Peripheral blood markers in the diagnosis of Alzheimer' s disease

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Fasting plasma homocysteine (pHcy) levels in 141 patients with clinical diagnosis of Alzheimer' s disease (AD, 72.5±7.6 years) were compared with those in 139 age-matched community-dwelling normal control subjects (normal control, 75.3±5.1 years). When AD was grouped into 2 subgroups according to the presence or absence of co-existing silent brain infarction (SBI) on magnetic resonance imaging. the pHcy levels in the subgroup with SBI (14.0±4.5 μmol/L) were significantly elevated (o<0.0001) compared to the other subgroup without SBI (11.5±4.4 μmol) and the normal control group (11.0±3.0 μmol/L). After adjusting for age, multiple regression model demonstrated that high pHcy levels>11.4 μmol/L were associated with an increased risk for developing SBI in AD (odds ratio 4.2, 95% C. I. 1.7-10.5, o=0.002). Other vascular risk factors such as gender. ApoE4 gene, hypertension, current smoking, and serum cholesterol levels did not have a significant effect on SBI. The pHcy levels did not differ significantly according to the severity of deep white matter lesions among AD patients. Notably, either age at onset, cognitive function, cerebrospinal fluid tau or amyloid β-peptide1-42 levels did not significantly correlate with pHcy levels in AD. Our results suggest that homocysteine may not confer a direct risk for AD but relates to co-existing SBI, a unique vascular condition that occurs independently of other vascular risks.