Yao Hiroshi, Araki Yuko, Takashima Yuki, Uchino Akira, Yuzuriha Takefumi, Hashimoto Manabu
Center for Emotional and Behavioral Disorders, National Hospital Organization Hizen Psychiatric Center, Kanzaki, Saga, Japan.
Graduate School of Integrated Science and Technology, Shizuoka University, Hamamatsu, Japan.
J Stroke Cerebrovasc Dis. 2017 Feb;26(2):420-424. doi: 10.1016/j.jstrokecerebrovasdis.2016.10.002. Epub 2016 Oct 27.
The purpose of this study was to determine the complex associations among chronic kidney disease (CKD), subclinical brain infarction (SBI), and cognitive impairment.
We used structural equation modeling (SEM) to examine the complex relationships among CKD, SBI, and cognitive function with Mini-Mental State Examination (MMSE; global function) and modified Stroop test (executive function) in a population-based cohort of 560 non-demented elderly subjects.
Path analysis based on SEM revealed that the direct paths from estimated glomerular filtration rate (eGFR) to SBI and from SBI to executive function were significant (β = -.10, P = .027, and β = .16, P < .001, respectively). Furthermore, the direct path from eGFR to executive function was also significant (β = -.12, P = .006), indicating that the effects of CKD on executive function are independent of SBI. The direct paths from age and education to global cognitive function were highly significant (β = -.17 and .22, respectively, P < .001), whereas the direct path from eGFR to MMSE was not significant.
Our findings indicate that CKD confers a risk of vascular cognitive impairment or executive dysfunction through mechanisms dependent and independent of SBI. Treating CKD may be a potential strategy to protect against vascular cognitive impairment or executive dysfunction in healthy elderly subjects.
本研究旨在确定慢性肾脏病（CKD）、亚临床脑梗死（SBI）和认知障碍之间的复杂关联。
我们采用结构方程模型（SEM），在一个基于人群的队列中，对560名非痴呆老年受试者进行研究，以检验CKD、SBI和认知功能之间的复杂关系，其中认知功能采用简易精神状态检查表（MMSE；整体功能）和改良斯特鲁普测验（执行功能）进行评估。
基于SEM的路径分析显示，从估计肾小球滤过率（eGFR）到SBI以及从SBI到执行功能的直接路径具有显著性（β分别为−0.10，P = 0.027；β为0.16，P < 0.001）。此外，从eGFR到执行功能的直接路径也具有显著性（β = −0.12，P = 0.006），这表明CKD对执行功能的影响独立于SBI。年龄和教育程度到整体认知功能的直接路径具有高度显著性（β分别为−0.17和0.22，P < 0.001），而从eGFR到MMSE的直接路径不具有显著性。
我们的研究结果表明，CKD通过依赖和独立于SBI的机制，带来血管性认知障碍或执行功能障碍的风险。治疗CKD可能是预防健康老年受试者血管性认知障碍或执行功能障碍的一种潜在策略。
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