Department of Clinical Sciences in Malmö, Lund University, Jan Waldenströms gata 35, 205 02, Malmö, Sweden.
Division of Geriatric Medicine, Skåne University Hospital, Jan Waldenströms gata 35, 205 02, Malmö, Sweden.
BMC Nephrol. 2021 Sep 21;22(1):314. doi: 10.1186/s12882-021-02517-5.
Chronic kidney disease, cardiovascular disease, and cognitive dysfunction are common in the elder population. There is evidence of a connection between these conditions, possibly by a shared vascular pathogenesis. Processing speed is commonly impaired in cerebrovascular disease.
The data was obtained from the population based study "Good aging in Skåne" (GÅS), and included 905 individuals (mean age = 68 years). We investigated the impact of impaired kidney function at baseline on the development of dementia, MCI, and impairment in specific cognitive domains at follow up 6 years later, using logistic regression models. Impaired kidney function was defined as GFR < 60 ml/min/1,73 m. GFR was estimated from creatinine and cystatin C, using the CKD-EPI formula. Function in the cognitive domains learning and memory, language, complex attention, executive function, perceptual-motor, as well as meta-memory, and global cognitive function, was assessed using a neuropsychological test battery consisting of 12 tests. We compared the test results from follow up, with the results obtained at baseline, using linear regression models in order to assess changes in performance in cognitive domains.
At follow up, 14 and 158 participants had developed dementia and MCI, respectively. We did not find evidence that moderately impaired eGFR at baseline increased the odds of dementia or MCI. A decline in processing speed was associated with impaired kidney function.
The effect on processing speed could represent early vascular implications on cognition. Even at moderately impaired kidney function, overview of cardiovascular risk factors could potentially prevent further cognitive impairment.
慢性肾脏病、心血管疾病和认知功能障碍在老年人群中较为常见。这些疾病之间存在一定关联，其潜在机制可能与血管病变有关。在脑血管疾病中，通常会出现处理速度受损的情况。
本研究的数据来源于基于人群的“斯科讷健康老龄化研究”（GÅS），共纳入了 905 名参与者（平均年龄 68 岁）。我们通过逻辑回归模型，研究了基线时肾功能受损对 6 年后痴呆、轻度认知障碍和特定认知领域损害发展的影响。肾功能受损定义为肾小球滤过率（GFR）<60ml/min/1.73m。GFR 是根据肌酐和胱抑素 C ，采用 CKD-EPI 公式估算得出的。采用包含 12 项测试的神经心理学测试组合评估学习和记忆、语言、复杂注意力、执行功能、知觉运动以及元记忆和整体认知功能等认知领域的功能。我们使用线性回归模型比较了随访时的测试结果与基线时的测试结果，以评估认知领域的表现变化。
随访时，有 14 名和 158 名参与者分别发展为痴呆和 MCI。我们没有发现证据表明基线时中度受损的 eGFR 会增加痴呆或 MCI 的发病风险。处理速度的下降与肾功能受损有关。
处理速度的影响可能代表了血管病变对认知功能的早期影响。即使肾功能仅出现中度受损，全面评估心血管危险因素也可能预防进一步的认知障碍。
