Just like a river that carries debris downstream, a certain compound called homocysteine can impact our thinking abilities. Scientists set out to investigate the relationship between homocysteine levels, small vessel disease in the brain, and cognitive function. They examined over 1,000 individuals and measured homocysteine levels in their blood, assessed small vessel disease using brain scans, and conducted cognitive assessments. The results showed that higher homocysteine levels were associated with both cognitive impairment and an increased burden of small vessel disease. Interestingly, the researchers discovered that part of the connection between homocysteine and cognitive impairment could be attributed to different imaging markers of small vessel disease. This suggests that small vessel disease acts as a mediator in this relationship. By understanding how homocysteine impacts our brain health through small vessel disease, we can develop strategies to prevent cognitive decline. To learn more about this fascinating research and its implications, check out the full article!

ObjectiveTo investigate the relations of serum total homocysteine (tHcy) with cerebral small vessel disease (CSVD) and cognitive function and evaluate whether CSVD mediates the effect of serum tHcy on cognitive function.MethodsA total of 1,033 consecutive eligible participants who received serum tHcy, brain magnetic resonance imaging (MRI), and neuropsychological assessment were included in this retrospective study. White matter hyperintensity, lacune, cerebral microbleed, and enlarged perivascular space were evaluated based on brain MRI. We used multivariate binary logistic regression analysis, multivariate ordinal logistic regression analysis, and mediation analyses to assess the relations of serum tHcy with CSVD and cognitive function.ResultsSerum tHcy levels were higher in patients with cognitive impairment than those with no cognitive impairment. Logistic regression analyses showed elevated serum tHcy was associated with cognitive impairment [odds ratio (OR): 10.475; 95% confidence interval (CI): 4.522 to 24.264; p < 0.001] and a higher CSVD burden score (OR: 17.151; 95% CI: 8.785 to 33.921; p < 0.001) after adjusting potential confounders. Compared with the lowest tHcy quartile, the multivariable-adjusted OR of the highest quartile was 4.851 (95% CI: 3.152 to 7.466; p for the trend < 0.001) for cognitive impairment, 3.862 (95% CI: 2.467 to 6.047; p for the trend < 0.001) for a severe CSVD burden score. Mediation analyses showed significant moderating effects (9.3–23.6%) by different imaging markers of CSVD on the association between higher serum tHcy levels and cognitive impairment.ConclusionElevated serum tHcy is associated with cognitive impairment and the development of CSVD. A proportion of the association between elevated serum tHcy and cognitive impairment may be attributed to the presence of different imaging markers of CSVD, especially the severe CSVD burden score.

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