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(Stroke. 2002;33:2343.)
© 2002 American Heart Association, Inc.

Editorial

Homocysteine, Stroke, and Dementia

Amos D. Korczyn, MD, MSc

From the Department of Neurology, Tel-Aviv University Medical School, Ramat-Aviv, Israel.

Correspondence to Amos D. Korczyn, MD, MSc, Sieratzki Chair of Neurology, Tel-Aviv University Medical School, Ramat-Aviv 69978, Israel.

Key Words: cerebrovascular disorders • dementia • epidemiology • folic acid • homocyst(e)ine • prevention

An extract of the first 250 words of the full text is provided, because this article has no abstract.

The increase in aging population worldwide is expected to cause an elevation in the prevalence of vascular diseases, including atherosclerosis, hypertension, diabetes mellitus, and hyperlipidemia, as well as their consequences: ischemic heart disease, peripheral vascular disease, and stroke. This will unavoidably result in an increase in the frequency of vascular dementia, which will only be enhanced because of the frequency of Alzheimer disease (AD) changes in these age groups. However, preventive strategies, which should be the best solution to these problems, are hampered by the fact that both disorders may be caused by several etiologies, such as primary lesions elsewhere in the body (heart, blood vessels), genetic factors, and primary degeneration of the brain and its vasculature.

It has been known for several decades that deficiency of certain vitamins, particularly vitamin B₁₂, can cause neurological dysfunction, including cognitive impairment, which can be reversed by correcting the deficiency. The neurological effects may well result from dysfunction of several metabolic pathways. However, the homocysteine pathway, in which vitamin B₁₂ and folic acid, as well as pyridoxine (vitamin B₆), function as cofactors, seems to play a central role. Deficiency of either of these vitamins causes a reduced methylation capacity, which could affect several metabolic processes in the central nervous system and elsewhere.

Hyperhomocysteinemia, or increased serum concentration of total homocysteine, has been identified as being associated with vascular disease, including cerebrovascular disease in general, particularly in subjects with significant carotid stenosis.^1,2 (The term total homocysteine refers to the fact that in . . . [Full Text of this Article]

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