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Motor, Affective, and Cognitive Associations

Padraig E. O'Suilleabhain, MB BCh; Victor Sung, BS; Carlos Hernandez, BS; Laura Lacritz, PhD; Richard B. Dewey, Jr, MD; Teodoro Bottiglieri, PhD; Ramon Diaz-Arrastia, MD, PhD

Arch Neurol. 2004;61:865-868.

Background  An elevated plasma homocysteine (Hcy) level has been prospectively associated with an increased risk of vascular and degenerative dementias. An Hcy elevation is prevalent in patients with Parkinson disease (PD) in part because levodopa metabolism produces Hcy. The clinical relevance of an elevated Hcy level in patients with PD is unknown.

Objective  To determine if hyperhomocysteinemia in patients with PD is associated with depression or with cognitive or physical impairments.

Design  Ninety-seven people with a mean (SD) PD duration of 3.6 (1.6) years completed the Beck Depression Inventory, a battery of 11 cognitive tests, and the motor and function components of the Unified Parkinson's Disease Rating Scale. Normalized scores for the affective, cognitive, and physical measures were compared between those with a normal Hcy level (n = 66) and those with hyperhomocysteinemia (n = 31) (Hcy level, >1.89 mg/L [>14 µmol/L]), controlling for age, sex, disease duration, and treatment.

Results  Subjects with an elevated Hcy level were slightly older (68 vs 62 years), but had similar plasma concentrations of vitamin B₁₂ and folate. Hyperhomocysteinemic patients were more depressed (P = .02) and had worse cognition (P<.01), but the physical measure did not differ.

Conclusions  Patients with PD and hyperhomocysteinemia are more likely to be depressed and to perform worse on neuropsychometric tasks compared with normohomocysteinemic patients. Further research is warranted to see if hyperhomocysteinemia is a reversible risk factor for neuropsychiatric burden in patients with PD.

From the Departments of Neurology (Drs O'Suilleabhain, Dewey, and Diaz-Arrastia) and Psychiatry (Dr Lacritz) and the Medical School (Messrs Sung and Hernandez), The University of Texas Southwestern Medical Center at Dallas; and the Institute ofMetabolic Disease, Baylor University Medical Center, Dallas (Dr Bottiglieri).

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