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. 2025 Aug;106(3):920-924.
doi: 10.1177/13872877251350297. Epub 2025 Jun 23.

Concerning the debate about homocysteine, B vitamins, and dementia

Joshua W Miller  1 , Andrew McCaddon  2 , Jin-Tai Yu  3 , Babak Hooshmand  4 , Helga Refsum  5 , A David Smith  6
Affiliations

Concerning the debate about homocysteine, B vitamins, and dementia

Joshua W Miller et al. J Alzheimers Dis. 2025 Aug.

Abstract

It is important to identify modifiable risk factors for dementia and to introduce policies to implement their modification. The Lancet Commission on Dementia Prevention, Intervention and Care failed to identify raised plasma homocysteine as a risk factor, despite considerable evidence; hence there is a need for a debate on this matter.

Keywords: Alzheimer's disease; B12; B6; dementia; folate; homocysteine; risk factor.

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Conflict of interest statement

Declaration of conflicting interestsThe author(s) declared the following potential conflicts of interest with respect to the research, authorship, and/or publication of this article: JWM is a member of the American Society for Nutrition and is a member of the Alzheimer's Prevention Expert Group of the Food for the Brain Foundation. AMcC is a member of the American Society for Nutrition and is a member of the Alzheimer's Prevention Expert Group of the Food for the Brain Foundation. BH has received speaker honoraria from the American Academy of Neurology and Warwar pharma. HR is named as an inventor on a patent held by University of Oxford concerning the use of B vitamins in the prevention of brain atrophy in mild cognitive impairment. ADS is named as an inventor on a patent held by University of Oxford concerning the use of B vitamins in the prevention of brain atrophy in mild cognitive impairment; he is a member of the Scientific Advisory Boards of Food for the Brain Foundation and Elysium Health and a member of the Alzheimer's Prevention Expert Group of the Food for the Brain Foundation.

References

    1. Smith AD, Refsum H, Bottiglieri T, et al. Homocysteine and dementia: an international consensus statement. J Alzheimers Dis 2018; 62: 561–570. - PMC - PubMed
    1. Livingston G, Huntley J, Liu KY, et al. Dementia prevention, intervention, and care: 2024 report of the Lancet standing Commission. Lancet 2024; 404: 572–628. - PubMed
    1. Miller JW, McCaddon A, Hooshmand B, et al. The Lancet ‘Omission': Why are homocysteine and B vitamins missing from the Lancet Commission's Report on Dementia Prevention, Intervention and Care? https://foodforthebrainorg/lancet-commission-letters/ (2024).
    1. Livingston G, Costafreda SG, Kivimaki M, et al. B vitamins and the 2024 Lancet Commission on dementia. Lancet 2025; 405: 623. - PubMed
    1. Smith AD, 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 2010; 5: e12244. - PMC - PubMed

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