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The Plasma Homocysteine Concentration Is Better Than That of Serum Methylmalonic Acid as a Marker for Sociopsychological Performance in a Psychogeriatric Population

¹ Department of Psychogeriatrics, Division of Clinical Chemistry, University of Lund, University Hospital, S-22185 Lund, Sweden.

² Department of Laboratory Medicine, Division of Clinical Chemistry, University of Lund, University Hospital, S-22185 Lund, Sweden.
^a Author for correspondence. Fax 46-46-189114; e-mail bjorn.hultberg{at}klinkem.lu.se

Background: Cobalamin/folate deficiency in elderly subjects may lead to psychiatric symptoms, but more often it increases the severity of various organic and nonorganic mental diseases. A major clinical problem, however, is the uncertainty and controversy concerning biochemical markers of cobalamin/folate deficiency to be used in the diagnostic evaluation of suspected cobalamin/folate deficiency.

Methods: We measured plasma homocysteine (tHcy), blood folate, serum methylmalonic acid, and serum cobalamin in 80 psychogeriatric patients (age, 77.3 ± 8.6 years) and 50 controls (age, 76.1 ± 8.0 years). We assessed associations of these tests with measures of cognitive and behavior performance by use of regression analyses.

Results: Plasma tHcy was increased in 45% of the psychogeriatric population (mean, 20.5 ± 9.2 µmol/L vs 15.3 ± 4.7 µmol/L for controls; P <0.01). Plasma tHcy correlated with severity of dementia (r = 0.36; P <0.01), the Katz ADL index (r = 0.29; P <0.05), the Berger scale (r = 0.29; P <0.05), and the score of symptoms (r = 0.39; P <0.001) in the psychogeriatric population. Similarly, blood folate was significantly correlated with these measures, but the concentrations of serum cobalamin and methylmalonic acid were not. In a stepwise multiple regression analysis including the biochemical markers, tHcy was the only significant predictor of the severity of dementia (r² = 0.11; P <0.01) and the score of symptoms (r² = 0.16; P <0.001).

Conclusion: Plasma tHcy is the best marker of those measured to investigate suspected tissue deficiency of cobalamin/folate.

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