Cerebral small vessel disease mediates the association between homocysteine and cognitive function

Objective: To 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. Methods: A total of 1033 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. Results: Serum tHcy levels were higher in patients with cognitive impairment than those with no cognitive impairment (median 17.5 vs 13.7 umol/L; P