Department of Geriatrics, Beijing Tongren Hospital, Capital Medical University, Beijing, China.
Psychogeriatrics. 2024 Nov;24(6):1187-1197. doi: 10.1111/psyg.13176. Epub 2024 Aug 16.
Cognitive impairment (CI) is common in older adults, especially those with renal dysfunction. We aimed to investigate the complex relationships among renal function, nutritional status, and CI in older people free from late chronic kidney disease (CKD) and severe CI.
A study of older people (≥60 years old) with an estimated glomerular filtration rate (eGFR) of >30 mL/min/1.73 m and Montreal Cognitive Assessment (MoCA) scores of >10 (n = 237) was conducted at Beijing Tongren Hospital. Their eGFR was determined using the CKD-EPI-cr-Cysc equation. Cognitive function was evaluated with the MoCA. We tested the relationship between eGFR and MoCA scores using Spearman correlation analysis and multivariate logistic regression analysis. We then conducted a mediation analysis to figure out the mediating roles of nutritional indicators (Mini Nutritional Assessment-Short Form (MNA-SF) scores, albumin (ALB), and haemoglobin (HGB)) between the eGFR and MoCA scores.
The incidence of CI was 48.5% (115/237) in older people. Spearman correlation analysis revealed that the better the kidney function, the better the cognitive function (R = 0.297, P < 0.001). Multivariate logistic regression analysis revealed that eGFR decrease per 15 mL/min/1.73 m (OR: 1.415, 95% confidence interval: 1.055-1.896, P = 0.020) was related to CI after adjusting for age and sex. However, the eGFR was not associated with cognitive decline after adjusting for nutritional indicators, behavioural risk factors, other biomarkers, and chronic conditions, suggesting that eGFR is not independently associated with CI. Mediation analysis revealed that the MNA-SF scores (ab = 0.006 (0.0002-0.012)) and HGB (ab = 0.008 (0.001-0.017)) were mediating factors between the eGFR and MoCA scores.
A decline in renal function can directly lead to CI and can also exacerbate cognitive deficits through intermediary factors such as MNA-SF scores and HGB. Therefore, correcting anaemia and improving nutritional status are significantly important for enhancing cognitive function in older patients, especially those with renal dysfunction.
认知障碍（CI）在老年人中很常见，尤其是那些肾功能不全的老年人。我们旨在研究肾功能、营养状况与无晚期慢性肾脏病（CKD）和严重 CI 的老年人的 CI 之间的复杂关系。
对北京同仁医院的≥60 岁、估计肾小球滤过率（eGFR）>30 mL/min/1.73 m 和蒙特利尔认知评估（MoCA）评分>10 的老年人（n=237）进行了一项研究。他们的 eGFR 采用 CKD-EPI-cr-Cysc 方程确定。使用 MoCA 评估认知功能。我们使用 Spearman 相关分析和多元逻辑回归分析来测试 eGFR 与 MoCA 评分之间的关系。然后，我们进行了中介分析，以确定营养指标（简易营养评估-短表（MNA-SF）评分、白蛋白（ALB）和血红蛋白（HGB））在 eGFR 和 MoCA 评分之间的中介作用。
老年人 CI 的发生率为 48.5%（115/237）。Spearman 相关分析显示，肾功能越好，认知功能越好（R=0.297，P<0.001）。多元逻辑回归分析显示，eGFR 每下降 15 mL/min/1.73 m（OR：1.415，95%置信区间：1.055-1.896，P=0.020）与调整年龄和性别后的 CI 相关。然而，在调整营养指标、行为危险因素、其他生物标志物和慢性疾病后，eGFR 与认知能力下降无关，表明 eGFR 与 CI 无独立关系。中介分析显示，MNA-SF 评分（ab=0.006（0.0002-0.012））和 HGB（ab=0.008（0.001-0.017））是 eGFR 与 MoCA 评分之间的中介因素。
肾功能下降可直接导致 CI，也可通过 MNA-SF 评分和 HGB 等中介因素加重认知缺陷。因此，纠正贫血和改善营养状况对提高老年患者，尤其是肾功能不全患者的认知功能具有重要意义。
