Wei Yudan, Wei Yinan Kevin, Zhu Jianmin
Department of Community Medicine, Mercer University School of Medicine, Macon, GA, USA.
Medical College of Georgia, Augusta University, Augusta, GA, USA.
J Neurol Sci. 2017 Apr 15;375:209-214. doi: 10.1016/j.jns.2017.01.071. Epub 2017 Jan 31.
Age-related decline in kidney function can be an important risk factor for cognitive impairment in older adults. In this study, we examined several kidney function measures for the association with cognitive function in older adults in hope to identify early and sensitive markers that can be used for the detection or screening for cognitive impairment.
A total of 1982 older participants (aged ≥60years) in the 1999-2002 National Health and Nutrition Examination Survey was analyzed for the association between kidney function and cognitive impairment using multivariate logistic regression and general linear models. Cognitive functioning was assessed during the household interview using a version of the Digit Symbol Substitution Test of the Wechsler Adult Intelligence Scale III. In our study, participants with a score of <31, the 25th percentiles of the distribution, or who were unable to complete the sample exercise due to cognitive limitations were classified as having cognitive impairment.
Of 1982 older adults, 503 were having cognitive impairment (weighted prevalence, 15.38%). Among the kidney function measures that we examined, the levels of serum cystatin C and urinary albumin were found being significantly associated with cognitive impairment after adjusting for age, sex, race/ethnicity, poverty status, education, physical activity, BMI, cigarette smoking, and alcohol consumption. Cognitive functioning scores were significantly decreasing with increasing levels of kidney dysfunction markers.
Serum cystatin C and urinary albumin that are early markers of chronic kidney disease might serve as early and effective markers for cognitive decline in older adults. Mechanisms underlying the observed association need to be further characterized.
肾功能的年龄相关性下降可能是老年人认知障碍的重要危险因素。在本研究中，我们检测了多项肾功能指标与老年人认知功能的关联，以期识别可用于认知障碍检测或筛查的早期敏感标志物。
利用多因素逻辑回归和一般线性模型，分析了1999 - 2002年国家健康与营养检查调查中1982名年龄≥60岁的老年参与者的肾功能与认知障碍之间的关联。在入户访谈期间，使用韦氏成人智力量表III的数字符号替换测验版本评估认知功能。在我们的研究中，得分低于分布第25百分位数（即<31分）或因认知受限无法完成样本练习的参与者被归类为患有认知障碍。
在1982名老年人中，503人患有认知障碍（加权患病率为15.38%）。在我们检测的肾功能指标中，校正年龄、性别、种族/民族、贫困状况、教育程度、身体活动、体重指数、吸烟和饮酒后，发现血清胱抑素C水平和尿白蛋白与认知障碍显著相关。随着肾功能障碍标志物水平的升高，认知功能得分显著下降。
作为慢性肾病早期标志物的血清胱抑素C和尿白蛋白可能是老年人认知衰退的早期有效标志物。所观察到的关联背后的机制需要进一步明确。
