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Parallel pathways for causation of cognitive impairment involving homocysteine. Raised tHcy may directly cause cognitive impairment (blue arrow). Many modifiable factors determine tHcy [3, 11]. Some of these factors may directly cause cognitive impairment (red arrows) as well as causing cognitive impairment indirectly by raising tHcy (grey arrows). Reverse causality (dashed line) could also explain the association of Hcy with cognitive impairment.
