Kidney Function and Cognitive Health in Older Adults: The Cardiovascular Health Study
Kidney Function and Cognitive Health in Older Adults: The Cardiovascular Health Study
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DOI：
10.1093/aje/kwu102
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发表时间：
2014-07-01
影响因子：
5
通讯作者：
Odden, Michelle C.
中科院分区：
文献类型：
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作者：
Darsie, Brendan;Shlipak, Michael G.;Odden, Michelle C.
最近的证据已经证明了肾功能在健康老龄化中的重要性。我们在心血管健康研究的3，907名参与者中检查了肾功能和认知功能变化之间的关系，这些参与者从1992年至1999年从美国4个社区招募并进行了研究。通过基于半胱氨酸蛋白酶抑制剂C的估计肾小球滤过率（eGFR（cys））测量肾功能。使用改良简易精神状态检查和数字符号替代测试评估认知功能，在年度访视期间最多进行7次。校正混杂因素后，eGFR（cys）与认知功能变化之间存在相关性; eGFR（cys）低于60 mL/min/1.73 m2的患者，其认知功能变化与eGFR（cys）之间的相关性为0.64。（95%置信区间：0.51，0.77）分/年，改良简易精神状态检查评分下降更快，与eGFR（cys）≥ 90 mL/min/1.73 m2的患者相比，数字符号替代试验评分下降速度更快（95%置信区间：0.28，0.56）分/年。对中间心血管事件的额外调整适度影响了这些关联。eGFR（cys）小于60 mL/min/1.73 m2的受试者与eGFR（cys）大于或等于90 mL/min/1.73 m2的受试者相比，平均无认知障碍生命年更少，与混杂因素和介导的心血管事件无关（平均差异=-0.44，95%置信区间：-0.62，-0.26）。肾功能较低的老年人认知功能恶化的风险较高。
Recent evidence has demonstrated the importance of kidney function in healthy aging. We examined the association between kidney function and change in cognitive function in 3,907 participants in the Cardiovascular Health Study who were recruited from 4 US communities and studied from 1992 to 1999. Kidney function was measured by cystatin C-based estimated glomerular filtration rate (eGFR(cys)). Cognitive function was assessed using the Modified Mini-Mental State Examination and the Digit Symbol Substitution Test, which were administered up to 7 times during annual visits. There was an association between eGFR(cys) and change in cognitive function after adjustment for confounders; persons with an eGFR(cys) of less than 60 mL/minute/1.73 m(2) had a 0.64 (95% confidence interval: 0.51, 0.77) points/year faster decline in Modified Mini-Mental State Examination score and a 0.42 (95% confidence interval: 0.28, 0.56) points/year faster decline in Digit Symbol Substitution Test score compared with persons with an eGFR(cys) of 90 or more mL/minute/1.73 m(2). Additional adjustment for intermediate cardiovascular events modestly affected these associations. Participants with an eGFR(cys) of less than 60 mL/minute/1.73 m(2) had fewer cognitive impairment-free life-years on average compared with those with eGFR(cys) of 90 or more mL/minute/1.73 m(2), independent of confounders and mediating cardiovascular events (mean difference = -0.44, 95% confidence interval: -0.62, -0.26). Older adults with lower kidney function are at higher risk of worsening cognitive function.