Neurocognition and Functional Performance in Older Veterans with CKD

患有 CKD 的老年退伍军人的神经认知和功能表现

• 批准号: 8857396
• 负责人: Leslie I. Katzel
• 金额: --
• 依托单位: BALTIMORE VA MEDICAL CENTER
• 依托单位国家: 美国
• 财政年份: 2010
• 资助国家: 美国
• 起止时间: 2010-07-01 至 2013-06-30
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/8857396
• 关键词: Accounting; Address; Adverse effects; Aerobic; Affect; Age; Albumins; Albuminuria; Atrophic; Biological Markers; Blood Vessels; Brain; Brain Diseases; Brain Pathology; Brain imaging; Cardiovascular Diseases; Cephalic; Cerebrovascular Circulation; Cerebrum; Chronic Kidney Failure; Clinical; Cognition; Cognitive; Cognitive deficits; Cohort Studies; Communities; Comorbidity; Control Groups; Dementia; Detection; Diabetes Mellitus; Dialysis procedure; Diffusion Magnetic Resonance Imaging; Disease; Elderly; Equation; Equilibrium; Evaluation; Excretory function; Exhibits; Frequencies; Functional disorder; Gait; Geriatrics; Health Personnel; Heart Diseases; High Prevalence; Hypertension; Image Analysis; Impairment; Individual; Infarction; Investigation; Kidney; Kidney Diseases; Laboratories; Link; Lower Extremity; Magnetic Resonance Imaging; Measurement; Measures; Mediating; Mediator of activation protein; Methods; Modeling; Monitor; Motor; Multivariate Analysis; Nephrology; Neurocognition; Neurocognitive; Neuropsychological Tests; Neuropsychology; Patient Self-Report; Patients; Pattern; Performance; Perfusion Weighted MRI; Physical Function; Population; Renal function; Research; Research Personnel; Risk; Risk Factors; Serum; Severities; Speed; Staging; Stroke; Structure; Symptoms; Testing; Upper Extremity; Urine; Vascular Diseases; Veterans; White Matter Hyperintensity; adverse outcome; aged; cerebral atrophy; cognitive function; executive function; frailty; high risk; hypoperfusion; method development; neuroimaging; older patient; post gamma-globulins; prevent; risk sharing; screening; white matter

DESCRIPTION (provided by applicant): Project Summary Chronic Kidney Disease (CKD) affects 1 out of 5 older adults in the US including more than 400,000 older veterans yet is often unrecognized by affected individuals and even their healthcare providers. Older adults with CKD suffer from a markedly higher risk of cognitive and physical dysfunction, including a 40% greater risk of dementia and a 75% greater risk of physical frailty. The factors which account for this risk are unclear; however, recent neuroimaging investigations suggest a greatly increased burden of covert brain pathology in association with CKD and reduced kidney function. Outside the context of CKD, these neuroimaging findings of subclinical ischemic brain disease - silent brain infarcts, white matter hyperintensities, atrophy, and hypoperfusion - are associated with reduced cognitive and physical function. However, there has been no formal statistical evaluation of subclinical ischemic brain disease as a mediator of the relations of CKD to physical and cognitive function, nor any investigations of the patterns of cognitive and physical dysfunction in older adults with CKD. We hypothesize that older veterans with CKD suffer from a greater burden of subclinical ischemic disease of the brain, which results in impaired neurocognition and physical function. In this revised proposal, we will conduct an observational cohort study of stroke-free community-dwelling older veterans (ages 60-85) with CKD not requiring dialysis (N=150, evenly distributed among mild, moderate and severe CKD), and a control group without CKD but frequency-matched on the common co-morbid conditions diabetes, hypertension and cardiac disease (N=50). We will obtain quantitative measurements of 1) kidney disease and function (including albuminuria and the renal biomarker cystatin C), 2) ischemic brain disease using MRI, 3) physical function and performance, and 4) multiple domains of neurocognitive function. The overall aims are to estimate the association of CKD and renal function measures with MRI-defined subclinical ischemic brain disease and cognitive and physical function. Multivariate analyses will be employed to identify patterns of functional deficits and alterations of brain structure in CKD. Structural equations models (SEM) will examine whether subclinical ischemic brain disease mediates the relations of CKD and associated renal function measures to neurocognition and physical function after accounting for major co-morbid conditions including hypertension, diabetes, and cardiac disease. Results of this investigation will be of critical importance in the development of methods to detect and ultimately prevent functional deficits among older adults with CKD, a highly prevalent and rapidly growing population.

描述（由申请人提供）： 项目摘要 慢性肾病 (CKD) 影响着美国五分之一的老年人，其中包括超过 400,000 名老年退伍军人，但受影响的个人甚至他们的医疗保健提供者往往没有意识到这一点。患有 CKD 的老年人患有认知和身体功能障碍的风险明显更高，其中患痴呆症的风险增加 40%，身体虚弱的风险增加 75%。造成这种风险的因素尚不清楚；然而，最近的神经影像学研究表明，与 CKD 和肾功能下降相关的隐性脑病理学负担大大增加。在 CKD 背景之外，这些亚临床缺血性脑病的神经影像学表现（无症状脑梗塞、白质高信号、萎缩和灌注不足）与认知和身体功能下降有关。然而，目前还没有对亚临床缺血性脑病作为 CKD 与身体和认知功能关系的中介进行正式的统计评估，也没有对患有 CKD 的老年人的认知和身体功能障碍模式进行任何调查。我们假设患有 CKD 的老年退伍军人承受着更大的亚临床缺血性疾病负担，这会导致神经认知和身体功能受损。在这项修订后的提案中，我们将对患有不需要透析的 CKD 的无卒中社区老年退伍军人（60-85 岁）（N = 150，均匀分布在轻度、中度和重度 CKD 中）和无 CKD 但对常见并发症糖尿病、高血压和心脏病进行频率匹配的对照组（N = 50）进行观察性队列研究。我们将获得 1) 肾脏疾病和功能（包括白蛋白尿和肾脏生物标志物胱抑素 C）、2) 使用 MRI 的缺血性脑疾病、3) 身体功能和表现以及 4) 神经认知功能的多个领域的定量测量。总体目标是评估 CKD 和肾功能测量与 MRI 定义的亚临床缺血性脑疾病以及认知和身体功能的关联。将采用多变量分析来识别 CKD 中的功能缺陷和大脑结构改变的模式。结构方程模型 (SEM) 将在考虑高血压、糖尿病和心脏病等主要共病后，研究亚临床缺血性脑病是否介导 CKD 和相关肾功能指标与神经认知和身体功能的关系。这项调查的结果对于开发检测并最终预防 CKD 老年人功能缺陷的方法至关重要，CKD 是一个高度流行且快速增长的人群。