面的最终得分更好，而安慰剂组在这些浓度下的得分相似。在omega-3状态良好的患者中，接受B族维生素治疗的患者中有33%的总体CDR评分为bb100，而安慰剂组为59%。对于所有三个结果测量，高浓度的二十二碳六烯酸单独显著增强了B族维生素的认知效果，而二十碳五烯酸似乎效果较差。当omega-3脂肪酸浓度较低时，B族维生素治疗对轻度认知障碍患者的认知能力下降没有影响，但当omega-3脂肪酸浓度在正常范围内时，B族维生素会相互作用，减缓认知能力下降。需要进行B族维生素与omega-3脂肪酸联合的临床试验，以确定是否有可能减缓MCI向AD的转化。
A randomized trial (VITACOG) in people with mild cognitive impairment (MCI) found that B vitamin treatment to lower homocysteine slowed the rate of cognitive and clinical decline. We have used data from this trial to see whether baseline omega-3 fatty acid status interacts with the effects of B vitamin treatment. 266 participants with MCI aged ≥70 years were randomized to B vitamins (folic acid, vitamins B6 and B12) or placebo for 2 years. Baseline cognitive test performance, clinical dementia rating (CDR) scale, and plasma concentrations of total homocysteine, total docosahexaenoic and eicosapentaenoic acids (omega-3 fatty acids) were measured. Final scores for verbal delayed recall, global cognition, and CDR sum-of-boxes were better in the B vitamin-treated group according to increasing baseline concentrations of omega-3 fatty acids, whereas scores in the placebo group were similar across these concentrations. Among those with good omega-3 status, 33% of those on B vitamin treatment had global CDR scores >0 compared with 59% among those on placebo. For all three outcome measures, higher concentrations of docosahexaenoic acid alone significantly enhanced the cognitive effects of B vitamins, while eicosapentaenoic acid appeared less effective. When omega-3 fatty acid concentrations are low, B vitamin treatment has no effect on cognitive decline in MCI, but when omega-3 levels are in the upper normal range, B vitamins interact to slow cognitive decline. A clinical trial of B vitamins combined with omega-3 fatty acids is needed to see whether it is possible to slow the conversion from MCI to AD.