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Bikbov B, Soler MJ, Pešić V, Capasso G, Unwin R, Endres M, Remuzzi G, Perico N, Gansevoort R, Mattace-Raso F, Bruchfeld A, Figurek A, Hafez G. Albuminuria as a risk factor for mild cognitive impairment and dementia-what is the evidence? Nephrol Dial Transplant 2021; 37:ii55-ii62. [PMID: 34739540 PMCID: PMC8713154 DOI: 10.1093/ndt/gfab261] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/30/2021] [Indexed: 01/02/2023] Open
Abstract
Kidney dysfunction can profoundly influence many organ systems, and recent evidence suggests a potential role for increased albuminuria in the development of mild cognitive impairment (MCI) or dementia. Epidemiological studies conducted in different populations have demonstrated that the presence of increased albuminuria is associated with a higher relative risk of MCI or dementia both in cross-sectional analyses and in studies with long-term follow-up. The underlying pathophysiological mechanisms of albuminuria's effect are as yet insufficiently studied, with several important knowledge gaps still present in a complex relationship with other MCI and dementia risk factors. Both the kidney and the brain have microvascular similarities that make them sensitive to endothelial dysfunction involving different mechanisms, including oxidative stress and inflammation. The exact substrate of MCI and dementia is still under investigation, however available experimental data indicate that elevated albuminuria and low glomerular filtration rate are associated with significant neuroanatomical declines in hippocampal function and grey matter volume. Thus, albuminuria may be critical in the development of cognitive impairment and its progression to dementia. In this review, we summarize the available evidence on albuminuria's link to MCI and dementia, point to existing gaps in our knowledge and suggest actions to overcome them. The major question of whether interventions that target increased albuminuria could prevent cognitive decline remains unanswered. Our recommendations for future research are aimed at helping to plan clinical trials and to solve the complex conundrum outlined in this review, with the ultimate goal of improving the lives of patients with chronic kidney disease.
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Affiliation(s)
- Boris Bikbov
- Istituto di Ricerche Farmacologiche Mario Negri IRCCS, Bergamo, Italy
| | - Maria José Soler
- Division of Nephrology Autonomous University of Barcelona, Hospital Universitari Vall d’Hebron, Barcelona, Spain
| | - Vesna Pešić
- Faculty of Pharmacy, University of Belgrade, Belgrade, Serbia
| | - Giovambattista Capasso
- Department Translational Medical Sciences, Univ. Campania “L. Vanvitelli”, Naples, Italy
- BIOGEM, Insititute Molecular Biology and Genetics, Ariano Irpino, Italy
| | - Robert Unwin
- Department of Renal Medicine, University College London, London, UK
| | - Matthias Endres
- Klinik und Hochschulambulanz für Neurologie, Charité-Universitätsmedizin Berlin, Berlin, Germany
| | - Giuseppe Remuzzi
- Istituto di Ricerche Farmacologiche Mario Negri IRCCS, Bergamo, Italy
| | - Norberto Perico
- Istituto di Ricerche Farmacologiche Mario Negri IRCCS, Bergamo, Italy
| | - Ron Gansevoort
- Department of Internal Medicine, University Medical Center Groningen, Groningen, The Netherlands
| | - Francesco Mattace-Raso
- Department of Internal Medicine, Erasmus MC University Medical Center, Rotterdam, The Netherlands
| | - Annette Bruchfeld
- Unit of Renal Medicine, Linköping and Karolinska University Hospital, Stockholm, Sweden
| | - Andreja Figurek
- Institute of Anatomy, University of Zurich, Zurich, Switzerland
| | - Gaye Hafez
- Department of Pharmacology, Faculty of Pharmacy, Altinbas University, Istanbul, Turkey
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Li H, Zhao S, Wang R, Gao B. The association between cognitive impairment/dementia and albuminuria: a systematic review and meta-analysis. Clin Exp Nephrol 2021; 26:45-53. [PMID: 34468878 PMCID: PMC8738457 DOI: 10.1007/s10157-021-02127-3] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/16/2021] [Accepted: 08/15/2021] [Indexed: 11/20/2022]
Abstract
Background To identify the association between albuminuria and dementia or cognitive impairment. Methods The literature search was performed to identify relevant scientific studies through August 2019, including PubMed/Medline and EMBASE. For inclusion, the studies had to fulfil the following criteria: population-based cohort, case–control or cross-sectional studies; quantifying an association of albuminuria with cognitive impairment or dementia; and reported odds ratio (OR), and the corresponding 95% confidential interval (95% CI). Random effects model was used to yield pooled estimates. Results A total of 16 studies (11 cohort studies and five cross-sectional studies) were included in the meta-analyses. Based on the fully adjusted estimates, albuminuria was associated with a significant higher risk of cognitive impairment or dementia. Furthermore, the same trend existed for cognitive impairment and dementia, respectively. In addition, both of Alzheimer’s diseases (AD) and vascular dementia (VaD) were significantly associated with albuminuria. Conclusion Albuminuria was significantly associated with cognitive impairment and dementia. Corresponding to an earlier subclinical time-point in kidney disease progress, albuminuria may be a potential factor predicting the future occurrence of dementia. Supplementary Information The online version contains supplementary material available at 10.1007/s10157-021-02127-3.
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Affiliation(s)
- Hongqin Li
- Department II of Urology, First Hospital of Jilin University, No. 71 Xinmin Street, Changchun, 130021, Jilin, China.,School of Pharmaceutical Science, Jilin University, Changchun, Jilin, China
| | - Shuailin Zhao
- Department II of Urology, First Hospital of Jilin University, No. 71 Xinmin Street, Changchun, 130021, Jilin, China
| | - Ruiyu Wang
- Department II of Urology, First Hospital of Jilin University, No. 71 Xinmin Street, Changchun, 130021, Jilin, China
| | - Baoshan Gao
- Department II of Urology, First Hospital of Jilin University, No. 71 Xinmin Street, Changchun, 130021, Jilin, China.
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Alvarez-Bueno C, Cunha PG, Martinez-Vizcaino V, Pozuelo-Carrascosa DP, Visier-Alfonso ME, Jimenez-Lopez E, Cavero-Redondo I. Arterial Stiffness and Cognition Among Adults: A Systematic Review and Meta-Analysis of Observational and Longitudinal Studies. J Am Heart Assoc 2020; 9:e014621. [PMID: 32106748 PMCID: PMC7335587 DOI: 10.1161/jaha.119.014621] [Citation(s) in RCA: 35] [Impact Index Per Article: 8.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
Background To estimate the strength of the cross‐sectional and longitudinal association between arterial stiffness, measured by pulse‐wave velocity, and cognitive function, distinguishing between global cognition, executive functions, and memory and to examine the influence of demographic, clinical, and assessment characteristics on this relationship. Methods and Results Systematic review of MEDLINE (via PubMed), Scopus, and WOS databases from their inception to March 2019, to identify cross‐sectional and longitudinal studies on the association between pulse‐wave velocity and cognitive domains (ie, global cognition, executive functions, and memory) among adult population. A total of 29 cross‐sectional and 9 longitudinal studies support the negative relationship between arterial stiffness and cognitive function, including global cognition, executive function, and memory. Demographic, clinical, and assessment characteristics did not substantially modify the strength of this association. Conclusions Evidence reveals a negative association between arterial stiffness, measured using pulse‐wave velocity, and cognition, specifically executive function, memory, and global cognition. This association seems to be independent of demographic, clinical, and assessment characteristics. These results accumulate evidence supporting that pulse‐wave velocity assessment could be a useful tool to identify individuals at high risk of cognitive decline or early stages of cognitive decline, to implement interventions aimed at slowing the progression to dementia.
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Affiliation(s)
- Celia Alvarez-Bueno
- Universidad de Castilla-La Mancha Health and Social Research Center Cuenca Spain
| | - Pedro G Cunha
- Internal Medicine Department Center for the Research and Treatment of Arterial Hypertension and Cardiovascular Risk Guimarães Portugal
| | - Vicente Martinez-Vizcaino
- Universidad de Castilla-La Mancha Health and Social Research Center Cuenca Spain.,Facultad de Ciencias de la Salud Universidad Autónoma de Chile Talca Chile
| | | | | | - Estela Jimenez-Lopez
- Universidad de Castilla-La Mancha Health and Social Research Center Cuenca Spain.,Department of Psychiatry Hospital Virgen de La Luz Cuenca Spain.,CIBERSAM (Biomedical Research Networking Centre in Mental Health) Barcelona Spain
| | - Ivan Cavero-Redondo
- Universidad de Castilla-La Mancha Health and Social Research Center Cuenca Spain
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4
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Impact of cystatin C and microalbuminuria on cognitive impairment in the population of community-dwelling Japanese. Atherosclerosis 2017; 265:71-77. [PMID: 28865325 DOI: 10.1016/j.atherosclerosis.2017.08.022] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/27/2017] [Revised: 08/16/2017] [Accepted: 08/23/2017] [Indexed: 12/16/2022]
Abstract
BACKGROUND AND AIMS Cognitive impairment is an important element affecting our well-being, and as such, early diagnosis is critical today. We investigated whether serum cystatin C and microalbuminuria are associated with cognitive impairment. METHODS A total of 1943 subjects (774 males, 1169 females, mean age 65.8 years) took part in the investigation, and underwent a health examination in Tanushimaru, Japan, in 2009. The participants' cognitive function was evaluated using of mini-mental state examination (MMSE). We measured the levels of serum cystatin C using latex nephelometric immunoassay. Spot urine samples were used to measure microalbuminuria levels. Multivariate linear regression analyses were used to assess the relationship between MMSE scores and the level of cystatin C or microalbuminuria. All statistical analyses were performed using the SAS system. RESULTS The mean values of log-transformed serum cystatin C levels and log-transformed microalbuminuria were 0.95 (range 0.41-7.11) mg/L and 10.7 (range 1.1-2600) mg/g·Cr, respectively. The means of MMSE score were 27.7 ± 2.5. In the multivariate linear regression analyses adjusted for age and sex, MMSE was significantly associated with systolic blood pressure (p = 0.024, inversely), cystatin C (p = 0.046, inversely) and microalbuminuria (p = 0.019, inversely), whereas estimated glomerular filtration rate (eGFR) had an insignificant association (p = 0.197). In the multiple stepwise linear regression analysis, age, history of stroke, systolic blood pressure, serum cystatin C were independently associated with MMSE levels. CONCLUSIONS We demonstrated for the first time that cognitive function was significantly and inversely associated with cystatin C and microalbuminuria, in the relatively younger general population.
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Georgakis MK, Dimitriou NG, Karalexi MA, Mihas C, Nasothimiou EG, Tousoulis D, Tsivgoulis G, Petridou ET. Albuminuria in Association with Cognitive Function and Dementia: A Systematic Review and Meta-Analysis. J Am Geriatr Soc 2017; 65:1190-1198. [PMID: 28152169 DOI: 10.1111/jgs.14750] [Citation(s) in RCA: 41] [Impact Index Per Article: 5.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/13/2023]
Abstract
OBJECTIVES Cerebral microvascular disease is considered to contribute to cognitive dysfunction. We opted to explore whether albuminuria, a marker of systemic microangiopathy, is associated with cognitive impairment, dementia, and cognitive function. DESIGN Systematic review; independent reviewers screened 2359 articles, derived through the search strategy, for identification of observational studies quantifying an association of albuminuria with the outcomes of interest, abstracted data on study characteristics and results and evaluated studies on quality using the Newcastle-Ottawa scale. SETTING Community. PARTICIPANTS Adults. MESUREMENTS Cognitive impairment and dementia, defined by validated neuropsychological tests or clinical guidelines, respectively, and cognitive function, assessed by validated instruments. RESULTS Thirty-two eligible studies were identified. Albuminuria was associated with cognitive impairment (Odds Ratio (OR): 1.35, 95% Confidence Interval (CI): 1.19-1.53; 7,852 cases), dementia (OR: 1.35, 95% CI: 1.10-1.65; 5,758 cases), clinical Alzheimer's disease (OR: 1.37, 95% CI: 1.11-1.69; 629 cases) and vascular dementia (OR: 1.96, 95% CI: 1.16-3.31; 186 cases); the effect remained significant among longitudinal, population-based and high quality studies. Time-to-event analysis on prospective studies of non-demented at baseline individuals also showed a significant association with incident dementia (Risk Ratio: 1.52, 95% CI: 1.16-1.99; 971 cases). Worse global cognitive performance (Hedge's g: -0.13, 95% CI: -0.18, -0.09; 68,348 subjects) and accelerated cognitive decline (g: -0.20, 95% CI: -0.34, -0.07; 31,792 subjects) were noted among subjects with albuminuria, who also scored lower in executive function, processing speed, verbal fluency, and verbal memory. CONCLUSIONS Albuminuria was independently associated with cognitive impairment, dementia and cognitive decline. The stronger effects for vascular dementia and cognitive performance in domains primarily affected by microvascular disease support that the association could be mediated by shared microvascular pathology in the kidney and the brain.
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Affiliation(s)
- Marios K Georgakis
- Department of Hygiene, Epidemiology and Medical Statistics, School of Medicine, National and Kapodistrian University of Athens, Athens, Greece
| | - Nikolaos G Dimitriou
- Department of Hygiene, Epidemiology and Medical Statistics, School of Medicine, National and Kapodistrian University of Athens, Athens, Greece
| | - Maria A Karalexi
- Department of Hygiene, Epidemiology and Medical Statistics, School of Medicine, National and Kapodistrian University of Athens, Athens, Greece
| | - Constantinos Mihas
- Department of Hygiene, Epidemiology and Medical Statistics, School of Medicine, National and Kapodistrian University of Athens, Athens, Greece.,Internal Medicine Department, General Hospital of Kimi, Kimi, Greece
| | - Efthimia G Nasothimiou
- Hypertension Unit and Cardiovascular Research Laboratory, First Department of Propaedeutic Internal Medicine, Laiko Hospital, Athens, Greece
| | - Dimitrios Tousoulis
- First Department of Cardiology, School of Medicine, Hippokrateion Hospital, National and Kapodistrian University of Athens, Athens, Greece
| | - Georgios Tsivgoulis
- Second Department of Neurology, Attikon University General Hospital, School of Medicine, National and Kapodistrian University of Athens, Athens, Greece.,Department of Neurology, University of Tennessee Health Sciences Center, Memphis, Tennessee, USA.,International Clinical Research Center, St. Anne's University Hospital in Brno, Brno, Czech Republic
| | - Eleni Th Petridou
- Department of Hygiene, Epidemiology and Medical Statistics, School of Medicine, National and Kapodistrian University of Athens, Athens, Greece
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Martens RJH, Kooman JP, Stehouwer CDA, Dagnelie PC, van der Kallen CJH, Koster A, Kroon AA, Leunissen KML, Nijpels G, van der Sande FM, Schaper NC, Sep SJS, van Boxtel MPJ, Schram MT, Henry RMA. Estimated GFR, Albuminuria, and Cognitive Performance: The Maastricht Study. Am J Kidney Dis 2016; 69:179-191. [PMID: 27291486 DOI: 10.1053/j.ajkd.2016.04.017] [Citation(s) in RCA: 54] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/05/2015] [Accepted: 04/24/2016] [Indexed: 11/11/2022]
Abstract
BACKGROUND Reduced estimated glomerular filtration rate (eGFR) and albuminuria have been associated with worse cognitive performance. However, few studies have examined whether these associations are confined to older individuals or may be extended to the middle-aged population. STUDY DESIGN Cross-sectional analyses of a prospective population-based cohort study. SETTING & PARTICIPANTS 2,987 individuals aged 40 to 75 years from the general population (The Maastricht Study). PREDICTOR eGFR and urinary albumin excretion (UAE). OUTCOMES Memory function, information processing speed, and executive function. MEASUREMENTS Analyses were adjusted for demographic variables (age, sex, and educational level), lifestyle factors (smoking behavior and alcohol consumption), depression, and cardiovascular disease risk factors (glucose metabolism status, waist circumference, total to high-density lipoprotein cholesterol ratio, triglyceride level, use of lipid-modifying medication, systolic blood pressure, use of antihypertensive medication, and prevalent cardiovascular disease). RESULTS UAE was <15mg/24 h in 2,439 (81.7%) participants, 15 to <30 mg/24 h in 309 (10.3%), and ≥30mg/24 h in 239 (8.0%). In the entire study population, UAE≥30mg/24 h was associated with lower information processing speed as compared to UAE<15mg/24 h (β [SD difference] = -0.148; 95% CI, -0.263 to -0.033) after full adjustment, whereas continuous albuminuria was not. However, significant interaction terms (P for interaction < 0.05) suggested that albuminuria was most strongly and extensively associated with cognitive performance in older individuals. Mean (±SD) eGFR, estimated by the CKD-EPI (Chronic Kidney Disease Epidemiology Collaboration) creatinine-cystatin C equation (eGFRcr-cys), was 88.4±14.6 mL/min/1.73m2. eGFRcr-cys was not associated with any of the domains of cognitive performance after full adjustment. However, significant interaction terms (P for interaction < 0.05) suggested that eGFRcr-cys was associated with cognitive performance in older individuals. LIMITATIONS Cross-sectional design, which limited causal inferences. CONCLUSIONS In the entire study population, albuminuria was independently associated with lower information processing speed, whereas eGFRcr-cys was not associated with cognitive performance. However, both were more strongly and extensively associated with cognitive performance in older individuals.
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Affiliation(s)
- Remy J H Martens
- Division of Nephrology, Department of Internal Medicine, Maastricht University Medical Center, Maastricht, the Netherlands; NUTRIM School of Nutrition and Translational Research in Metabolism, Maastricht University, Maastricht, the Netherlands
| | - Jeroen P Kooman
- Division of Nephrology, Department of Internal Medicine, Maastricht University Medical Center, Maastricht, the Netherlands; NUTRIM School of Nutrition and Translational Research in Metabolism, Maastricht University, Maastricht, the Netherlands
| | - Coen D A Stehouwer
- Department of Internal Medicine, Maastricht University Medical Center, Maastricht, the Netherlands; CARIM School for Cardiovascular Diseases, Maastricht University, Maastricht, the Netherlands
| | - Pieter C Dagnelie
- CARIM School for Cardiovascular Diseases, Maastricht University, Maastricht, the Netherlands; CAPHRI School for Public Health and Primary Care, Maastricht University, Maastricht, the Netherlands; Department of Epidemiology, Maastricht University, Maastricht, the Netherlands
| | - Carla J H van der Kallen
- Department of Internal Medicine, Maastricht University Medical Center, Maastricht, the Netherlands; CARIM School for Cardiovascular Diseases, Maastricht University, Maastricht, the Netherlands
| | - Annemarie Koster
- CAPHRI School for Public Health and Primary Care, Maastricht University, Maastricht, the Netherlands; Department of Social Medicine, Maastricht University, Maastricht, the Netherlands
| | - Abraham A Kroon
- Department of Internal Medicine, Maastricht University Medical Center, Maastricht, the Netherlands; CARIM School for Cardiovascular Diseases, Maastricht University, Maastricht, the Netherlands
| | - Karel M L Leunissen
- Division of Nephrology, Department of Internal Medicine, Maastricht University Medical Center, Maastricht, the Netherlands; NUTRIM School of Nutrition and Translational Research in Metabolism, Maastricht University, Maastricht, the Netherlands
| | - Giel Nijpels
- Department of General Practice, VU University Medical Center, Amsterdam, the Netherlands; EMGO Institute for Health and Care Research, VU University Medical Center, Amsterdam, the Netherlands
| | - Frank M van der Sande
- Division of Nephrology, Department of Internal Medicine, Maastricht University Medical Center, Maastricht, the Netherlands
| | - Nicolaas C Schaper
- Department of Internal Medicine, Maastricht University Medical Center, Maastricht, the Netherlands; CARIM School for Cardiovascular Diseases, Maastricht University, Maastricht, the Netherlands; CAPHRI School for Public Health and Primary Care, Maastricht University, Maastricht, the Netherlands
| | - Simone J S Sep
- Department of Internal Medicine, Maastricht University Medical Center, Maastricht, the Netherlands; CARIM School for Cardiovascular Diseases, Maastricht University, Maastricht, the Netherlands
| | - Martin P J van Boxtel
- Department of Psychiatry and Neuropsychology, Alzheimer Centre Limburg, Maastricht University Medical Center, Maastricht, the Netherlands; MHeNs School for Mental Health and Neuroscience, Maastricht University, Maastricht, the Netherlands
| | - Miranda T Schram
- Department of Internal Medicine, Maastricht University Medical Center, Maastricht, the Netherlands; CARIM School for Cardiovascular Diseases, Maastricht University, Maastricht, the Netherlands
| | - Ronald M A Henry
- Department of Internal Medicine, Maastricht University Medical Center, Maastricht, the Netherlands; CARIM School for Cardiovascular Diseases, Maastricht University, Maastricht, the Netherlands.
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Lim SL, Gao Q, Nyunt MSZ, Gong L, Lunaria JB, Lim ML, Ling A, Lam CSP, Richards AM, Ling LH, Ng TP. Vascular Health Indices and Cognitive Domain Function: Singapore Longitudinal Ageing Studies. J Alzheimers Dis 2015; 50:27-40. [DOI: 10.3233/jad-150516] [Citation(s) in RCA: 31] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/21/2023]
Affiliation(s)
- Shir Lynn Lim
- Department of Cardiology, National University Heart Center, Singapore
| | - Qi Gao
- Gerontology Research Programme, Department of Psychological Medicine, Yong Loo Lin School of Medicine, National University of Singapore, Singapore
| | - Ma Shwe Zin Nyunt
- Gerontology Research Programme, Department of Psychological Medicine, Yong Loo Lin School of Medicine, National University of Singapore, Singapore
| | - Lingli Gong
- Department of Medicine, Yong Loo Lin School of Medicine, National University of Singapore, Singapore
| | - Josephine B. Lunaria
- Department of Medicine, Yong Loo Lin School of Medicine, National University of Singapore, Singapore
| | - May Li Lim
- Gerontology Research Programme, Department of Psychological Medicine, Yong Loo Lin School of Medicine, National University of Singapore, Singapore
| | - Audrey Ling
- Gerontology Research Programme, Department of Psychological Medicine, Yong Loo Lin School of Medicine, National University of Singapore, Singapore
| | - Carolyn Su-Ping Lam
- Department of Cardiology, National University Heart Center, Singapore
- Department of Medicine, Yong Loo Lin School of Medicine, National University of Singapore, Singapore
- Department of Cardiology, National Heart Center, Singapore
- Cardiovascular and Metabolic Disorders Program, Duke-NUS Graduate Medical School Singapore, Singapore
| | - Arthur Mark Richards
- Department of Medicine, Yong Loo Lin School of Medicine, National University of Singapore, Singapore
- Cardiovascular Research Institute, National University Health System, Singapore
- Christchurch Heart Institute, University of Otago, New Zealand
| | - Lieng Hsi Ling
- Department of Cardiology, National University Heart Center, Singapore
- Department of Medicine, Yong Loo Lin School of Medicine, National University of Singapore, Singapore
| | - Tze Pin Ng
- Gerontology Research Programme, Department of Psychological Medicine, Yong Loo Lin School of Medicine, National University of Singapore, Singapore
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Barzilay JI, Morgan TM, Murray AM, Bryan RN, Williamson JD, Schnall A, Launer LJ. Brain MRI Volume Findings in Diabetic Adults With Albuminuria: The ACCORD-MIND Study. J Gerontol A Biol Sci Med Sci 2015; 71:803-10. [PMID: 26589241 DOI: 10.1093/gerona/glv187] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/25/2015] [Accepted: 09/28/2015] [Indexed: 01/19/2023] Open
Abstract
BACKGROUND Albuminuria is associated with cognitive impairment in people with type 2 diabetes mellitus (T2DM). The brain volume correlates of albuminuria in people with T2DM have not been well investigated. METHODS We examined 502 individuals with T2DM (9-12 years duration; mean age ~62 years) who had a brain MRI at baseline and at 40 months. Baseline MRI findings were examined by the presence or absence of albuminuria (≥30mg/g creatinine). Changes in MRI findings were examined by whether albuminuria was persistent, intermittent, or absent during follow-up. RESULTS At baseline, participants with albuminuria (28.7% of the cohort) had more abnormal white matter volume (AWMV) than participants without albuminuria on unadjusted analysis. This difference was attenuated with adjustment for systolic blood pressure, which was higher in participants with albuminuria than in those without albuminuria. During ~3.5 years of follow-up, participants with persistent albuminuria (15.8%) had a greater increase in new AWMV than participants without albuminuria (59.8%) or those with intermittent albuminuria on unadjusted analysis. This difference was attenuated with adjustment for age and systolic blood pressure. There were no significant differences in gray matter volume and total brain volume between participants with or without albuminuria at baseline or during follow-up. There was no significant effect modification of these findings by estimated glomerular filtration rate (eGFR) at baseline or change in eGFR during follow-up. CONCLUSIONS In this diabetic cohort, baseline albuminuria and persistent albuminuria were not independently associated with any significant differences in brain volume measurements compared with participants without albuminuria.
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Affiliation(s)
- Joshua I Barzilay
- Division of Endocrinology, Kaiser Permanente of Georgia and the Division of Endocrinology, Emory University School of Medicine, Atlanta, Georgia.
| | - Timothy M Morgan
- Department of Biostatistical Sciences, Wake Forest University, Winston Salem, North Carolina
| | - Anne M Murray
- Division of Geriatrics, Department of Medicine, Hennepin County Medical Center and University of Minnesota, Minneapolis
| | - R Nick Bryan
- Department of Radiology, University of Pennsylvania Health System, Philadelphia
| | - Jeff D Williamson
- Sticht Center on Aging, Wake Forest University, Winston Salem, North Carolina
| | - Adrian Schnall
- Department of Medicine, Case Western Reserve University School of Medicine, Cleveland, Ohio
| | - Lenore J Launer
- Laboratory of Epidemiology and Population Sciences, Intramural Research Program, National Institute on Aging, Bethesda, Maryland
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9
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van der Veen PH, Geerlings MI, Visseren FLJ, Nathoe HM, Mali WPTM, van der Graaf Y, Muller M. Hypertensive Target Organ Damage and Longitudinal Changes in Brain Structure and Function: The Second Manifestations of Arterial Disease-Magnetic Resonance Study. Hypertension 2015; 66:1152-8. [PMID: 26503971 DOI: 10.1161/hypertensionaha.115.06268] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/18/2015] [Accepted: 06/10/2015] [Indexed: 01/19/2023]
Abstract
Hypertension has been related to structural and functional brain changes. In high-risk populations, hypertensive target organ damage might better represent exposure to high blood pressure than the blood pressure measurement itself. We examined the association of hypertensive target organ damage with longitudinal changes in brain structure and function within the Second Manifestations of Arterial Disease-Magnetic Resonance (SMART-MR) study. Renal function, albuminuria, and left ventricular hypertrophy on electrocardiography were measured in 663 patients with manifest arterial disease (mean age, 57±9 years; 81% men). Automated brain segmentation was used to quantify progression of global brain atrophy (change in brain parenchymal fraction) and progression of cerebral small vessel disease on 1.5T magnetic resonance imaging, and memory and executive functioning were assessed at baseline and after on average 3.9 years of follow-up. Regression analyses showed that an increasing number of signs of target organ damage was associated with more progression of global brain atrophy and more rapid decline in memory performance. Compared with no target organ damage, mean differences in change in brain parenchymal fraction (95% confidence interval) for 1 and ≥2 signs of organ damage were -0.12 (-0.30; 0.06) and -0.41 (-0.77; -0.05) % intracranial volume, and mean (95% confidence interval) differences in change in memory performance (z score) were -0.15 (-0.29; -0.00) and -0.27 (-0.54; -0.01). Results were independent of blood pressure, antihypertensive treatment, and other confounders. Hypertension target organ damage was not associated with progression of cerebral small vessel disease or change in executive functioning. Routinely assessed signs of hypertensive target organ damage, and in particular impaired renal function, could be used to identify patients at the highest risk of cognitive decline.
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Affiliation(s)
- Pieternella H van der Veen
- From the Department of Radiology (P.H.v.d.V., W.P.T.M.M.), Julius Center for Health Sciences and Primary Care (P.H.v.d.V., M.I.G., Y.v.d.G.), Department of Vascular Medicine (F.L.J.V.), and Department of Cardiology (H.M.N.), University Medical Center Utrecht, Utrecht, The Netherlands; and Department of Gerontology and Geriatrics, Leiden University Medical Center, Leiden, The Netherlands (M.M.)
| | - Mirjam I Geerlings
- From the Department of Radiology (P.H.v.d.V., W.P.T.M.M.), Julius Center for Health Sciences and Primary Care (P.H.v.d.V., M.I.G., Y.v.d.G.), Department of Vascular Medicine (F.L.J.V.), and Department of Cardiology (H.M.N.), University Medical Center Utrecht, Utrecht, The Netherlands; and Department of Gerontology and Geriatrics, Leiden University Medical Center, Leiden, The Netherlands (M.M.).
| | - Frank L J Visseren
- From the Department of Radiology (P.H.v.d.V., W.P.T.M.M.), Julius Center for Health Sciences and Primary Care (P.H.v.d.V., M.I.G., Y.v.d.G.), Department of Vascular Medicine (F.L.J.V.), and Department of Cardiology (H.M.N.), University Medical Center Utrecht, Utrecht, The Netherlands; and Department of Gerontology and Geriatrics, Leiden University Medical Center, Leiden, The Netherlands (M.M.)
| | - Hendrik M Nathoe
- From the Department of Radiology (P.H.v.d.V., W.P.T.M.M.), Julius Center for Health Sciences and Primary Care (P.H.v.d.V., M.I.G., Y.v.d.G.), Department of Vascular Medicine (F.L.J.V.), and Department of Cardiology (H.M.N.), University Medical Center Utrecht, Utrecht, The Netherlands; and Department of Gerontology and Geriatrics, Leiden University Medical Center, Leiden, The Netherlands (M.M.)
| | - Willem P T M Mali
- From the Department of Radiology (P.H.v.d.V., W.P.T.M.M.), Julius Center for Health Sciences and Primary Care (P.H.v.d.V., M.I.G., Y.v.d.G.), Department of Vascular Medicine (F.L.J.V.), and Department of Cardiology (H.M.N.), University Medical Center Utrecht, Utrecht, The Netherlands; and Department of Gerontology and Geriatrics, Leiden University Medical Center, Leiden, The Netherlands (M.M.)
| | - Yolanda van der Graaf
- From the Department of Radiology (P.H.v.d.V., W.P.T.M.M.), Julius Center for Health Sciences and Primary Care (P.H.v.d.V., M.I.G., Y.v.d.G.), Department of Vascular Medicine (F.L.J.V.), and Department of Cardiology (H.M.N.), University Medical Center Utrecht, Utrecht, The Netherlands; and Department of Gerontology and Geriatrics, Leiden University Medical Center, Leiden, The Netherlands (M.M.)
| | - Majon Muller
- From the Department of Radiology (P.H.v.d.V., W.P.T.M.M.), Julius Center for Health Sciences and Primary Care (P.H.v.d.V., M.I.G., Y.v.d.G.), Department of Vascular Medicine (F.L.J.V.), and Department of Cardiology (H.M.N.), University Medical Center Utrecht, Utrecht, The Netherlands; and Department of Gerontology and Geriatrics, Leiden University Medical Center, Leiden, The Netherlands (M.M.)
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Gul CB, Oz Gul O, Cander S, Eroglu A, Hartavi M, Keni N, Bayindir A, Ersoy C, Ertürk E, Tuncel E, İmamoğlu Ş. Relationship between glycemic control, microalbuminuria and cognitive functions in elderly type 2 diabetic patients. Ren Fail 2014; 36:1258-62. [DOI: 10.3109/0886022x.2014.938576] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
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O'Hare AM, Walker R, Haneuse S, Crane PK, McCormick WC, Bowen JD, Larson EB. Relationship between longitudinal measures of renal function and onset of dementia in a community cohort of older adults. J Am Geriatr Soc 2013; 60:2215-22. [PMID: 23231548 DOI: 10.1111/j.1532-5415.2012.04238.x] [Citation(s) in RCA: 33] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
OBJECTIVES To evaluate the association between dynamic measures of renal function ascertained over time and onset of dementia. DESIGN Prospective community cohort study. SETTING Group Health, Seattle, Washington. PARTICIPANTS Two thousand nine hundred sixty-eight adults aged 65 and older followed for the development of dementia over a median of 6.0 years (interquartile range 3.1-10.1 years). MEASUREMENTS Time-varying measures of renal function were constructed based on 49,340 serum creatinine measurements and included average estimated glomerular filtration rate (eGFR), eGFR trajectory, and variability in eGFR around this trajectory over 5-year exposure windows. The association between these three eGFR exposure measures and risk of dementia was estimated using a Cox regression model adjusted for other participant characteristics. Time-varying measures of urine protein by dipstick were also adjusted for in sensitivity analyses. RESULTS Participants with a lower eGFR had a higher incidence of dementia, but this did not reach statistical significance in adjusted analyses (omnibus P = .14). There were trends toward a higher adjusted incidence of dementia in participants with positive eGFR trajectories (omnibus P = .07) and greater variability in eGFR (omnibus P = .04) over time. The results of sensitivity analyses, including those in which time-varying measures of proteinuria were included, were consistent with those of the primary analysis. CONCLUSION In a community cohort of older adults followed for a median of 6 years, strong associations were not found between measures of kidney disease severity and progression and incident dementia.
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Affiliation(s)
- Ann M O'Hare
- Group Health Research Institute, Group Health Cooperative, Seattle, Washington 98119, USA.
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Heringa SM, van den Berg E, Dekker JM, Nijpels G, Kessels RPC, Kappelle LJ, Stehouwer CDA, Biessels GJ. Albuminuria and cognitive functioning in an older population: the Hoorn study. Dement Geriatr Cogn Disord 2012; 32:182-7. [PMID: 22024942 DOI: 10.1159/000333076] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 09/12/2011] [Indexed: 11/19/2022] Open
Abstract
BACKGROUND/AIMS Markers of vascular disease elsewhere in the body may reflect vascular abnormalities in the brain relevant to age-related cognitive decline and dementia. We examined the association between albuminuria, as a marker of microvascular damage, and cognition in older individuals. METHODS 380 individuals (age 73 ± 6 years), participating in the population-based Hoorn Study, underwent extensive neuropsychological examination in 2005-2008, and urinary albumin-to-creatinine ratios measurements in 2000-2001 (n = 378) and/or 2005-2008 (n = 346). Cognition was expressed in z-scores on 6 domains. RESULTS In 2000-2001, 42 participants were with and 336 without albuminuria, and in 2005-2008 51 were with and 295 were without. In age-, sex- and premorbid IQ-adjusted analyses, participants with albuminuria 5-7 years earlier had slightly lower z-scores for the domains attention and executive functioning [mean difference: -0.21 (95% CI -0.40 to -0.02)] and language [-0.36 (95% CI -0.63 to -0.09)]. No statistically significant differences in cognition were found between participants with and without albuminuria at the time of neuropsychological testing. CONCLUSION Albuminuria predicts future modest cognitive decrements, but concurrent albuminuria is unrelated to cognitive functioning. The link between albuminuria and cognitive dysfunction may convey an etiological message, but because effect sizes were modest its value in prognostic models for cognitive decline may be limited.
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Affiliation(s)
- S M Heringa
- Department of Neurology, Rudolf Magnus Institute of Neuroscience, University Medical Center, Utrecht, The Netherlands. s.m.heringa @ umcutrecht.nl
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Abdelhafiz AH, Ahmed S, El Nahas M. Microalbuminuria: marker or maker of cardiovascular disease. Nephron Clin Pract 2011; 119 Suppl 1:e6-10. [PMID: 21832857 DOI: 10.1159/000328015] [Citation(s) in RCA: 67] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022] Open
Abstract
Advancing age is associated with albuminuria and vascular changes. This review will explore the putative links between the two. Vascular ageing involves endothelial dysfunction as well as increased arterial diameter, wall thickness and stiffness, ultimately leading to arterial sclerosis. This process is accelerated by a defective vascular repair process. Endothelial dysfunction is likely to be involved in the initiation and development of microalbuminuria. It is often followed by the development and progression of atherosclerosis. Initially, microalbuminuria is reversible but becomes fixed with the progression of vascular structural changes including glomerulosclerosis. The prevalence of microalbuminuria increases with age and has been shown to be a marker of widespread microvasculopathy at various levels including cerebral, cardiac and renal microcirculations. This has been linked to endpoint clinical events, with microalbuminuria increasing the risk of cognitive impairment and strokes, cardiovascular disease outcomes, and progression to end-stage renal failure. Evidence of microvascular damage such as microalbuminuria associated with increased cardiovascular risk may suggest that microvascular damage and dysfunction predate overt macrovascular disease. Microalbuminuria and reduced glomerular filtration rate (GFR) may be markers of different pathologic processes. It is likely that microalbuminuria and reduced GFR simply represent, respectively, the spectrum of renal vascular manifestations from systemic endothelial dysfunction (microvascular disease) to systemic atherosclerosis (macrovascular disease).
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Affiliation(s)
- Ahmed H Abdelhafiz
- Department of Elderly Medicine, Rotherham General Hospital, Rotherham, UK. ahmedhafiz @ hotmail.com
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Joosten H, Izaks GJ, Slaets JPJ, de Jong PE, Visser ST, Bilo HJG, Gansevoort RT. Association of cognitive function with albuminuria and eGFR in the general population. Clin J Am Soc Nephrol 2011; 6:1400-9. [PMID: 21566108 PMCID: PMC3109938 DOI: 10.2215/cjn.05530610] [Citation(s) in RCA: 47] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/28/2010] [Accepted: 01/30/2011] [Indexed: 11/23/2022]
Abstract
BACKGROUND AND OBJECTIVES Recent studies found different associations of cognitive function with albuminuria or estimated GFR (eGFR). Most studies were limited to the elderly or did not take both renal variables into account. Therefore, this study analyzed the association of cognitive function with albuminuria and eGFR in community-dwelling persons aged 35 to 82 years. DESIGN, SETTING, PARTICIPANTS, & MEASUREMENTS This was a cross-sectional study comprising 4095 participants of the Prevention of Renal and Vascular End-Stage Disease (PREVEND) study. Cognitive function, measured with the Ruff Figural Fluency Test (RFFT), was treated as the dependent variable, and albuminuria and eGFR were treated as independent variables. RESULTS The prevalence of albuminuria <10, 10 to 29, and ≥30 mg/24 h was 54%, 31%, and 15%, respectively. Mean eGFR (± SD) was 79 ± 15 ml/min per 1.73 m(2). Because of interaction between albuminuria and age, analyses were performed per age tertile. After multivariate adjustment, albuminuria ≥ 30 mg/24 h, but not eGFR, was associated with lower RFFT score in the youngest tertile (B -5.3; 95% CI, -0.6 to -9.2; P = 0.05), but not in older tertiles. Moreover, subjects in the youngest tertile with increasing albuminuria (5-15 and >15 mg/24 h) before RFFT measurement had lower mean RFFT scores than subjects with stable albuminuria: mean difference -4.9 (P = 0.3) and -6.7 (P = 0.03), respectively. CONCLUSIONS In this community-based cohort, elevated albuminuria was associated with worse cognitive function in young but not in old persons. There was no association of eGFR with cognitive function.
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Affiliation(s)
- Hanneke Joosten
- Department of Internal Medicine, University Medical Centre Groningen, University of Groningen, Groningen, The Netherlands.
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Rabkin SW, Jarvie G. Comparison of vascular stiffness in vascular dementia, Alzheimer dementia and cognitive impairment. Blood Press 2011; 20:274-83. [PMID: 21623679 DOI: 10.3109/08037051.2011.566246] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/19/2023]
Abstract
Abstract Defining the vascular component(s) of the clinical diagnosis of vascular cognitive impairment (VCI) and vascular dementia (VaD) continues to be problematic. The goal of this study was to determine whether vascular stiffness, measured by pulse wave velocity (PWV), is altered in VaD, to study the utility of PWV in differentiating VaD from Alzheimer dementia (AD) and the relationship between PWV and cognitive function. A qualitative and quantitative structured analysis of the literature was conducted until September 2010, using a search strategy based on the key words: dementia, vascular dementia, dementia of vascular origin, cognitive function and arterial stiffness or pulse wave velocity. Seventeen studies assessed large vessel vascular stiff by PWV and related it to cognitive function or dementia. Six of these studies compared PWV in 154 persons with VaD, 207 with AD and 197 controls without dementia. Mean PWV was significantly (p < 0.0001) higher in VaD compared with controls. Mean PWV was significantly (p = 0.002) higher in VaD compared with AD. Fourteen studies examined the relationship between PWV and cognitive function. The majority of studies (nine of 14) reported a significant correlation between PWV and cognitive function. Four of eight studies that evaluated the relation using univariate analysis reported a significant correlation of PWV with the Mini Mental State Exam (MMSE) or Hasegawa Dementia Scale, and the correlation with MMSE between studies showed a close agreement of correlation coefficients (0.206 to 0.27). In multivariate analysis, adjusted for a wide range of possible confounding factors, the majority or 80% (eight out of 10) studies comprising a population of 6,034 individuals found a significant inverse relationship between PWV and cognitive function. In summary, vascular stiffness is inversely related to cognitive function. Vascular stiffness is greater in VaD compared with AD, suggesting PWV may be useful in identifying VaD.
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Affiliation(s)
- Simon W Rabkin
- Department of Medicine, University of British Columbia, Vancouver, B.C., Canada.
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Carlson BW, Neelon VJ, Carlson JR, Hartman M, Bliwise DL. Cerebral oxygenation in wake and during sleep and its relationship to cognitive function in community-dwelling older adults without sleep disordered breathing. J Gerontol A Biol Sci Med Sci 2011; 66:150-6. [PMID: 21076087 PMCID: PMC3011955 DOI: 10.1093/gerona/glq200] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/16/2010] [Accepted: 09/24/2010] [Indexed: 11/12/2022] Open
Abstract
BACKGROUND This descriptive cross-sectional study investigated the relationships between cerebral oxygen reserve and cognitive function in community-dwelling older adults. METHODS Participants (72 women and 40 men) underwent standard polysomnography, including regional measures of percent oxyhemoglobin saturation (rcSO(2)) determined by cerebral oximetry. Two variables were used to calculate cerebral oxygen reserve: (a) awake rcSO(2) (mean presleep rcSO(2)) and (b) the change in rcSO(2) from before sleep to the end of the first non-rapid-eye movement cycle. General linear models, adjusted for the effects of education and occupation, tested differences in performance on standard tests of memory, attention, and speed of mental processing. RESULTS Awake rcSO(2) values were normal (60%-79.9%) in 64 participants, marginal (50%-59.9%) in 41, and low (43%-49.9%) in 7. Participants with normal awake levels had higher cognitive function than those with low levels (p < .05). Changes in rcSO(2) were greatest in participants with marginal awake rcSO(2) values; among whom, those who increased rcSO(2) during sleep (n = 17) had better memory function than the 24 who did not (p < .05). CONCLUSIONS Low awake rcSO(2) values mark individuals with low cerebral oxygen reserves and generally lower cognitive function; marginal awake rcSO(2) values that fall during sleep may indicate loss of cerebral oxygen reserve and an increased risk for cognitive decline. Further studies may clarify the significance of and mechanisms underlying individual differences in awake rcSO(2) and the changes that occur in rcSO(2) while asleep.
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Affiliation(s)
- Barbara W Carlson
- School of Nursing, The University of North Carolina at Chapel Hill, CB 7460 Carrington Hall, Chapel Hill, NC 27599, USA.
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Abstract
Recent research suggests that pulse pressure (PP), a putative marker of vascular integrity, may be associated with brain microvascular damage and age-related cognitive decline. Thus, the present study examined the relationship between PP and cognition in a sample of healthy nondemented older adults. One hundred nine participants were administered neurological and neuropsychological evaluations and determined to be nondemented. Regression analyses were used to examine the relationships among pulse pressure (PP) [systolic blood pressure (SBP)--diastolic blood pressure (DBP)], age, and cognition. PP and related measures were inversely correlated with global cognitive functioning and scores on a composite measure of language function, even after adjusting for age, education, and relevant vascular risk factors. Results indicate that increases in the pulsatile component of blood pressure may convey added risk of global cognitive decline and specific impairment in language abilities.
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Jassal SK, Kritz-Silverstein D, Barrett-Connor E. A prospective study of albuminuria and cognitive function in older adults: the Rancho Bernardo study. Am J Epidemiol 2010; 171:277-86. [PMID: 20061364 DOI: 10.1093/aje/kwp426] [Citation(s) in RCA: 81] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
Chronic kidney disease is a risk factor for cognitive impairment. Albuminuria is an early manifestation of chronic kidney disease and a marker of endothelial dysfunction and vascular risk. Results of prior studies of albuminuria and cognitive function are contradictory. The authors studied 1,345 community-dwelling women and men in southern California (mean age, 75 years) at a 1992-1996 research clinic visit, when urine albumin/creatinine ratio (ACR) was measured in spot morning urine and cognitive function was evaluated by using the Mini-Mental State Examination Trail-Making Test B, and category fluency test. An ACR of > or =30 mg/g was found in 17% of women and 15% of men in 1992-1996. Analysis of covariance was used to compare cognitive function score by categorical ACR. Between 1999 and 2002, 759 participants returned for repeat cognitive function testing. For men, but not women, baseline albuminuria, but not estimated glomerular filtration rate, was associated with reduced cognitive function at follow-up on all tests (P's < 0.05). An ACR of > or =30 mg/g was associated with greater annual decline in Mini-Mental State Examination and category fluency scores. Albuminuria may be an easily measured marker predicting future cognitive function decline. Results imply a common underlying mechanism affecting the renal and cerebral microvasculature.
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Affiliation(s)
- Simerjot K Jassal
- VA San Diego Healthcare System, 3350 La Jolla Village Drive, Division of GIM/G, MC 111N, San Diego, CA 92161, USA.
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Knopman DS. Invited commentary: Albuminuria and microvascular disease of the brain--a shared pathophysiology. Am J Epidemiol 2010; 171:287-9; author reply 290-1. [PMID: 20061365 DOI: 10.1093/aje/kwp429] [Citation(s) in RCA: 38] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/23/2023] Open
Abstract
This commentary considers the implications of the association between albuminuria and cognitive decline described by Jassal et al. in this issue of the Journal (Am J Epidemiol. 2010;171(3):290-291). The authors report that men with albuminuria had a greater likelihood than men without albuminuria of experiencing declines in cognitive function over a 6.6-year period. Albuminuria is the result of endothelial damage in the kidney, which, in turn, is the result of microvascular disease. If one of the key mechanisms of brain microvascular disease is leakage of serum proteins into the brain extracellular space, in a fashion parallel to albuminuria that occurs in nephrosclerosis, several facets of cerebrovascular disease and cognitive decline are explained. First, brain microvascular disease would not be recognized by traditional clinical features of cerebrovascular disease because brain microvascular disease occurs gradually and insidiously. Second, the extravasation of serum proteins as a result of brain microvascular disease would account for the perivascular distribution of white matter hyperintensities on magnetic resonance imaging. Albuminuria might be a useful screening test for generalized microvascular disease and, if detected, might reasonably prompt brain imaging and more intensive therapeutic efforts to forestall further endothelial dysfunction in the kidney, brain, and elsewhere.
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Affiliation(s)
- David S Knopman
- Department of Neurology, Mayo Clinic, 200 First Street SW, Rochester, MN 55905, USA.
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