Role of homocysteine in age-related vascular and non-vascular diseases

被引:94
作者
Parnetti, L
Bottiglieri, T
Lowenthal, D
机构
[1] Perugia University,Department of Clinical Medicine, Pathology and Pharmacology
[2] University of Texas,Department of Neurology
[3] Southwestern Medical School,Geriatric Research, Education and Clinical Center, VA Medical Center, Pharmacology and Exercise Science
[4] University of Florida,undefined
关键词
dementia; depression; folate; homocysteine; vascular disease; vitamin B12;
D O I
10.1007/BF03341827
中图分类号
R592 [老年病学]; C [社会科学总论];
学科分类号
03 ; 0303 ; 100203 ;
摘要
Homocysteine (Hey) may represent a metabolic link in the pathogenesis of atherosclerotic vascular diseases and old-age dementias. Hyperhomocysteinemia is an independent risk factor for coronary artery disease and peripheral vascular disease, and is also associated with cerebrovascular disease; specifically, the risk of extracranial carotid atherosclerosis significantly increases in relation to Hey levels. Hey is a reliable marker of vitamin B12 deficiency, a common condition in the elderly which is known to induce neurological deficits including cognitive impairment; a high prevalence of folate deficiency has been reported in psychogeriatric patients suffering from depression and dementia. Both these vitamins occupy a key position in the remethylation and synthesis of S-adenosylmethionine (SAMe), a major methyl donor in CNS; therefore, deficiencies in either of these vitamins lead to a decrease in SAMe and increase in Hcy, which can be critical in the aging brain. Another pathogenetic mechanism linking high Hey levels to reduced cognitive performances in the elderly might be represented by excitotoxicity, since hyperhomocysteinemia may lead to an excessive production of homocysteic acid and cysteine sulphinic acid, which act as endogenous agonists of NMDA receptors. Considering the reasonably high prevalence in the general population of a genetic predisposition to a thermolabile form of the enzyme 5,10-methylenetetrahydrofolate reductase (MTHFR), hyperhomocysteinemia can be seen as the result of multiple genetic and environmental factors leading to vascular and/or neurodegenerative disorders where age-related involutive phenomena represent a common pathogenetic ground. Systematic studies in different psychogeriatric conditions monitoring Hey levels and clinical features before and after vitamin supplementation are therefore highly recommended. (C) 1997, Editrice Kurtis.
引用
收藏
页码:241 / 257
页数:17
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