{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,4]],"date-time":"2026-10-04T07:29:27Z","timestamp":1791098967475,"version":"4.1.0"},"reference-count":35,"publisher":"Ovid Technologies (Wolters Kluwer Health)","issue":"8","content-domain":{"domain":["www.ahajournals.org"],"crossmark-restriction":true},"short-container-title":["Stroke"],"published-print":{"date-parts":[[2013,8]]},"abstract":"<jats:sec>\n            <jats:title>Background and Purpose\u2014<\/jats:title>\n            <jats:p>High plasma total homocysteine (tHcy) has been associated with cognitive impairment but lowering tHcy with B-vitamins has produced equivocal results. We aimed to determine whether B-vitamin supplementation would reduce tHcy and the incidence of new cognitive impairment among individuals with stroke or transient ischemic attack \u22656 months previously.<\/jats:p>\n          <\/jats:sec>\n          <jats:sec>\n            <jats:title>Methods\u2014<\/jats:title>\n            <jats:p>A total of 8164 patients with stroke or transient ischemic attack were randomly allocated to double-blind treatment with one tablet daily of B-vitamins (folic acid, 2 mg; vitamin B6, 25 mg; vitamin B12, 500 \u03bcg) or placebo and followed up for 3.4 years (median) in the VITAmins TO Prevent Stroke (VITATOPS) trial. For this prespecified secondary analysis of VITATOPS, the primary outcome was a new diagnosis of cognitive impairment, defined as a Mini-Mental State Examination (MMSE) score &lt;24 on \u22652 follow-up visits. Secondary outcomes were cognitive decline, and the mean tHcy and MMSE at final follow-up.<\/jats:p>\n          <\/jats:sec>\n          <jats:sec>\n            <jats:title>Results\u2014<\/jats:title>\n            <jats:p>\n              A total of 3089 participants (38%) voluntarily undertook the MMSE &gt;6 months after the qualifying stroke; 2608 participants were cognitively unimpaired (MMSE \u226524), of whom 2214 participants (1110 B-vitamins versus 1104 placebo) had follow-up MMSEs during 2.8 years (median). At final follow-up, allocation to B-vitamins, compared with placebo, was associated with a reduction in mean tHcy (10.2 \u03bcmol\/L versus 14.2 \u03bcmol\/L;\n              <jats:italic>P<\/jats:italic>\n              &lt;0.001) but no change from baseline in the mean MMSE score (\u22120.22 points versus \u22120.25 points; difference, 0.03; 95% confidence interval, \u22120.13 to 0.19;\n              <jats:italic>P<\/jats:italic>\n              =0.726) and no difference in the incidence of cognitive impairment (5.51% versus 5.47%; risk ratio, 1.01; 95% confidence interval, 0.69\u20131.48;\n              <jats:italic>P<\/jats:italic>\n              =0.976), cognitive decline (9.1% versus 10.3%; risk ratio, 0.89; 0.67\u20131.18;\n              <jats:italic>P<\/jats:italic>\n              =0.414), or cognitive impairment or decline (11.0% versus 11.3%; risk ratio, 0.98; 0.75\u20131.27;\n              <jats:italic>P<\/jats:italic>\n              =0.855).\n            <\/jats:p>\n          <\/jats:sec>\n          <jats:sec>\n            <jats:title>Conclusions\u2014<\/jats:title>\n            <jats:p>Daily supplementation with folic acid, vitamin B6, and vitamin B12 to a self-selected clinical trial cohort of cognitively unimpaired patients with previous stroke or transient ischemic attack lowered mean tHcy but had no effect on the incidence of cognitive impairment or cognitive decline, as measured by the MMSE, during a median of 2.8 years.<\/jats:p>\n          <\/jats:sec>\n          <jats:sec>\n            <jats:title>Clinical Trial Registration\u2014<\/jats:title>\n            <jats:p>\n              URL:\n              <jats:ext-link xmlns:xlink=\"http:\/\/www.w3.org\/1999\/xlink\" ext-link-type=\"uri\" xlink:href=\"http:\/\/www.controlled-trials.com\">http:\/\/www.controlled-trials.com<\/jats:ext-link>\n              . Unique identifier: ISRCTN74743444; URL:\n              <jats:ext-link xmlns:xlink=\"http:\/\/www.w3.org\/1999\/xlink\" ext-link-type=\"uri\" xlink:href=\"http:\/\/www.clinicaltrials.gov\">http:\/\/www.clinicaltrials.gov<\/jats:ext-link>\n              . Unique identifier: NCT00097669.\n            <\/jats:p>\n          <\/jats:sec>","DOI":"10.1161\/strokeaha.113.001886","type":"journal-article","created":{"date-parts":[[2013,6,14]],"date-time":"2013-06-14T05:53:43Z","timestamp":1371189223000},"page":"2232-2239","update-policy":"https:\/\/doi.org\/10.1161\/crossmarkpolicy","source":"Crossref","is-referenced-by-count":77,"title":["Effect of B Vitamins and Lowering Homocysteine on Cognitive Impairment in Patients With Previous Stroke or Transient Ischemic Attack"],"prefix":"10.1161","volume":"44","author":[{"given":"Graeme J.","family":"Hankey","sequence":"first","affiliation":[{"name":"From the School of Medicine and Pharmacology, The University of Western Australia, Perth, Western Australia, Australia (G.J.H.) and Stroke Unit, Department of Neurology, Royal Perth Hospital, Perth, Australia (G.J.H.); Department of Clinical Biochemistry, PathWest Laboratory Medicine (F.M.v.B.), Royal Perth Hospital, Perth, Australia; WA Centre for Health and Ageing, Centre for Medical Research and School of Psychiatry and Clinical Neurosciences, University of Western Australia, Perth, Western..."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Andrew H.","family":"Ford","sequence":"additional","affiliation":[{"name":"From the School of Medicine and Pharmacology, The University of Western Australia, Perth, Western Australia, Australia (G.J.H.) and Stroke Unit, Department of Neurology, Royal Perth Hospital, Perth, Australia (G.J.H.); Department of Clinical Biochemistry, PathWest Laboratory Medicine (F.M.v.B.), Royal Perth Hospital, Perth, Australia; WA Centre for Health and Ageing, Centre for Medical Research and School of Psychiatry and Clinical Neurosciences, University of Western Australia, Perth, Western..."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Qilong","family":"Yi","sequence":"additional","affiliation":[{"name":"From the School of Medicine and Pharmacology, The University of Western Australia, Perth, Western Australia, Australia (G.J.H.) and Stroke Unit, Department of Neurology, Royal Perth Hospital, Perth, Australia (G.J.H.); Department of Clinical Biochemistry, PathWest Laboratory Medicine (F.M.v.B.), Royal Perth Hospital, Perth, Australia; WA Centre for Health and Ageing, Centre for Medical Research and School of Psychiatry and Clinical Neurosciences, University of Western Australia, Perth, Western..."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"John W.","family":"Eikelboom","sequence":"additional","affiliation":[{"name":"From the School of Medicine and Pharmacology, The University of Western Australia, Perth, Western Australia, Australia (G.J.H.) and Stroke Unit, Department of Neurology, Royal Perth Hospital, Perth, Australia (G.J.H.); Department of Clinical Biochemistry, PathWest Laboratory Medicine (F.M.v.B.), Royal Perth Hospital, Perth, Australia; WA Centre for Health and Ageing, Centre for Medical Research and School of Psychiatry and Clinical Neurosciences, University of Western Australia, Perth, Western..."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Kennedy R.","family":"Lees","sequence":"additional","affiliation":[{"name":"From the School of Medicine and Pharmacology, The University of Western Australia, Perth, Western Australia, Australia (G.J.H.) and Stroke Unit, Department of Neurology, Royal Perth Hospital, Perth, Australia (G.J.H.); Department of Clinical Biochemistry, PathWest Laboratory Medicine (F.M.v.B.), Royal Perth Hospital, Perth, Australia; WA Centre for Health and Ageing, Centre for Medical Research and School of Psychiatry and Clinical Neurosciences, University of Western Australia, Perth, Western..."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Christopher","family":"Chen","sequence":"additional","affiliation":[{"name":"From the School of Medicine and Pharmacology, The University of Western Australia, Perth, Western Australia, Australia (G.J.H.) and Stroke Unit, Department of Neurology, Royal Perth Hospital, Perth, Australia (G.J.H.); Department of Clinical Biochemistry, PathWest Laboratory Medicine (F.M.v.B.), Royal Perth Hospital, Perth, Australia; WA Centre for Health and Ageing, Centre for Medical Research and School of Psychiatry and Clinical Neurosciences, University of Western Australia, Perth, Western..."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Denis","family":"Xavier","sequence":"additional","affiliation":[{"name":"From the School of Medicine and Pharmacology, The University of Western Australia, Perth, Western Australia, Australia (G.J.H.) and Stroke Unit, Department of Neurology, Royal Perth Hospital, Perth, Australia (G.J.H.); Department of Clinical Biochemistry, PathWest Laboratory Medicine (F.M.v.B.), Royal Perth Hospital, Perth, Australia; WA Centre for Health and Ageing, Centre for Medical Research and School of Psychiatry and Clinical Neurosciences, University of Western Australia, Perth, Western..."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jose C.","family":"Navarro","sequence":"additional","affiliation":[{"name":"From the School of Medicine and Pharmacology, The University of Western Australia, Perth, Western Australia, Australia (G.J.H.) and Stroke Unit, Department of Neurology, Royal Perth Hospital, Perth, Australia (G.J.H.); Department of Clinical Biochemistry, PathWest Laboratory Medicine (F.M.v.B.), Royal Perth Hospital, Perth, Australia; WA Centre for Health and Ageing, Centre for Medical Research and School of Psychiatry and Clinical Neurosciences, University of Western Australia, Perth, Western..."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Udaya K.","family":"Ranawaka","sequence":"additional","affiliation":[{"name":"From the School of Medicine and Pharmacology, The University of Western Australia, Perth, Western Australia, Australia (G.J.H.) and Stroke Unit, Department of Neurology, Royal Perth Hospital, Perth, Australia (G.J.H.); Department of Clinical Biochemistry, PathWest Laboratory Medicine (F.M.v.B.), Royal Perth Hospital, Perth, Australia; WA Centre for Health and Ageing, Centre for Medical Research and School of Psychiatry and Clinical Neurosciences, University of Western Australia, Perth, Western..."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Wasim","family":"Uddin","sequence":"additional","affiliation":[{"name":"From the School of Medicine and Pharmacology, The University of Western Australia, Perth, Western Australia, Australia (G.J.H.) and Stroke Unit, Department of Neurology, Royal Perth Hospital, Perth, Australia (G.J.H.); 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