Sep 222010

Brain Atrophy and B VitaminsBrain atrophy involves the loss of neurons. Some degree of atrophy and subsequent brain shrinkage is common with old age, even in people who are cognitively healthy. However, this atrophy is accelerated in people with mild cognitive impairment and even faster in those who ultimately progress from mild cognitive impairment to Alzheimer’s disease.

Many factors have been implicated in affecting the rate of brain atrophy, one of which is high levels of an amino acid in the blood called homocysteine. Studies have shown that raised levels of homocysteine increase the risk of Alzheimer’s disease. In a recent randomised controlled trial, researchers investigated the role of vitamin B in regulating levels of homocysteine. They specifically wanted to test whether lowering homocysteine through giving high doses of vitamin B for two years could reduce the rate of brain atrophy in people with pre-existing mild cognitive impairment.

Volunteers aged 70 and older with concerns about their memory were recruited for this study. It was specified that volunteers should have a diagnosis of mild cognitive impairment (MCI), defined using specific criteria. These included a concern about memory that did not interfere with activities of daily living and pre-specified scores on some cognitive scales assessing word recall and fluency.

The study excluded people with a diagnosis of dementia, who were taking anti-dementia drugs or who had active cancer. People taking folic acid and vitamin B6 or B12 above certain doses were also excluded.

Every six months, the volunteers were randomly assigned to receive either high-dose oral vitamin B tablets (0.8 mg folic acid, 0.5 mg vitamin B12 and 20 mg vitamin B6) or placebo pills during the two-year period. The participants, their partners and all staff directly involved in the study were unaware which pills participants were taking. The double blind nature of the study was important as it eliminated potential biases associated with the patients’ or researchers’ knowledge of which treatment was being received.

MRI scans were performed at the start of the study and again after two years. The researchers used these scans to calculate the rate of brain atrophy each year. A total of 271 people were randomly assigned a treatment, although five did not start the study. A similar proportion from each treatment group dropped out along the course of the study. The researchers measured adherence to the study treatments by counting returned tablets. For the main analysis of brain shrinkage, the researchers used data on 168 people (85 receiving active treatment and 83 receiving placebo) who had completed an MRI at both the start and at follow-up. The analyses took into account a variety of factors that may be linked to brain atrophy or use of vitamin B, which the researchers had tested and found to be important. These factors were age, blood pressure, initial brain volume and concentration of homocysteine at the start of the study.

Treatment with vitamin B tablets had notable effects on the levels of homocysteine in the blood, reducing it by 22.5 percent. Levels of homocysteine increased by 7.7 percent in the placebo group. Overall, treatment with B vitamins for a period of 24 months led to a reduction in the rate of brain atrophy. After the age of the participants was taken into account, the rate of shrinkage in people receiving the vitamins was 30 percent less than in the placebo group (0.76 percent shrinkage and 1.08 percent shrinkage respectively). The effect was greater in people who were more compliant with taking their medication and in those who started with the highest levels of homocysteine. The researchers also found that, overall, the safety of vitamins was good with no adverse events.

The researchers concluded that they have shown that a “simple and safe treatment” can slow down the accelerated rate of brain atrophy in people with mild cognitive impairment. This is an important but early study in establishing the effects of vitamin B on the stages of brain atrophy that precede Alzheimer’s disease. It assessed the effects of the vitamin on the rate of brain shrinkage, a process that has been linked to old age, mild cognitive impairment and Alzheimer’s disease in other studies. Although other studies have found that the rate of brain atrophy is linked to cognitive decline, this particular study did not assess whether the participants’ brain changes translated into changes of cognitive ability or memory.

This was a well-conducted, albeit small, study. It was a randomized controlled trial, which is the most appropriate way to assess the effects of a new treatment. No study is perfect, though, and the researchers highlighted some shortcomings:

  • The treatment was a combination of three B vitamins, so the researchers could not determine whether these have different effects individually.
  • The study was not set up to assess the effects of treatment on cognition, but only on the rate of change in brain measurements.

This study will pave the way for future research into the use of vitamin B to prevent Alzheimer’s disease. Based on the evidence gathered so far, it is too early to claim that vitamin B can prevent clinical disease, but these results are promising. It is also interesting to note that this is a major study that exemplifies the use of potential biomarkers such as imaging, in therapeutic trials for MCI and AD.

A, Smith SM, de Jager CA et al. Homocysteine-Lowering by B Vitamins Slows the Rate of Accelerated Brain Atrophy in Mild Cognitive Impairment: A Randomized Controlled Trial. PLoS One 5(9): e12244

Michael S. Rafii, M.D., Ph.D.
Associate Medical Director, ADCS Medical Core
This post originally appeared in Alzheimer’s Insights, an ADCS Blog.

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  8 Responses to “Brain Atrophy and B Vitamins”

  1. This is AMAZING news! There is such a strong connection between nutritional/vitamin deficiencies and this disease. And this is a step closer to preventing it from devastating our aging and subsequent populations.

  2. I'd like to note that the researchers did not recommend taking Vitamin B for preventing AD – on the one hand, as stated above, because it is to early to claim it could be useful; on the other hand because the role of B-Vitamins in cancer is still unknown. The doses used were also very high.

  3. Finally, an issue that I am passionate about. I have looked for information of this caliber for the last several hours. Your site is greatly appreciated.

  4. What 3 B vitamins were used in the survey? B6 was one. what was the dosage, 20mg? Was it B12 and what other?

  5. My daughter is 4months old and she was diagnosed with brain vitamin is really effective?please help.tnx

  6. Is Vit B good or bad?

  7. Hello, I immediately recognized the signs the character Dina was having. About five years ago, my mother’s health started declining. She had two sisters, one was in a nursing home and the oldest sister still at home being cared for by her son. Her middle sister first went through it. After her husband died, she started seeing things, saying strange things. Her family tried taking care if her, but eventually put her in a nursing home. I would often take my mom and her sister to see her. Everytime, we saw her change. Sometimes she was aggressive, paranoid, and not herself. She and her older sister were pianist. She still loved to play for awhile until she couldn’t anymore. She died a couple years ago. Her oldest sister too went through the same kind if journey and now is in a memory Care unit. I retired early from my teaching job and now have my mom live with me. At first my two younger brothers couldn’t face their mother having this disease. My mom retired and cared for a friend’s mom, then her friend, and finally my father before he died. And now, I live caring for my mom. I sometimes feel like the parent. Mom has difficulty with so many things. She still at the moment dresses herself (although I have to often remind her to wear a different outfit because she tends to pick the same outfit she may have worn the day before though she has plenty of clothes.). She likes familiar and doesn’t like leaving home much. Not like my mom who loved doing and going places. I find sometimes I’m frustrated and lose my patience, but I don’t mean to, but sometimes it’s really hard. My middle brother got angry with me when I told him mother had dementia (now I know it’s more, her doctor confirmed Alzheimer’s). He said it was the same as calling mother stupid. And, I told him, no. It’s a disease, a condition. Mother is still our mother and she’s dealing and understands that she can’t help it. But, I’ll be with her to help het. Recently, j saw my own doctor to test me. Because I’m concerned that I too may get it. I passed the oral test. And last week had an MRI so that my doctor has a starting point from now. So if later I start having issues, then there’s a record of me, when I was still me. Thank you for sharing this valuable life story of so many.

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