Teng Yubo, Zhang Jingyi, Yang Boxiang, Luo Qin, Xue Yu, Zhang Miao
Heilongjiang University of Chinese Medicine, Harbin, China.
The Second Hospital Affiliated of Heilongjiang University of Chinese Medicine, Harbin, China.
PLoS One. 2025 May 5;20(5):e0321519. doi: 10.1371/journal.pone.0321519. eCollection 2025.
Cognitive impairment is an escalating challenge in aging populations, with risk factors extending beyond traditional domains. The urine albumin-to-creatinine ratio (UACR), a marker of kidney and vascular health, has been associated with systemic dysfunction, yet its association with cognitive impairment remains underexplored. This study aims to delve into the association between UACR and cognitive function in older adults.
This study conducted a cross-sectional analysis using data from the 2011-2014 National Health and Nutrition Examination Survey (NHANES), including 2,385 adults aged ≥60 years. Cognitive function was assessed using composite 'Cognitive Scores' derived from standardized tests. Participants were categorized into quartiles based on UACR levels. Multivariate linear regression models were used to evaluate the association between UACR and cognitive scores. Additionally, multivariate logistic regression models were used to assess the relationship between UACR and cognitive impairment, adjusting for demographic and clinical covariates. Smooth curve fitting and interaction analyses were also performed to further investigate the relationship between UACR and cognitive impairment.
For every 10-unit increase in UACR, cognitive scores declined by 0.019 (β = -0.019, 95% CI: -0.036 to -0.002; P < 0.05), and the odds of cognitive impairment increased by 2.6% (OR = 1.026, 95% CI: 1.004 to 1.048; P < 0.05). This trend was also observed in participants with UACR levels below 30, where for every 10-unit increase in UACR, cognitive scores decreased by 0.013 (β = -0.013, 95% CI: -0.027 to -0.001; P < 0.05), and the odds of cognitive impairment increased by 1.4% (OR = 1.014, 95% CI: 1.003 to 1.038; P < 0.05). The study also identified a nonlinear relationship, where the risk of cognitive impairment increased with rising UACR levels, but this risk plateaued at a UACR value of 12.86. Hypertension was found to be a significant factor influencing the relationship between UACR and cognitive impairment (P for interaction < 0.05).
This study highlights the significant association between elevated UACR and cognitive impairment in older adults. Notably, even at lower UACR levels, increases in UACR are associated with a higher risk of cognitive impairment. These findings underscore the importance of incorporating kidney health management into strategies aimed at preventing cognitive decline. Further longitudinal studies are needed to clarify the causal relationship and explore interventions targeting UACR to preserve cognitive function.
认知障碍在老年人群中是一个日益严峻的挑战，其风险因素超出了传统范畴。尿白蛋白与肌酐比值（UACR）作为肾脏和血管健康的标志物，已被证实与全身性功能障碍相关，但其与认知障碍的关联仍有待深入研究。本研究旨在探究老年人UACR与认知功能之间的关联。
本研究利用2011 - 2014年美国国家健康与营养检查调查（NHANES）的数据进行横断面分析，纳入了2385名年龄≥60岁的成年人。认知功能通过标准化测试得出的综合“认知分数”进行评估。参与者根据UACR水平被分为四分位数。采用多元线性回归模型评估UACR与认知分数之间的关联。此外，使用多元逻辑回归模型评估UACR与认知障碍之间的关系，并对人口统计学和临床协变量进行了调整。还进行了平滑曲线拟合和交互分析，以进一步探究UACR与认知障碍之间的关系。
UACR每增加10个单位，认知分数下降0.019（β = -0.019，95%置信区间：-0.036至-0.002；P < 0.05），认知障碍的几率增加2.6%（OR = 1.026，95%置信区间：1.004至1.048；P < 0.05）。在UACR水平低于30的参与者中也观察到了这一趋势，即UACR每增加10个单位，认知分数下降0.013（β = -0.013，95%置信区间：-0.027至-0.001；P < 0.05），认知障碍的几率增加1.4%（OR = 1.014，95%置信区间：1.003至1.038；P < 0.05）。该研究还发现了一种非线性关系，即认知障碍的风险随着UACR水平的升高而增加，但在UACR值为12.86时达到平稳。研究发现高血压是影响UACR与认知障碍关系的一个重要因素（交互作用P < 0.05）。
本研究强调了老年人UACR升高与认知障碍之间的显著关联。值得注意的是，即使在较低的UACR水平下，UACR的升高也与更高的认知障碍风险相关。这些发现强调了将肾脏健康管理纳入预防认知衰退策略的重要性。需要进一步的纵向研究来阐明因果关系，并探索针对UACR的干预措施以保护认知功能。
