Plasma vitamine B12-status en cerebrale witte stof-laesies

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Laatste aanpassing: 04-11-14

Verhoogde homocysteïne is geassocieerd met een hogere prevalentie van cerebrale witte stof-laesies en infarcten en slechtere cognitieve prestaties. Witte vlekken op de MRI van de hersenen dus.
Dit deed de vraag rijzen of de factoren die betrokken zijn bij het homocysteïne metabolisme, zoals vitamine B12, ook in verband staan met deze resultaten. 
Deze studie onderzocht het verband tussen de verschillende markers van de vitamine B12-status met cerebrale witte stof-laesies, infarcten en cognitie. 

De resultaten geven aan dat vitamine B12 status in het normale bereik verband houdt met de ernst van de witte stof laesies, vooral periventriculaire laesies. 
Gezien de afwezigheid van een verband met cerebrale infarcten, is de veronderstelling dat deze relatie wordt verklaard door de effecten op de toestand van de myeline in de hersenen en niet via vasculaire mechanismen.

Plasma vitamin B12 status and cerebral white-matter lesions

L M L de Lau1,2, A D Smith3, H Refsum3,4, C Johnston3 and M M B Breteler1

1 Department of Epidemiology & Biostatistics, Erasmus Medical Centre, Rotterdam, The Netherlands
2 Department of Neurology, Erasmus Medical Centre, Rotterdam, The Netherlands
3 OPTIMA, Department of Physiology, Anatomy & Genetics, Oxford, UK
4 Department of Nutrition, Institute of Basic Medical Sciences, University of Oslo, Oslo, Norway

Correspondence to:
Dr M M B Breteler, Department of Epidemiology and Biostatistics, Erasmus Medical Centre, PO Box 2040, 3000 CA Rotterdam, The Netherlands;

Background and objective: Elevated homocysteine has been associated with a higher prevalence of cerebral white-matter lesions and infarcts, and worse cognitive performance. This raises the question whether factors involved in homocysteine metabolism, such as vitamin B12, are also related to these outcomes. This study examined the association of several markers of vitamin B12 status with cerebral white-matter lesions, infarcts and cognition.

Methods: The study evaluated the association of plasma concentrations of vitamin B12, methylmalonic acid, holotranscobalamin and transcobalamin saturation with cerebral white-matter lesions and infarcts at baseline and cognition at baseline and during follow-up among 1019 non-demented elderly participants of the population-based Rotterdam Scan Study. Analyses were adjusted for several potential confounders, including homocysteine and folate concentration.

Results: Poorer vitamin B12 status was significantly associated with greater severity of white-matter lesions, in particular periventricular white-matter lesions, in a concentration-related manner. Adjustment for common vascular risk factors (including blood pressure, smoking, diabetes and intima media thickness) did not alter the associations. Adjustment for homocysteine and folate modestly weakened the associations. No association was observed for any of the studied markers of vitamin B12 status with presence of brain infarcts and baseline cognition or cognitive decline during follow-up.

Conclusions: These results indicate that vitamin B12 status in the normal range is associated with severity of white-matter lesions, especially periventricular lesions. Given the absence of an association with cerebral infarcts, it is hypothesised that this association is explained by effects on myelin integrity in the brain rather than through vascular mechanisms.

Journal of Neurology, Neurosurgery, and Psychiatry 2009;80:149-157

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