ROLE OF HYPERHOMOCYSTEINEMIA IN THE PATHOGENESIS AND CLINICAL COURSE OF CHRONIC CEREBRAL ISCHEMIA

Abstract

Objective. To assess the relationship between plasma homocysteine levels and clinical-neurological, cognitive, neuroimaging, and hemodynamic parameters in patients with chronic cerebral ischemia (CCI).

Materials and Methods. A prospective comparative study was conducted on 60 patients with CCI stages I–III. Cognitive status was evaluated using the MoCA and FAB scales. Brachiocephalic arteries were assessed by Doppler ultrasound, brain MRI was performed with Fazekas scale scoring, and plasma homocysteine levels were measured. Results. Homocysteine levels increased significantly with the severity of CCI (p<0.001). Elevated hyperhomocysteinemia was associated with decreased MoCA and FAB scores, thickening of the carotid artery intima–media complex, increased frequency of ≥50% stenosis, and a higher number of leukoaraiosis and lacunar infarcts on MRI (p<0.001). Homocysteine levels correlated negatively with MoCA scores (r=–0.52) and positively with Fazekas scale scores (r=+0.57). Conclusion. Hyperhomocysteinemia may serve as an independent biomarker of chronic cerebral ischemia progression and severity of cognitive impairment.