Cognitive Decline in Chronic Renal Insufficiency

描述(由申请人提供)： 慢性肾功能不全(CRI)和认知障碍是老年人的常见疾病，两者都与卫生保健利用率的提高和生活质量的下降有关。CRI是否与随着时间的推移而加速的认知老化有关还没有解决。我们有初步的横断面证据表明CRI可能与老年人的认知障碍有关，但还没有关于CRI和认知结果之间的关系的前瞻性研究。如果能够建立这样的关联，患者的临床护理可能会受到认知障碍筛查、更密切地监测治疗依从性以及使用药物和其他改善认知的策略的直接影响。这项建议的目的是调查CRI的严重程度是否与CRI老年患者的认知功能下降有关，评估CRI和认知功能之间的关系是否被有针对性的人口统计和临床因素改变，并检查认知下降的潜在机制，如心血管疾病和炎症。 我们的目标将作为正在进行的NIDDK资助的慢性肾功能不全队列(CRIC)研究的辅助研究。这项前瞻性研究将在一大批有代表性的CRI患者中研究CRI的流行病学和预后。在720名参加拟议的CRIC认知功能辅助研究的老年CRIC参与者中，我们将以经济高效的方式1)确定CRI与55岁以上CRIC参与者3-4年认知功能下降之间的关联；2)评估CRI与认知功能下降之间的关联在不同患者亚组之间是否一致，例如不同种族和民族、患有和不患有糖尿病的患者；3)阐明可能调节CRI与认知功能下降(包括心血管疾病和炎症)之间关联的几种机制。评估CRI典型人群中认知障碍的性质将为确定CRI患者的疾病负担和医疗保健需求提供关键数据。此外，了解这些关系可能有助于识别潜在的可改变的危险因素，并治疗认知障碍，从而保持肾脏疾病患者的独立性。

DESCRIPTION (provided by applicant): Chronic renal insufficiency (CRI) and cognitive impairment are common diseases in the elderly, both associated with increased health-care utilization and decreased quality of life. Whether CRI is associated with accelerated cognitive aging over time has not been addressed. We have preliminary cross-sectional evidence that CRI may be associated with cognitive impairment in the elderly, but no prospective studies have been conducted on the relationship between CRI and cognitive outcomes. If such an association can be established, the clinical care of patients could be directly influenced by screening for cognitive impairment, more close monitoring of treatment adherence and the use of drugs and other strategies to improve cognition. The goals of this proposal are to investigate whether severity of CRI is associated with greater cognitive decline in older individuals with CRI, to assess whether the relation between CRI and cognitive function is modified by targeted demographic and clinical factors, and to examine potential mechanisms of cognitive decline, such as cardiovascular disease and inflammation. Our aims will be addressed as an ancillary study to the ongoing NIDDK-funded Chronic Renal Insufficiency Cohort (CRIC) study. This prospective study will examine the epidemiology and outcomes of CRI in a large, representative population of patients with CRI. Among 720 older CRIC participants who enroll in the proposed CRIC Cognitive Function Ancillary Study, we will cost-efficiently 1) determine the association between CRI and 3-4 year cognitive decline among CRIC participants over age 55 years; 2) evaluate whether the association between CRI and cognitive decline is consistent among different patient subgroups such as those of different races and ethnicities, and those with and without diabetes mellitus; 3) elucidate several mechanisms that may mediate the association between CRI and cognitive decline, including cardiovascular disease and inflammation. Assessing the nature of cognitive impairment in a representative population with CRI will provide crucial data for determining the burden of disease and health care needs of those with CRI. Moreover, understanding these relations may help to identify potential modifiable risk factors and to treat cognitive impairment thereby maintaining independence among patients with renal disease