How we wish to be cited:
Norberg B. Homocysteine - body and soul [debate]. Rondel 2000; 5. URL: http://www.rondellen.net

Homocysteine – body and soul!
Bo Norberg

Karin Nilsson, registered nurse, was born in Malmö, Sweden, 1950. She served as nurse in internal medicine and psychogeriatrics in Lund from 1976 and has held the position of research nurse at the Department of Psychogeriatrics, Lund University Hospital, from 1990. She defends her doctorial theses (1) Friday Nov. 3, 2000, at 1 o´clock p.m., in the lecture hall of the House of Psychiatry, University Hospital of Lund.

The aim of the study was to evaluate the diagnostic potentials of four different biochemical markers, serum cobalamin, blood folate, plasma homocysteine, and serum methylmalonic acid. The second aim was to investigate the relationship between these markers and various clinical and functional parameters of the nervous system in patients with dementia disorders (1).

The concentration of plasma homocysteine was increased and elevated in about 40-50% of the psychogeriaric patients, while the concentrations of serum cobalamins and serum methylmalonic acid were not changed.

The concentration of blood folate was significantly decreased in patients with dementia. Both plasma homocysteine and serum methylmalonic acid normalized when the patients received cobalamin/folate supplementation. The extent of the decrease of the markers was associated with the degree of tissue deficiency of cobalamin.

Plasma homocysteine and blood folate concentrations correlated significantly with the severity of dementia and symptoms indicating cognitive impairment and delirium, such as memory impairment, disorientation, and clinical fluctuations. There was no such relation between concentrations of serum cobalamins and serum methylmalonic acid and any of those clinical parameters.

Cobalamin/folate supplementation improved cognitive functions only in patients with elevated plasma homocysteine levels. Clinical improvement after cobalamin supplementation was related to changes in the regional cerebral blood flow. The study indicates that plasma homocysteine is the best marker, out of those investigated, for detection of cobalamin/folate deficiency in psychogeriatric patients.

It is evident from the original papers (2-7), that the present theses like most modern research provide a team work, reflecting joint efforts by many competent minds with devotion and resources. The interesting intervention study (7) is at present only available in the theses (1).

The Rondel – the editor of which had the honor to serve as consultant in Karin Nilsson´s ward for short periods 1976-80 – wishes her the best of luck in future defense and attack of scientific problems.

References

  1. Nilsson K. Cobalamin/folate status and its relation to cognition and behaviour in psychogeriatric patients. Dissertation, Department of Psychogeriatrics, Lund Yniversity Hospital, 2000.
  2. Nilsson K, Gustafson L, Fäldt R, Andersson A, Brattström L, Lindgren A, Israelsson B, Hultberg B. Hyperhomocysteinemia – a common finding in a psychogeriatric population. Europ J Clin Invest 1996; 26853-9.
  3. Nilsson K, Gustafson L, Fäldt R, Andersson A,Vaara L, Nilsson R, Alm B, Hultberg B. Plasma methylmalonic acid in relation to serum cobalamin and plasma homocysteine in a psychogeriatric population and the effect of cobalamin treatment. Int J Ger Psych 1997; 12:67-72.
  4. Nilsson K, Gustafson L, Hultberg B. Plasma homocysteine is a sensitive marker for tissue deficiency of both cobalamins and folates in a psychogeriatric population. Dement Geriatr Cogn Disord 1999; 10:476-82.
  5. Nilsson K, Warkenheim S, Hultberg B, Fäldt R, Gustafson L. Treatment of cobalamin deficiency in dementia, evaluated clinically and with cerebral blood flow measurements. Ageing Clin Exp Res 2000; 12:199-207.
  6. Nilsson K, Gustafson L, Hultberg B. The plasma homocysteine concentration is better than that of serum methylmalonic acid as marker for sociopsychological performance in a psychogeriatric population. Clin Chem 2000; 46:691-6-
  7. Nilsson K, Gustafson L, Hultberg B. Improvement of cognitive functions after cobalamin/folate supplementation in elderly patients with dementia and elevated plasma homocysteine. (submitted).

The complete dissertation, reprints of basic papers included, may be requested from:

Karin Nilsson, Department of Psychogeriatrics, University Hospital, SE-221 85 Lund, Sweden. E-mail: karin.nilsson@nc.lund.ltskane.se

Updated april 02, 2004