Turku PET Centre, University of Turku, c/o Turku University Hospital, Turku, Finland.
Turku City Hospital, University of Turku, Turku, Finland.
J Alzheimers Dis. 2018;62(2):635-648. doi: 10.3233/JAD-170972.
Microalbuminuria, defined as urine albumin-to-creatinine ratio (UACR)>3.0 mg/mmol and ≤ 30 mg/mmol, is an early marker of endothelial damage of the renal glomeruli. Recent research suggests an association among microalbuminuria, albuminuria (UACR > 3.0 mg/mmol), and cognitive impairment. Previous studies on microalbuminuria, albuminuria, and cognition in the middle-aged have not provided repeated cognitive testing at different time-points. We hypothesized that albuminuria (micro- plus macroalbuminuria) and microalbuminuria would predict cognitive decline independently of previously reported risk factors for cognitive decline, including cardiovascular risk factors. In addition, we hypothesized that UACR levels even below the cut-off for microalbuminuria might be associated with cognitive functioning. These hypotheses were tested in the Finnish nationwide, population-based Health 2000 Survey (n = 5,921, mean age 52.6, 55.0% women), and its follow-up, Health 2011 (n = 3,687, mean age at baseline 49.3, 55.6% women). Linear regression analysis was used to determine the associations between measures of albuminuria and cognitive performance. Cognitive functions were assessed with verbal fluency, word-list learning, word-list delayed recall (at baseline and at follow-up), and with simple and visual choice reaction time tests (at baseline only). Here, we show that micro- plus macroalbuminuria associated with poorer word-list learning and a slower reaction time at baseline, with poorer word-list learning at follow-up, and with a steeper decline in word-list learning during 11 years after multivariate adjustments. Also, higher continuous UACR consistently associated with poorer verbal fluency at levels below microalbuminuria. These results suggest that UACR might have value in evaluating the risk for cognitive decline.
微量白蛋白尿，定义为尿白蛋白与肌酐比值（UACR）＞3.0mg/mmol 且≤30mg/mmol，是肾脏肾小球内皮损伤的早期标志物。最近的研究表明，微量白蛋白尿、白蛋白尿（UACR＞3.0mg/mmol）和认知障碍之间存在关联。以前关于中年人的微量白蛋白尿、白蛋白尿和认知的研究没有在不同时间点提供重复的认知测试。我们假设白蛋白尿（微量白蛋白尿加大量白蛋白尿）和微量白蛋白尿将独立于以前报道的认知能力下降的危险因素（包括心血管危险因素）预测认知能力下降。此外，我们假设即使低于微量白蛋白尿截断值的 UACR 水平也可能与认知功能相关。这些假设在芬兰全国范围内的基于人群的健康 2000 调查（n=5921，平均年龄 52.6，55.0%为女性）及其随访健康 2011 调查（n=3687，基线平均年龄 49.3，55.6%为女性）中进行了测试。线性回归分析用于确定白蛋白尿测量值与认知表现之间的关联。使用词汇流畅性、词汇列表学习、词汇列表延迟回忆（在基线和随访时）以及简单和视觉选择反应时间测试（仅在基线时）评估认知功能。在这里，我们表明微量白蛋白尿加大量白蛋白尿与基线时词汇列表学习较差和反应时间较慢相关，与随访时词汇列表学习较差以及在多元调整后 11 年内词汇列表学习下降较快相关。此外，较高的连续 UACR 与低于微量白蛋白尿水平的词汇流畅性较差相关。这些结果表明 UACR 可能在评估认知能力下降的风险方面具有价值。
