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Research Article

Homocysteine-Lowering by B Vitamins Slows the Rate of Accelerated Brain Atrophy in Mild Cognitive Impairment: A Randomized Controlled Trial

  • A. David Smith equal contributor mail,

    equal contributor Contributed equally to this work with: A. David Smith, Helga Refsum

    david.smith@pharm.ox.ac.uk

    Affiliations: Oxford Project to Investigate Memory and Ageing (OPTIMA), University of Oxford, Oxford, United Kingdom, University Department of Pharmacology and Department of Physiology, Anatomy & Genetics, University of Oxford, Oxford, United Kingdom

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  • Stephen M. Smith,

    Affiliation: Department of Clinical Neurology, Oxford Centre for Functional Magnetic Resonance Imaging of the Brain, University of Oxford, Oxford, United Kingdom

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  • Celeste A. de Jager,

    Affiliation: Oxford Project to Investigate Memory and Ageing (OPTIMA), University of Oxford, Oxford, United Kingdom

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  • Philippa Whitbread,

    Affiliation: Oxford Project to Investigate Memory and Ageing (OPTIMA), University of Oxford, Oxford, United Kingdom

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  • Carole Johnston,

    Affiliations: Oxford Project to Investigate Memory and Ageing (OPTIMA), University of Oxford, Oxford, United Kingdom, University Department of Pharmacology and Department of Physiology, Anatomy & Genetics, University of Oxford, Oxford, United Kingdom

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  • Grzegorz Agacinski,

    Affiliation: Oxford Project to Investigate Memory and Ageing (OPTIMA), University of Oxford, Oxford, United Kingdom

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  • Abderrahim Oulhaj,

    Affiliation: Oxford Project to Investigate Memory and Ageing (OPTIMA), University of Oxford, Oxford, United Kingdom

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  • Kevin M. Bradley,

    Affiliation: Department of Radiology and Nuclear Medicine, Oxford Radcliffe Hospitals NHS Trust, Oxford, United Kingdom

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  • Robin Jacoby,

    Affiliation: University Department of Psychiatry, University of Oxford, Oxford, United Kingdom

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  • Helga Refsum equal contributor

    equal contributor Contributed equally to this work with: A. David Smith, Helga Refsum

    Affiliations: Oxford Project to Investigate Memory and Ageing (OPTIMA), University of Oxford, Oxford, United Kingdom, University Department of Pharmacology and Department of Physiology, Anatomy & Genetics, University of Oxford, Oxford, United Kingdom, Department of Nutrition, Institute of Basic Medical Sciences, University of Oslo, Oslo, Norway

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  • Published: September 08, 2010
  • DOI: 10.1371/journal.pone.0012244

Reader Comments (3)

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Doubts about clinical relevance, measuring technique

Posted by euthman on 10 Sep 2010 at 13:42 GMT

First of all, most radiologists don't even mention brain atrophy in MRI reports, because there is little or no correlation between apparent atrophy and brain function. Reporting it only causes the patients and their doctors problems when they or a potential insurer reads it. Second, using MRI for quantitative assessment of brain atrophy has "not reached the mainstream" of radiology (according to our hospital radiologist, who is recently out of training, therefore probably up to date on the latest). Third, I am very skeptical that a sampling technique such as MRI can measure volume changes at the levels of precision they are reporting here (1% and less). Where is there validation of this technique against actual brain weights at autopsy? Fourth, the scatter plots showing results are far, far from convincing. If there is any protective effect vis-a-vis placebo, there is much more variation within each group (treated and placebo) than between the two groups.

Fifth (and IMO the biggest problem), they tested a proprietary combination vitamin product which allegedly contains folate, B6, and B12. They did not mention that the products were independently assayed for composition. (In the United States nutritional supplements do not fall under the FDA regulatory umbrella.)

No competing interests declared.