Lau Wei Ling, Fisher Mark, Fletcher Evan, DeCarli Charles, Troutt Hayden, Corrada María M, Kawas Claudia, Paganini-Hill Annlia
Division of Nephrology and Hypertension, University of California, Irvine School of Medicine, Orange, CA, United States.
Department of Neurology, University of California, Irvine School of Medicine, Irvine, CA, United States.
Front Med (Lausanne). 2021 Sep 20;8:671945. doi: 10.3389/fmed.2021.671945. eCollection 2021.
Cognitive decline is common in chronic kidney disease (CKD). While the evidence of vascular cognitive impairment in this population is robust, the role of Alzheimer's pathology is unknown. We evaluated serum cystatin C-estimated glomerular filtration rate (eGFR), brain amyloid-β positron emission tomography (PET) imaging, and cognitive function in 166 participants from The 90+ Study. Mean age was 93 years (range 90-107) and 101 (61%) were women; 107 participants had normal cognitive status while 59 participants had cognitive impairment no dementia (CIND) or dementia. Mean ± standard deviation cystatin C was 1.59 ± 0.54 mg/L with eGFR 40.7 ± 18.7 ml/min/1.73m. Higher amyloid-β burden was associated with dementia, but not with age, diabetes, hypertension, or cardiovascular disease. We found no association between brain amyloid-β burden and cystatin C eGFR. We previously reported that kidney function was associated with cognition and cerebral microbleeds in the same cohort of oldest-old adults (90+ years old). Collectively, these findings suggest that microvascular rather than Alzheimer's pathology drives CKD-associated cognitive dysfunction in this population.
认知功能下降在慢性肾脏病（CKD）中很常见。虽然该人群中血管性认知障碍的证据确凿，但阿尔茨海默病病理学的作用尚不清楚。我们对来自“90岁以上研究”的166名参与者的血清胱抑素C估算的肾小球滤过率（eGFR）、脑淀粉样蛋白β正电子发射断层扫描（PET）成像和认知功能进行了评估。平均年龄为93岁（范围90 - 107岁），101名（61%）为女性；107名参与者认知状态正常，而59名参与者有非痴呆性认知障碍（CIND）或痴呆。胱抑素C的均值±标准差为1.59±0.54mg/L，eGFR为40.7±18.7ml/min/1.73m²。更高的淀粉样蛋白β负荷与痴呆相关，但与年龄、糖尿病、高血压或心血管疾病无关。我们发现脑淀粉样蛋白β负荷与胱抑素C eGFR之间无关联。我们之前报道过，在同一组年龄最大的老年人（90岁以上）中，肾功能与认知及脑微出血有关。总体而言，这些发现表明，在该人群中，微血管病变而非阿尔茨海默病病理学导致了CKD相关的认知功能障碍。
