Homocysteine as a potential biochemical marker for depression in elderly stroke survivors

BACKGROUND: Elderly stroke survivors have been reported to be at risk of malnutrition and depression. Vitamin B-related metabolites such as methylmalonic acid and homocysteine have been implicated in depression. OBJECTIVE: We conducted a study exploring the relationship between homocysteine and post-stroke depression. DESIGN: Three methodologies were used: Observational cohort study of elderly Swedish patients (n=149) 1.5 years post-stroke, assessed using Diagnostic and Statistical Manual of Mental Disorders, Montgomery Åsberg Depression Rating Scale and serum blood levels of methylmalonic acid and homocysteine. RESULTS: Homocysteine significantly correlated with depressive symptomatology in stroke survivors (β=0.18*). Individuals with abnormal levels of methylmalonic acid and homocysteine were almost twice more likely to show depressive symptomatology than those with normal levels (depressive symptoms 22%; no depressive symptoms 12%). Comparison of methylmalonic acid and homocysteine levels with literature data showed fewer stroke survivors had vitamin deficiency than did reference individuals (normal range 66%; elevated 34%). CONCLUSIONS: Homocysteine is significantly associated with depressive symptomatology in elderly Swedish stroke survivors.