Abstract 173: Effect Of B-Vitamins On Cognition In Patients With Prior Stroke
High serum total homocysteine (tHcy) and stroke are associated with increased risks of cognitive decline and cognitive impairment. This study aimed to determine whether B-vitamin treatment would reduce the risk of cognitive decline and cognitive impairment among individuals with recent stroke or transient ischemic attack (TIA) of the brain.
Methods: 8,164 patients with recent stroke or TIA (< 7 months) were randomly allocated to double-blind treatment with one tablet daily of placebo or B-vitamins (folic acid 2 mg, vitamin B6 25 mg, vitamin B12 500 μg) and followed for a median of 3.4 years for the occurrence of stroke, myocardial infarction or death due to vascular causes in the VITAmins TO Prevent Stroke (VITATOPS) trial. The Mini-Mental State Examination (MMSE) score was undertaken at least 6 months after the qualifying stroke (baseline) and every 6 months thereafter for the duration of follow-up. The primary outcome for this pre-specified secondary analysis was the composite of a decline of 3 or more points in the MMSE score compared with the baseline score at > 6 months after the qualifying stroke (cognitive decline) or a new MMSE score < 24 (cognitive impairment).
Results: Among the 2214 participants who undertook the MMSE at least 6 months after the qualifying stroke event, and who were not cognitively impaired (MMSE > 24), and who underwent repeat MMSE assessments over a median of 2.8 years, there was no significant difference in the incidence of cognitive decline or cognitive impairment among participants assigned B-vitamins compared with placebo (24.6% vs 21.7%; risk ratio [RR]: 1.13, 95% confidence interval [CI]: 0.97 to 1.32 ; p=0.1113) and no difference in cognitive decline alone (22.7% vs 20.7%; RR: 1.10, 95% CI: 0.94 to 1.19; p=0.2417). These results were consistent among clinical subgroups. From baseline (at 6 months post-stroke), the MMSE score decreased by a mean of 0.22 (SD 1.82) among participants assigned B-vitamins vs 0.25 (SD 2.08) among participants assigned placebo (p=0.7258).
Conclusion: Daily administration of folic acid, vitamin B6 and vitamin B12 to non-demented patients with previous stroke or TIA for a median of 2.8 years had no significant effect, compared with placebo, on the rate of cognitive decline or incidence of cognitive impairment.
- © 2012 by American Heart Association, Inc.