Moderate renal impairment and risk of dementia among older adults: The cardiovascular health cognition study
Moderate renal impairment and risk of dementia among older adults: The cardiovascular health cognition study
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DOI：
10.1097/01.asn.0000131529.60019.fa
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发表时间：
2004-07-01
影响因子：
13.6
通讯作者：
Kuller, LH
中科院分区：
文献类型：
--
作者：
Seliger, SL;Siscovick, DS;Kuller, LH
肾损害与颈动脉粥样硬化和中风的风险增加有关，这是认知功能障碍和痴呆的决定因素。本研究的目的是确定中度肾功能损害是否与社区居住的老年人中的痴呆事件有关。参与心血管健康认知研究的无痴呆症患者（n = 3349）被纳入分析。通过神经学测试证实了痴呆事件。通过血清肌酐的倒数（1/SCr）估计基线时的肾功能;中度肾损害定义为女性SCr ≥ 1.3 mg/dl，男性SCr ≥ 1.5 mg/dl。考克斯回归模型被用来估计肾损害与痴呆事件的关联。由于SCr也是肌肉质量的函数，因此作者确定了SCr与痴呆之间的关系是否在基线时没有严重合并症的个体中特别强，如自我报告的一般健康状况所反映的那样。在中位6年的随访中，有477例痴呆病例。校正潜在混杂因素后，中度肾功能不全与痴呆风险增加37%相关（95%CI = 1.06 - 1.78）。类似地，1/SCr降低0.5个单位（相当于SCr从1.0 mg/dl增加到2.0 mg/dl）与26%的风险增加相关（95% CI = 1.02至1.60）。这些关联仅存在于84%的报告健康状况良好的老年人中。在那些健康状况良好的人中，较高的SCr与血管型痴呆有关，但与阿尔茨海默型痴呆无关。中度肾功能损害，反映了较高的SCr，是与一个额外的风险事件痴呆症的个人在良好的优秀的健康。需要采取措施预防或延迟中度肾损害患者痴呆的发生。
Renal impairment is associated with an increased risk of carotid atherosclerosis and stroke, determinants of cognitive dysfunction and dementia. The purpose of this study was to determine whether moderate renal impairment is associated with incident dementia among community-dwelling older adults. Participants in the Cardiovascular Health Cognition Study without prevalent dementia (n = 3349) were included in the analysis. Incident dementia was confirmed through neurologic testing. Renal function at baseline was estimated by the inverse of serum creatinine (1/SCr); moderate renal impairment was defined as SCr greater than or equal to 1.3 mg/dl for women and greater than or equal to 1.5 mg/dl for men. Cox regression models were used to estimate the association of renal impairment with incident dementia. Because SCr is also a function of muscle mass, the authors determined whether the relationship between SCr and dementia was particularly strong among individuals without severe comorbidity at baseline, as reflected by self-reported general health status. There were 477 incident dementia cases over a median 6 yr follow-up. After adjustment for potential confounders, moderate renal insufficiency was associated with a 37% increased risk of dementia (95% CI = 1.06 to 1.78). Similarly, a 0.5-unit decrement in 1/SCr (equivalent to an increase in SCr from 1.0 to 2.0 mg/dl) was associated with a 26% increased risk (95% CI = 1.02 to 1.60). These associations were present only among the 84% of older adults who reported good-excellent health. Among those in good-excellent health, higher SCr was associated with vascular-type dementia but not Alzheimer-type dementia. Moderate renal impairment, reflected by a higher SCr, is associated with an excess risk of incident dementia among individuals in good-excellent health. Strategies to prevent or delay the onset of dementia in patients with moderate renal impairment are needed.