IMPACT OF HYPERHOMOCYSTEINEMIA TREATMENT ON COGNITIVE DECLINE DUE TO ALZHEIMER’S DISEASE AND RELATED DISORDERS
W.R. Shankle, J. Hara, M.S. Rafii, J. Russell
J Aging Res Clin Practice 2013;2(4):319-324
Objectives: Studies have produced conflicting results assessing hyperhomocysteinemia (HYH) treatment with B vitamins in patients with normal cognition, Alzheimer’s disease or a related disorder (ADRD). This study examined whether HYH treatment with Cerefolin®/Cerefolin-NAC® (CFLN) influenced cognitive decline. Design: Retrospective cohort study of subjects followed longitudinally. Setting: Outpatient clinic for cognitive disorders. Participants: Of 934 patients, 109 HYH patients met inclusion criteria to analyze effect of CFLN (N=86: median treatment duration and 90% confidence band = 17.3 [0-52.4] months) vs. no CFLN (N=23). Intervention: CFLN vs. no treatment. Measurements: Cognitive outcome measures included MCI Screen (memory), CERAD Drawings (constructional praxis), Ishihara Number Naming (object recognition), Trails A and B (executive function), and F-A-S test (verbal fluency). Dependent or predictor measures included demographics, functional severity, CFLN and no CFLN treatment duration, ADRD diagnosis, memantine and cholinesterase inhibitor treatment, apolipoprotein E (ApoE) genotype and quantitative MRI volumes. The data were analyzed using linear mixed effects models with covariate adjustment and random effects for functional severity. Results: Treatment duration on vs. off CFLN slowed decline in memory, constructional praxis, and executive function, even after controlling for ApoE genotype and regional brain volumes. CFLN treatment slowed cognitive decline significantly more for patients with milder baseline severity. Conclusion: This retrospective study showed that CFLN significantly slowed cognitive decline among HYH patients. Longer CFLN treatment duration and milder baseline severity were both significant factors. These findings warrant prospective validation.