Albuminuria and dementia in the elderly: A community study
Albuminuria and dementia in the elderly: A community study
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DOI：
10.1053/j.ajkd.2007.12.044
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发表时间：
2008-08-01
影响因子：
13.2
通讯作者：
Kuller, Lewis H.
中科院分区：
文献类型：
--
作者：
Barzilay, Joshua I.;Fitzpatrick, Annette L.;Kuller, Lewis H.
背景：痴呆症与视网膜微血管疾病有关。在这项研究中，我们研究了认知状态(正常认知、轻度认知障碍和痴呆症)是否与蛋白尿有关，研究设计：横断面分析。背景和参与者：2316名来自心血管健康认知研究的参与者，他们接受了脑部磁共振成像和蛋白尿测试。预测者：蛋白尿增加一倍。结果：根据神经心理学和临床评估定义痴呆。测量：使用多项Logistic模型估计痴呆症和轻度认知障碍合并蛋白尿增加一倍的优势比(OR)和95%的可信区间(CI)。结果：283名参与者(12.2%)患有痴呆症，344名(14.9%)患有轻度认知障碍，1689名(72.9%)认知正常。与认知正常的参与者相比，蛋白尿增加一倍与痴呆症的风险增加相关(OR，1.22；95%CI，1.15至1.29)。调整普遍存在的心血管疾病和心血管危险因素、血脂水平、C反应蛋白水平、估计的肾小球滤过率和载脂蛋白E-4基因后，这种相关性减弱，但仍有统计学意义(OR，1.12；95%CI，1.03至1.22)。在未校正的分析中，轻度认知障碍与蛋白尿相关，但与其他因素的校正无关。限制：结果是横断面的；因果关系不能归结。结论：蛋白尿的存在增加了痴呆的几率。这些发现表明，老年人大脑和肾脏对微血管疾病的共同易感性起到了作用。
Background: Dementia is associated with microvascular disease of the retina. In this study, we examine whether cognitive status (normal cognition, mild cognitive impairment, and dementia) is associated with albuminuria, a microvascular disorder of the kidney.Study Design: Cross-sectional analysis.Setting & Participants: 2,316 participants from the Cardiovascular Health Cognition Study who underwent brain magnetic resonance imaging and testing for albuminuria.Predictor: Doubling of albuminuria.Outcome: Dementia defined according to neuropsychological and clinical evaluation.Measurements: Multinomial logistic modeling was used to estimate odds ratios (ORs) and 95% confidence intervals (CIs) of dementia and mild cognitive impairment with doubling of albuminuria compared with the odds with normal cognition.Results: 283 participants (12.2%) had dementia, 344 (14.9%) had mild cognitive impairment, and 1,689 (72.9%) had normal cognition. Compared with participants with normal cognition, doubling of albuminuria was associated with increased odds of dementia (OR, 1.22; 95% CI, 1.15 to 1.29). Adjustment for prevalent cardiovascular disease and cardiovascular risk factors, lipid levels, C-reactive protein level, estimated glomerular filtration rate, and apolipoprotein E-4 genotype attenuated this association, but it remained statistically significant (OR, 1.12; 95% CI, 1.03 to 1.22). Mild cognitive impairment was associated with albuminuria on unadjusted analysis, but not with adjustment for other factors.Limitations: Results are cross-sectional; causality cannot be imputed.Conclusions: The odds of dementia increased in the presence of albuminuria. These findings suggest a role of shared susceptibility for microvascular disease in the brain and kidney in older adults.