肾功能与老年人认知能力下降的速度相关。
Kidney function is associated with the rate of cognitive decline in the elderly.
作者信息
Buchman Aron S, Tanne D, Boyle P A, Shah R C, Leurgans S E, Bennett D A
机构信息
Rush Alzheimer's Disease Center, Rush University Medical Center, Chicago, IL 60612, USA.
出版信息
Neurology. 2009 Sep 22;73(12):920-7. doi: 10.1212/WNL.0b013e3181b72629. Epub 2009 Aug 5.
OBJECTIVE
We tested the hypothesis that impaired kidney function in the elderly is associated with a more rapid rate of cognitive decline.
METHODS
Baseline serum was used to calculate estimated glomerular filtration rate (eGFR), using the Modification of Diet in Renal Disease formula, for 886 elderly without dementia participating in the Rush Memory and Aging Project, a prospective, observational cohort study. Kidney function was also dichotomized into impairment or no impairment based on eGFR < or >or=60 mL/min/1.73 m(2). Structured cognitive testing was performed at baseline and at annual evaluations, using a battery of 19 cognitive tests summarized into global cognition and 5 cognitive domains.
RESULTS
In mixed-effects models adjusted for age, sex, and education, a lower eGFR at baseline was associated with a more rapid rate of cognitive decline (estimate 0.0008, SE <0.001, p = 0.017). The increased rate of cognitive decline associated with a 15-mL/min/1.73 m(2) lower eGFR at baseline (approximately 1 SD) was similar to the effect of being 3 years older at baseline. Impaired kidney function at baseline was associated with a more rapid rate of cognitive decline (estimate -0.028, SE <0.009, p = 0.003). The increased rate of cognitive decline associated with impaired kidney function at baseline was approximately 75% the effect of ApoE4 allele on the rate of cognitive decline. Baseline kidney function was associated with declines in semantic memory, episodic memory, and working memory but not visuospatial abilities or perceptual speed.
CONCLUSION
Impaired kidney function is associated with a more rapid rate of cognitive decline in old age.
目的
我们检验了这样一个假设，即老年人肾功能受损与认知能力下降速度加快有关。
方法
在一项前瞻性观察队列研究——拉什记忆与衰老项目中，对886名无痴呆症的老年人，使用肾病饮食改良公式，通过基线血清计算估计肾小球滤过率（eGFR）。根据eGFR<或≥60 mL/分钟/1.73 m²，肾功能也被分为受损或未受损两类。在基线和年度评估时进行结构化认知测试，使用一组19项认知测试，这些测试汇总为整体认知和5个认知领域。
结果
在对年龄、性别和教育程度进行调整的混合效应模型中，基线时较低的eGFR与认知能力下降速度加快有关（估计值为0.0008，标准误<0.001，p = = 0.017）。基线时eGFR降低15 mL/分钟/1.73 m²（约1个标准差）所导致的认知能力下降速度加快，与基线时年龄大3岁的影响相似。基线时肾功能受损与认知能力下降速度加快有关（估计值为-0.028，标准误<0.009，p = 0.003）。基线时肾功能受损导致的认知能力下降速度加快，约为载脂蛋白E4等位基因对认知能力下降速度影响的75%。基线肾功能与语义记忆、情景记忆和工作记忆的下降有关，但与视觉空间能力或感知速度无关。
结论
肾功能受损与老年人认知能力下降速度加快有关。
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