Article

Chronic kidney disease is associated with incident cognitive impairment in the elderly: the INVADE study.

Department of Psychiatry and Psychotherapy, Technische Universität München, Munich, Germany.
Nephrology Dialysis Transplantation (Impact Factor: 3.49). 05/2009; 24(10):3144-50. DOI: 10.1093/ndt/gfp230
Source: PubMed

ABSTRACT Limited data exist regarding the relationship between decreased renal function and cognitive impairment.
A total of 3679 participants of the Intervention Project on Cerebrovascular Diseases and Dementia in the Community of Ebersberg (INVADE) composed the community-based cohort study. Measures of renal function were estimated using the Cockcroft-Gault equation and divided into normal, mild and moderate-to-severe impaired renal function (creatinine clearance >or=60, 45-59 and <45 mL/min/1.73 m(2), respectively). The main outcome measures were cognitive impairment at baseline and new cognitive impairment after a 2-year follow-up. Cognitive function was measured using the 6-Item Cognitive Impairment Test (6CIT). Multiple logistic regression analysis was used to assess the association between renal function and cognitive impairment.
At baseline, 396 participants (10.8%) had cognitive impairment. After the 2-year follow-up, 194 participants (6.2%) developed new cognitive impairment. The incidence of cognitive impairment across the groups with normal renal function, mild and moderate-to-severe kidney disease at baseline were 5.8, 9.9 and 21.5%, respectively. Multiple logistic regression analysis after adjustment for possible confounders including traditional cardiovascular risk factors showed a significant association for participants with moderate-to-severe kidney disease at baseline to develop new cognitive impairment after the 2-year follow-up [odds ratio: 2.14 (95% confidence interval: 1.18-3.87), P = 0.01].
In summary, moderate-to-severe impaired renal function is associated with incident cognitive impairment after 2 years in a large cohort of elderly subjects.

Download full-text

Full-text

Available from: Dirk Sander, Jul 05, 2015
0 Followers
 · 
123 Views
  • [Show abstract] [Hide abstract]
    ABSTRACT: Early stage chronic kidney disease has been related to cognitive decline recently, while the association between them has never been explored in a Chinese population. This prospective study included a 1,351 community-based Chinese population >40 years and with estimated glomerular filtration rate (eGFR) >30 ml/min/ 1.73 m(2). Kidney function was assessed by eGFR at baseline; cognitive function was evaluated by Mini-Mental State Examination (MMSE) both at baseline and 4 years later, and MMSE score decreased < or =2 was defined as cognitive decline using analysis of Reliable Change Indices. There were 1,243 participants (92.0%) with valid data of MMSE at the second visit. Altogether there were 66 (5.3%) incident cognitive decline cases during 4 years of follow-up. After adjusting for potential confounders including urinary albumin-to-creatinine ratio, the odds ratio of developing cognitive decline was 1.35 (95% CI 0.69-2.65) among participants with eGFR 60-89 ml/min/1.73 m(2) and was 2.73 (95% CI 1.00-7.56) among participants with eGFR 30-59 ml/min/1.73 m(2), compared to those with eGFR > or =90 ml/min/1.73 m(2). Our prospective study suggests that kidney function is associated with a cognitive decline in a Chinese population and the relation is independent of urinary albumin excretion.
    American Journal of Nephrology 01/2010; 32(2):117-21. DOI:10.1159/000315618 · 2.65 Impact Factor
  • [Show abstract] [Hide abstract]
    ABSTRACT: Data regarding the relationship between physical activity and cognitive impairment are limited and controversial. We examined whether physical activity is associated with incident cognitive impairment during follow-up. As part of a community-based prospective cohort study in southern Bavaria, Germany, 3903 participants older than 55 years were enrolled between 2001 and 2003 and followed up for 2 years. Physical activity (classified as no activity, moderate activity [<3 times/wk], and high activity [> or =3 times/wk]), cognitive function (assessed by the 6-Item Cognitive Impairment Test), and potential confounders were evaluated. The main outcome measure was incident cognitive impairment after 2 years of follow-up. At baseline, 418 participants (10.7%) had cognitive impairment. After a 2-year follow-up, 207 of 3485 initially unimpaired subjects (5.9%) developed incident cognitive impairment. Compared with participants without physical activity, fully adjusted multiple logistic regression analysis showed a significantly reduced risk of incident cognitive impairment after 2 years for participants with moderate or high physical activity at baseline (odds ratio [OR], 0.57; 95% confidence interval [CI], 0.37-0.87 [P = .01]; and OR, 0.54; 95% CI, 0.35-0.83 [P = .005]; respectively). Further subanalysis including participants (n = 2029) without functional impairment and without prodromal phase of dementia resulted in an even higher reduction of risk of incident cognitive impairment for participants with moderate or high physical activity (OR, 0.44; 95% CI, 0.24-0.83 [P = .01]; and OR, 0.46; 95% CI, 0.25-0.85 [P = .01]; respectively) compared with no activity. Moderate or high physical activity is associated with a reduced incidence of cognitive impairment after 2 years in a large population-based cohort of elderly subjects.
    Archives of internal medicine 01/2010; 170(2):186-93. DOI:10.1001/archinternmed.2009.498 · 13.25 Impact Factor
  • Source
    [Show abstract] [Hide abstract]
    ABSTRACT: Chronic kidney disease is a risk factor for cognitive impairment. Albuminuria is an early manifestation of chronic kidney disease and a marker of endothelial dysfunction and vascular risk. Results of prior studies of albuminuria and cognitive function are contradictory. The authors studied 1,345 community-dwelling women and men in southern California (mean age, 75 years) at a 1992-1996 research clinic visit, when urine albumin/creatinine ratio (ACR) was measured in spot morning urine and cognitive function was evaluated by using the Mini-Mental State Examination Trail-Making Test B, and category fluency test. An ACR of > or =30 mg/g was found in 17% of women and 15% of men in 1992-1996. Analysis of covariance was used to compare cognitive function score by categorical ACR. Between 1999 and 2002, 759 participants returned for repeat cognitive function testing. For men, but not women, baseline albuminuria, but not estimated glomerular filtration rate, was associated with reduced cognitive function at follow-up on all tests (P's < 0.05). An ACR of > or =30 mg/g was associated with greater annual decline in Mini-Mental State Examination and category fluency scores. Albuminuria may be an easily measured marker predicting future cognitive function decline. Results imply a common underlying mechanism affecting the renal and cerebral microvasculature.
    American journal of epidemiology 02/2010; 171(3):277-86. DOI:10.1093/aje/kwp426 · 4.98 Impact Factor