Center for Emotional and Behavioral Disorders, National Hospital Organization Hizen Psychiatric Center, Kanzaki, Saga, Japan.
Hypertens Res. 2011 Sep;34(9):1023-8. doi: 10.1038/hr.2011.83. Epub 2011 Jun 23.
Although recent studies have found that chronic kidney disease (CKD) is an independent risk factor for cognitive impairment in population-based cohorts, the mechanisms of cognitive impairment in subjects with CKD are unclear. We examined 503 elderly subjects (mean age: 72.4 years), who were living independently at home without apparent dementia, using MRI. The subject was judged as having frontal lobe dysfunction if the scores on the modified Stroop test were higher than the fifth quintile for each given decade. Serum creatinine values, measured by the enzymatic method, were used for the Japanese equation of estimated glomerular filtration rate (eGFR). Subjects in the frontal lobe dysfunction group tended to have higher blood pressure, lower eGFR and more lacunar infarcts, and were less educated. When possible confounders were entered into the multivariate logistic regression model, the independent predictors of frontal lobe dysfunction were eGFR (odds ratio 0.854; 95% confidence interval (CI) 0.743-0.983 per 10 ml min(-1) per 1.73 m(2)) and the number of lacunar infarction (odds ratio 1.460; 95% CI 1.127-1.892). The mean of the logarithmically transformed Stroop test scores in the eGFR<60 ml min(-1) per 1.73 m(2) group was 1.376 (95% CI 1.301-1.451), which was significantly higher than that (1.250) for the eGFR 60-89 ml min(-1) per 1.73 m(2) group (95% CI 1.215-1.285) (P=0.009) and tended to be higher than that (1.264) for the eGFR ≥90 ml min(-1) per 1.73 m(2) group (95% CI 1.188-1.340) (analysis of covariance, adjusted for age). The present study showed that CKD and subclinical lacunar infarction independently contributed to frontal lobe dysfunction in healthy elderly subjects.
尽管最近的研究发现慢性肾脏病（CKD）是人群中认知障碍的独立危险因素，但 CKD 患者认知障碍的机制尚不清楚。我们使用 MRI 检查了 503 名年龄在 72.4 岁的独立居住在家且无明显痴呆的老年人。如果改良 Stroop 测试的分数高于每个给定十年的第五个五分位数，则判断受试者存在额叶功能障碍。使用酶法测量血清肌酐值，用于估计肾小球滤过率（eGFR）的日本方程。额叶功能障碍组的受试者往往血压较高、eGFR 较低、腔隙性梗死较多，且受教育程度较低。当将可能的混杂因素纳入多变量逻辑回归模型时，额叶功能障碍的独立预测因子是 eGFR（比值比 0.854；95%置信区间（CI）每 10ml·min(-1)·1.73m(-2)降低 0.743-0.983）和腔隙性梗死的数量（比值比 1.460；95%CI 1.127-1.892）。eGFR<60ml·min(-1)·1.73m(-2)组中对数转换的 Stroop 测试评分的平均值为 1.376（95%CI 1.301-1.451），明显高于 eGFR 60-89ml·min(-1)·1.73m(-2)组（95%CI 1.215-1.285）（P=0.009），并且倾向于高于 eGFR≥90ml·min(-1)·1.73m(-2)组（95%CI 1.188-1.340）（协方差分析，调整年龄）。本研究表明，CKD 和亚临床腔隙性梗死独立导致健康老年人的额叶功能障碍。
