Kidney Function and Cognitive and Functional Decline in Elderly Adults: Findings from the Singapore Longitudinal Aging Study
Kidney Function and Cognitive and Functional Decline in Elderly Adults: Findings from the Singapore Longitudinal Aging Study
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DOI：
10.1111/j.1532-5415.2012.04043.x
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发表时间：
2012-07-01
影响因子：
6.3
通讯作者：
Tze Pin Ng
中科院分区：
文献类型：
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作者：
Feng, Liang;Yap, Keng Bee;Tze Pin Ng
目的在一项前瞻性队列研究中，探讨较低的肾小球滤过率（eGFR）或慢性肾脏疾病（CKD）是否与随后的认知和日常生活工具活动（IADL）下降有关。设计前瞻性队列研究，随访4年。Setting一般团体字。参与者来自新加坡纵向老龄化研究的1315名55岁及以上的成年人。基线数据包括eGFR水平、CKD的存在（eGFR < 60 mL/min / 1.73 m2）和已知的混杂因素。认知能力下降定义为在简易精神状态检查（MMSE）中下降2分或以上，功能下降定义为在IADL评分中下降2分或以上。结果在多变量分析中，eGFR水平的降低和CKD的存在与随访中认知能力下降的几率较大相关，独立于混杂的危险因素：eGFR每降低10 mL/min/1.73 m2，认知能力下降的几率估计增加14%（优势比= 1.94,95%可信区间= 1.233.05；CKD与非CKD的P = 0.004）。在基线时认知正常亚组（MMSE bbb23）中也发现了类似的关联。在整个样本中，CKD，而不是eGFR，被发现与较高的IADL下降风险显著相关。结论老年人CKD与认知功能下降有显著相关性。未来的研究应着眼于开发和评估延缓或预防老年人肾功能受损的认知能力下降和身体残疾的策略。
Objectives To investigate whether lower estimated glomerular filtration rate (eGFR) or chronic kidney disease (CKD) was associated with subsequent cognitive and instrumental activity of daily living (IADL) decline in a prospective cohort study. Design Prospective cohort study, followed for up to 4 years. Setting General community. Participants One thousand three hundred fifteen adults aged 55 and older from the Singapore Longitudinal Aging Study. Measurements Baseline data included eGFR levels, presence of CKD (eGFR < 60 mL/min per 1.73 m2), and known confounders. Cognitive decline was defined as a drop of 2 or more points on the Mini-Mental State Examination (MMSE) and functional decline as a drop of 2 or more points in IADL score. Results Decreasing levels of eGFR and the presence of CKD were associated with greater odds of cognitive decline at follow-up independent of confounding risk factors in multivariate analyses: estimated 14% increment in odds of cognitive decline per 10 mL/min/1.73 m2 decrease in eGFR (odds ratio = 1.94, 95% confidence interval = 1.233.05; P = .004 for CKD vs non-CKD). Similar associations were found in a cognitively normal subgroup (MMSE > 23) at baseline. In the whole sample, CKD, but not eGFR, was found to be significantly associated with higher risk of IADL decline. Conclusion CKD in older persons was significantly associated with cognitive and functional decline. Future research should target the development and evaluation of strategies to delay or prevent cognitive decline and physical disability in elderly adults with impaired kidney function.