老年人社区居住者的肾功能标志物与纵向认知能力：Rancho Bernardo 研究。
Markers of Kidney Function and Longitudinal Cognitive Ability Among Older Community-Dwelling Adults: The Rancho Bernardo Study.
机构信息
Department of Family Medicine and Public Health, University of California San Diego, La Jolla, CA, USA.
Herbert Wertheim School of Public Health and Human Longevity Science, University of California San Diego, La Jolla, CA, USA.
出版信息
J Alzheimers Dis. 2021;83(1):319-331. doi: 10.3233/JAD-201605.
BACKGROUND
Reduced kidney function has been associated with cognitive decline. Most studies have examined a single marker of kidney function and have limited duration of follow-up.
OBJECTIVE
This study evaluated associations between markers of kidney function (urine albumin, estimated glomerular filtration rate [eGFR], and hyperuricemia) with cognitive performance over time.
METHODS
This is a longitudinal study of 1,634 community-dwelling adults (mean age = 71.7 years), with kidney function markers and cognitive ability measured at baseline (1992-1996) and at up to five additional time points with a maximum of 23.4 years (mean = 8.1 years) of follow-up. Associations between kidney function and cognitive performance were assessed using linear mixed effects models. Testing for interaction by sex was conducted.
RESULTS
Albuminuria (urine albumin-to-creatinine ratio [ACR]≥30 mg/g) was associated with steeper annual declines in global cognitive function (MMSE, β= -0.12, p = 0.003), executive function (Trails B, β= 4.50, p < 0.0001) and episodic memory (Buschke total recall, β= -0.62, p = 0.02) scores in men. Results were similar when cognitive test scores were regressed on latent trajectory classes of ACR. In men, hyperuricemia (serum uric acid [SUA]≥6.8 mg/dl for men and SUA≥6.0 mg/dl for women) was associated with lower baseline MMSE (β= -0.70, p = 0.009) scores but not with MMSE change over time. No such associations were detected in women. There were no significant associations between eGFR and cognitive performance for either sex.
CONCLUSION
In older men, albuminuria is an independent predictor of subsequent cognitive decline. More investigations are needed to explain the observed sex differences and the potential relationship between hyperuricemia and poorer global cognition.
背景
肾功能下降与认知能力下降有关。大多数研究都只检测了肾功能的单一标志物，且随访时间有限。
目的
本研究评估了肾功能标志物（尿白蛋白、估算肾小球滤过率[eGFR]和高尿酸血症）与随时间推移的认知表现之间的关联。
方法
这是一项对 1634 名居住在社区的成年人（平均年龄为 71.7 岁）进行的纵向研究，在基线（1992-1996 年）和最多 5 个额外时间点（最长随访时间为 23.4 年，平均 8.1 年）测量了肾功能标志物和认知能力。使用线性混合效应模型评估肾功能与认知表现之间的关联。进行了按性别测试交互作用的分析。
结果
白蛋白尿（尿白蛋白与肌酐比值[ACR]≥30mg/g）与男性的整体认知功能（MMSE，β=−0.12，p=0.003）、执行功能（Trails B，β=4.50，p<0.0001）和情景记忆（Buschke 总回忆，β=−0.62，p=0.02）的年度下降速度更快有关。当将认知测试分数回归到 ACR 的潜在轨迹分类时，结果相似。在男性中，高尿酸血症（血清尿酸[SUA]男性≥6.8mg/dl，女性 SUA≥6.0mg/dl）与较低的基线 MMSE（β=−0.70，p=0.009）评分相关，但与随时间推移的 MMSE 变化无关。在女性中未发现这种关联。肾功能 eGFR 与男性和女性的认知表现均无显著关联。
结论
在老年男性中，白蛋白尿是随后认知能力下降的独立预测因素。需要进一步研究来解释观察到的性别差异以及高尿酸血症与较差的整体认知之间的潜在关系。
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