权益分类	功能权益	普通用户	{{item.name}}会员
{{category.name}}	{{benefitItem.name}}

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

基本信息

批准号：
7871588
负责人：
Leslie I. Katzel
金额：
--
依托单位：
BALTIMORE VA MEDICAL CENTER
依托单位国家：
美国
项目类别：
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/7871588
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 Screening procedure Serum Severities Speed Staging Stroke Structure Symptoms Testing Upper Extremity Urine Vascular Diseases Veterans adverse outcome aged cerebral atrophy cognitive function executive function frailty high risk method development neuroimaging older patient post gamma-globulins prevent risk sharing white matter

项目摘要

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. PUBLIC HEALTH RELEVANCE: Chronic Kidney Disease (CKD) affects over 400,000 older veterans yet is frequently unrecognized. Older patients with CKD are at markedly higher risk for physical and cognitive deficit, but the specific patterns of deficits and the mechanisms which account for them are uncertain. However, there is increasing evidence that CKD patients have an increased risk of covert vascular disease of the brain, which could have adverse effects on brain function. The proposed research will study older veterans with and without chronic kidney disease to characterize the patterns of deficits in physical function and cognition associated with kidney disease, and examine whether an increased burden of covert vascular disease on brain imaging accounts for these deficits related to CKD. These investigations are the first steps in efforts to preserve brain function in older veterans with CKD, a large and under-recognized population.