Bo Jiang, Yumei Chen
BMC Neurology 2014, 14:217 doi:10.1186/s12883-014-0217-9
Published: 30 November 2014
Abstract (provisional)
BackgroundVascular cognitive impairment-no dementia (VCIND) refers to the early or mild cognitive impairment induced by cerebral vascular injury. Research shows that serum total homocysteine (tHcy) level is an independent risk factor for cerebral vascular disease and may be closely related to cognitive function.Current studies on the tHcy level in VCIND patients are limited, and the relationship of tHcy with cognitive function remains unclear. This study aims to investigate the tHcy levels in patients with VCIND and to determine their correlation with cognitive function, as well as to provide useful clues for preventing and treating VCIND.MethodsThe tHcy, folate, and vitamin B12 levels in 82 patients with VCIND were reviewed retrospectively and compared with those of 80 stroke patients without cognitive impairment and 69 healthy controls by using the Montreal Cognitive Assessment (MoCA) scale and the event-related potential P300 to evaluate cognitive function.ResultsThe tHcy levels in the VCIND group were higher than those in the other two groups, whereas the folate and Vitamin B12 levels in the VCIND group were lower than those of the other two groups. The tHcy levels in the stroke group were higher than those in the control group, and the folate and vitamin B12 levels in the stroke group were lower than those in the control group. The patients in the VCIND group with high tHcy exhibited lower MoCA scores and prolonged P300 latency than those in with normal tHcy. Correlation analysis showed that tHcy level is positively correlated with P300 latency period and negatively correlated with MoCA score.ConclusionThe tHcy levels were significantly higher and the vitamin B12 and folate levels were significantly lower in the patients with VCIND than those in the other groups. The high tHcy levels in the VCIND patients may be correlated with impaired cognitive function.
Notes:
There is a genetic defect – prevalent among at least 30% of the population that lowers or prevents conversion of folate to activated folate, depending on your DNA. It’s the MTHFR enzyme genetic defect. I know about it because I have it. Anyway, there is an easy fix even if you have the most severe form of the genetic defect. Activated folate supplement – relatively cheap and easy to find at most specialty grocery stores. Folate is converted to methionine. Methionine is converted to SAMe and SAMe is a precursor for seratonin. Activated folate is also needed to make other neurotransmitters and convert homocysteine to methionine.
So if you have patients with mood disorders and taking SSRIs, perhaps they have the MTHFR genetic defect? But at what dose of activated folate? Also, I’ve read even though folate (Vitamin B9) is water soluble there is such a thing as excessive folate. Supposedly taking enough B12 quenches excessive folate. I personally use a chewable B12 at 2500 micrograms. And I take 800 micrograms of activated folate daily. But I’ve seen much larger doses sold online. The lab report I have says lack of activated folate can “predispose an individual to certain psychiatric disorders and/or memory and attention deficits. Patients who are compound heterozygous for MTHFR C677T and MTHFR A1298C polymorphisms should consider supplementation with active L-methylfolate in combination with vitamin B12. Increased homocysteine levels may reflect other conditions (B-vitamin deficiencies, renal disease, etc.), which should be evaluated prior to initiating supplementation.” But again, what dose?
How you can find out if you have the genetic defect – it’s a simple blood test. Just specify MTHFR. It’s found in coagulation genetics. There are two tests. One for the MTHFR C677T gene and the other MTHFR A1298C gene. The paperwork I have specifies an estimated genotype frequency of 49.3% for C/C, 39.8% C/T and 10.9% T/T for the C677T gene. And estimated genotype frequency of C/C 7.12%, 30% C/T, and 58.6% A/A for A1298C gene. I’m in the middle of both listed as Abby Normal. Reduced activity of MTHFR.
The lab used was Health Diagnostic Laboratory Inc.
Approx 46% of the population have one copy (heterozygous) for the C6777 MTHFR gene. This slows the enzyme by ~40%; conversion to folate. If you are homozygous it slows it by ~70%; likewise does a compound heterozygous profile (one copy of 6777 & 1298). Methylcobalamin is required to bind to folate in order to lower Hcy and also produce methionine. ATP & Mg are required to convert Methionine to SAMe which is your major methyl donor (second most important working substrate in the body next to ATP). There are over 200 enzymatic rxns that require SAMe. I happen to be the lucky winner of a compound heterozygous MTHFR along with many others snps within as well as outside of the methylation cycle. This explains many of my past health issues!
As far as supplementing with methylfolate & MB12, it’s not cut & dry!! Both are methyl donors & some people can’t handle methyl donors (especially if they have high oxidative stress & are toxic). There are three basic rxns when supplementing with methylfolate: 1) the person responds well & stays well. It’s “like a magic pill” 2) they respond well & then TANK (me) 3) they TANK immediately. There are many factors why they might not do well & MANY MANY nuances in managing these cases. Methylation, mitochondria & metabolism are three major cycles that all play (spin) off of each other & generally you can’t just address one. Vagal tone is a MAJOR role player as well!
If you start supplementing with methylfolate & MB12, start slow & titrate up. These generally are not supplements that one should be taking everyday; most of the time you pulse the frequency & dosage PRN depending on the patients chemical, physical & emotional stress levels as well as their diet. Good rule of thumb is always start with diet, lifestyle and “gut rehab” first!!
If anyone is interested in learning more e-mail me. I’m doing some web classes on this stuff as I have studied extensively & work with some of the “master gurus” on this stuff!! There’s nothing like trying to help yourself & your family be healthy that’ll make you learn everything possible 😉
Monika Buerger, BA, DC
Monika Buerger [mailto:drbdc4u@aol.com]