Division of Nephrology and Hypertension, University of California Irvine School of Medicine, Orange, CA, USA.
Department of Neurology, University of California Irvine School of Medicine, Irvine, CA, USA; Department of Anatomy & Neurobiology, University of California Irvine School of Medicine, Irvine, CA, USA.
Neurobiol Aging. 2020 Sep;93:78-84. doi: 10.1016/j.neurobiolaging.2020.04.022. Epub 2020 Apr 29.
Chronic kidney disease is emerging as a novel risk factor for cerebrovascular disease, but this association remains largely unexplored in older adults. Cystatin C is a more accurate measure than creatinine of kidney function in the elderly. We evaluated cystatin C, cognitive function, and brain imaging in 193 participants from The 90+ Study neuroimaging component. The mean age was 93.9 years; 61% were women. Mean cystatin C was 1.62 mg/L with estimated glomerular filtration rate 39.2 mL/min/1.73 m. Performance on measures of global cognition, executive function, and visual-spatial ability declined at higher tertiles of cystatin C (lower kidney function). Higher cystatin C was significantly associated with infratentorial microbleeds and lower gray matter volume. Adjusted risk of incident dementia was increased in the middle and high cystatin C tertile groups compared with the low group (hazard ratio in highest tertile 3.81 [95% confidence interval 1.14-12.7]), which appeared to be explained in part by the presence of cerebral microbleeds. Overall, cystatin C was associated with cognitive performance, brain imaging pathology, and decline to dementia in this oldest-old cohort.
慢性肾脏病正成为脑血管疾病的一个新的危险因素，但这一关联在老年人中仍很大程度上未被探索。半胱氨酸蛋白酶抑制剂 C 是一种比肌酐更能准确衡量老年人肾功能的指标。我们评估了来自 90+ 研究神经影像学部分的 193 名参与者的半胱氨酸蛋白酶抑制剂 C、认知功能和脑部影像学。平均年龄为 93.9 岁，61%为女性。半胱氨酸蛋白酶抑制剂 C 的平均值为 1.62mg/L，肾小球滤过率估计为 39.2mL/min/1.73m。在半胱氨酸蛋白酶抑制剂 C 较高三分位（较低的肾功能）时，全球认知、执行功能和视觉空间能力的测量结果下降。较高的半胱氨酸蛋白酶抑制剂 C 与幕下微出血和灰质体积减少显著相关。与低半胱氨酸蛋白酶抑制剂 C 组相比，中、高半胱氨酸蛋白酶抑制剂 C 三分位组发生痴呆的风险增加（最高三分位的风险比为 3.81[95%置信区间为 1.14-12.7]），这似乎部分归因于脑微出血的存在。总的来说，在这个最年长的队列中，半胱氨酸蛋白酶抑制剂 C 与认知表现、脑部影像学病理以及向痴呆的进展有关。
