肾功能障碍和大脑皮质变薄对老年人群认知变化的影响。

Impacts of Kidney Dysfunction and Cerebral Cortical Thinning on Cognitive Change in Elderly Population.

机构信息

Institute of Epidemiology and Preventive Medicine, College of Public Health, National Taiwan University, Taiwan.

Department of Neurology, National Taiwan University Hospital, Taiwan.

出版信息

J Alzheimers Dis. 2020;76(1):225-236. doi: 10.3233/JAD-200053.

DOI:10.3233/JAD-200053

PMID:32444541

Abstract

BACKGROUND

Cerebral cortical thickness is a neuroimaging biomarker to predict cognitive decline, and kidney dysfunction (KD) is associated with cortical thinning.

OBJECTIVE

This study aimed to investigate the effects of KD and cortical thinning on cognitive change in a prospective cohort study.

METHODS

A total of 244 non-demented participants were recruited from elderly health checkup program and received cognitive exams including Montreal Cognitive Assessment (MoCA) and different cognitive domains at baseline and three biannual follow-ups afterwards. KD was defined as having either glomerular filtration rate <60 ml/min/1.73 m2 or proteinuria. Cortical thickness of global, lobar, and Alzheimer's disease (AD) signature area were derived from magnetic resonance imaging at baseline, and cortical thinning was defined as the lowest tertile of cortical thickness. Generalized linear mixed models were applied to evaluate the effects of KD and cortical thinning on cognitive changes.

RESULTS

KD was significantly associated with the decline in attention function (β= -0.29). Thinning of global (β= -0.06), AD signature area (β= -0.06), temporal (β= -0.06), and parietal lobes (β= -0.06) predicted poor verbal fluency over time, while temporal lobe thinning also predicted poor MoCA score (β= -0.19). KD modified the relationship between thinning of global, frontal, and limbic, and change of logical memory function (pinteraction < 0.05). When considering jointly, participants with both KD and cortical thinning had greatest decline in attention function compared with those without KD or cortical thinning (β= -0.51, ptrend = 0.008).

CONCLUSIONS

KD and cortical thinning have joint effect on cognitive decline, especially the attention function. Reverse associations may exist between cortical thinning and memory function in participants with KD, though the results should be interpreted cautiously as an exploratory analysis.

摘要

背景

大脑皮质厚度是预测认知能力下降的神经影像学生物标志物，而肾功能不全（KD）与皮质变薄有关。

目的

本研究旨在通过前瞻性队列研究，探讨 KD 和皮质变薄对认知变化的影响。

方法

从老年健康体检计划中招募了 244 名非痴呆参与者，并在基线和之后的 3 次每两年一次的随访中接受了认知测试，包括蒙特利尔认知评估（MoCA）和不同的认知领域。KD 的定义为肾小球滤过率 <60 ml/min/1.73 m2 或蛋白尿。在基线时从磁共振成像中得出了大脑皮质厚度的全球、叶和阿尔茨海默病（AD）特征区域，皮质变薄定义为皮质厚度的最低三分位数。应用广义线性混合模型评估 KD 和皮质变薄对认知变化的影响。

结果

KD 与注意力功能下降显著相关（β= -0.29）。大脑皮质厚度的全球（β= -0.06）、AD 特征区域（β= -0.06）、颞叶（β= -0.06）和顶叶（β= -0.06）变薄与语言流畅性随时间的下降有关，而颞叶变薄也与 MoCA 评分下降有关（β= -0.19）。KD 改变了大脑皮质厚度的全球、额叶和边缘变薄与逻辑记忆功能变化之间的关系（pinteraction < 0.05）。当共同考虑时，与无 KD 或皮质变薄的参与者相比，同时患有 KD 和皮质变薄的参与者注意力功能下降最大（β= -0.51，ptrend = 0.008）。