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Research has shown that alcohol stimulates hepatocytes to release extracellular vesicles containing CD40L in a caspase-3-dependent manner [167], thereby activating macrophages and increasing the production of inflammatory cytokines
[115] This functionality is lost in vitamin B 12 deficiency, resulting in an increased homocysteine level and the trapping of folate as 5-methyl-tetrahydrofolate, from which THF (the active form of folate) cannot be recovered
Most of the studies that show these drugs work look at patients over a period of years
Whilst human studies demonstrating an impact on cognitive decline are still lacking, the current evidence points towards these drugs having a preventative effect, rather than in patients with established cognitive impairment
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