Higuchi Masaya, Chen Randi, Abbott Robert D, Bell Christina, Launer Lenore, Ross G Webster, Petrovitch Helen, Masaki Kamal
*Department of Geriatric Medicine, The John A. Hartford Foundation Center of Excellence in Geriatrics, John A. Burns School of Medicine, University of Hawaii ‡Kuakini Medical Center ¶Veterans Affairs Pacific Islands Health Care System, Honolulu, HI †Department of Family and Community Medicine, Southern Illinois University School of Medicine, Springfield, IL §Center for Epidemiologic Research in Asia, Shiga University of Medical Science, Otsu-shi, Shiga-ken, Japan ∥National Institute on Aging, Bethesda, MD.
Alzheimer Dis Assoc Disord. 2015 Jul-Sep;29(3):200-5. doi: 10.1097/WAD.0000000000000082.
Impaired renal function has been linked to cognitive impairment. We assessed mid-life proteinuria and late-life cognitive function in elderly Asian men.
The Honolulu Heart Program is a prospective study that began in 1965 with 8006 Japanese-American men aged 45 to 68 years. Mid-life proteinuria was detected by urine dipstick in 1971 to 1974. The Honolulu-Asia Aging Study began 20 years later, with cognitive assessment by the Cognitive Abilities Screening Instrument (CASI) in 3734 men. Standard criteria were used to classify 8-year incident dementia and subtypes.
The age-adjusted incidence of dementia increased significantly from 13.8, to 22.8, to 39.7 per 1000 person years follow-up, among those with no, trace, and positive mid-life proteinuria (P=0.004). Using linear regression adjusting for age, education, APOEε4, stroke, hypertension, systolic blood pressure, diabetes, fasting blood glucose, physical activity, and baseline CASI, those with positive proteinuria had significantly higher annual change in CASI over 8 years follow-up (-1.24, P=0.02) (reference=no proteinuria). Multivariate Cox regression found that positive proteinuria had a significant association with incident all-cause dementia (RR=2.66; 95%CI, 1.09-6.53; P=0.03), but no significant associations with incident Alzheimer disease or vascular dementia.
Mid-life proteinuria was an independent predictor for late-life incident all-cause dementia and cognitive decline over 8 years.
肾功能受损与认知障碍有关。我们评估了亚洲老年男性中年期蛋白尿与晚年认知功能之间的关系。
檀香山心脏项目是一项前瞻性研究，始于1965年，研究对象为8006名年龄在45至68岁之间的日裔美国男性。1971年至1974年通过尿试纸检测中年期蛋白尿。20年后开展了檀香山-亚洲老龄化研究，对3734名男性使用认知能力筛查工具（CASI）进行认知评估。采用标准标准对8年新发痴呆及其亚型进行分类。
在无、微量和阳性中年期蛋白尿的人群中，年龄调整后的痴呆发病率从每1000人年随访13.8例显著增加至22.8例，再到39.7例（P=0.004）。在对年龄、教育程度、APOEε4、中风、高血压、收缩压、糖尿病、空腹血糖、身体活动和基线CASI进行线性回归调整后，蛋白尿阳性者在8年随访期间的CASI年度变化显著更高（-1.24，P=0.02）（参考=无蛋白尿）。多变量Cox回归发现，蛋白尿阳性与全因性痴呆的发生有显著关联（RR=2.66；95%CI，1.09-6.53；P=0.03），但与阿尔茨海默病或血管性痴呆的发生无显著关联。
中年期蛋白尿是晚年全因性痴呆发生和8年认知衰退的独立预测因素。
