Association Between Renal Function and Cognitive Ability Domains in the Einstein Aging Study: A Cross-Sectional Analysis

Zammit, Andrea R.; Katz, Mindy J.; Lai, Jennifer Y.; Zimmerman, Molly E.; Bitzer, Markus; Lipton, Richard B.

doi:10.1093/gerona/glu185

Cited by 26 publications

(33 citation statements)

References 48 publications

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“…Our findings support previous reports that showed no association between eGFR and cognitive impairment [6,[20][21][22], but contrast to those that did report a significant association [5,9,[23][24][25][26][27][28][29][30]. In addition, other studies also reported significant associations between renal impairment characterised by the presence of microalbuminuria and cognitive impairment [10,20,21,31].…”

Section: Discussionsupporting

confidence: 86%

Estimated Glomerular Filtration Rate is not Associated with Alzheimer’s Disease in a Northern Ireland Cohort

Paterson

Williams

Passmore

et al. 2017

JAD

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Section: Discussionsupporting

confidence: 86%

Estimated Glomerular Filtration Rate is not Associated with Alzheimer’s Disease in a Northern Ireland Cohort

Paterson

Williams

Passmore

et al. 2017

JAD

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“…The Maine-Syracuse study found similar results; tests of visual memory and scanning were strongly associated with eGFR < 60 mL/min/1.73 m 2 as was global cognitive function. 5 In contrast to other studies, 5, 28 ours found that eGFR < 45 mL/min/1.73 m 2 was associated with lower performance in all cognitive domains, not only executive function, which is often reported to be the most affected by CKD due to its proposed vascular or subcortical origins. For the mild to moderate reduced eGFR groups (eGFR 30- <60 mL/min/1.73 m 2 ), we found significant albeit modest impairment in all cognitive domains including verbal (episodic) memory at approximately 0.25–0.5 SD below expected performance.…”

Section: Discussioncontrasting

confidence: 83%

The Brain in Kidney Disease (BRINK) Cohort Study: Design and Baseline Cognitive Function

Murray

Bell

Tupper

et al. 2016

American Journal of Kidney Diseases

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Background The Brain in Kidney Disease (BRINK) Study aims to identify mechanisms that contribute to increased risk of cognitive impairment (CI) in chronic kidney disease (CKD) patients. We describe the rationale, design, and methods of the study and report baseline recruitment and cognitive function results. Study Design Longitudinal observational cohort study of the epidemiology of CI in CKD. The primary aim is to characterize the association between (a) baseline and incident stroke, white matter disease, estimated glomerular filtration rate (eGFR), inflammation, microalbuminuria, dialysis initiation, and (b) cognitive decline over 3 years in a CKD cohort with mean eGFR < 45 mL/min/1.73 m2. Setting & Participants Community-dwelling participants aged 45 years or older recruited from four health systems into two groups: reduced eGFR, defined as eGFR < 60 mL/min/1.73 m2 (non-dialysis-dependent), and control, defined as eGFR ≥ 60 mL/min/1.73 m2. Predictor eGFR group. Outcomes Performance on cognitive function tests and structural brain magnetic resonance imaging. Measurements Sequential cognitive and physical function testing, serum and urine biomarker measurement, and brain magnetic resonance images over 3 years. Results Of 554 participants, mean age was 69.3 years; 333, 88, and 133 had eGFR <45 (non-dialysis dependent, non-transplant), 45-<60, and ≥ 60 (controls) mL/min/1.73 m2, respectively. Mean eGFR in the reduced eGFR participants was 34.3 mL/min/1.73 m2. Baseline cognitive performance was significantly associated with eGFR in all domains except language. Participants with eGFR < 30 mL/min/1.73 m2 performed significantly worse than those with eGFR ≥ 30 mL/min/1.73 m2 on tests of memory, processing speed, and executive function. Participants with reduced eGFR overall scored worst on the Immediate Brief Visual-Spatial Memory Test-Revised. Limitations Healthy cohort bias, competing risk of death versus cognitive decline. Conclusions Cognitive function was significantly worse in participants with eGFR < 30 mL/min/1.73 m2. Future BRINK analyses will measure risk factors for cognitive decline using the longitudinal data.

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“…Attention and executive function in one study were also found to be more severe in CKD Stage 5 (7). Similar results displaying an association between executive dysfunction and poor renal function were found in community-dwelling populations independent of age, ethnicity, education, vascular and lifestyle variables (3, 13, 18, 22). In a study on a sample of 649 community-dwelling participants (70+ year olds) from the Einstein Aging Study, low eGFR (<45mL/min/1.73m 2 ) was associated with reduced performance on components of frontal executive function, but not with episodic memory or general ability (22).…”

Section: Cognitive Impairment In Ckdsupporting

confidence: 78%

Cognitive Impairment and Dementia in Older Adults With Chronic Kidney Disease

Zammit

Katz

Bitzer

et al. 2016

Alzheimer Disease &Amp; Associated Disorders

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Individuals with chronic kidney disease (CKD), especially older adults, are at more risk of experiencing cognitive impairment, possibly leading to mild cognitive impairment (MCI) and/or dementia. Studies report associations between CKD and cognitive impairment; although unclear, there seems to be a graded association between stage of CKD and affected cognitive domains, with executive function being affected earlier in the process than episodic memory and global ability. In CKD, dysxecutive MCI and vascular dementia are also more prominent than other subtypes. Explanations are directed towards traditional and non-traditional vascular factors, which may also explain or mediate the association between CKD and type of cognitive impairment. Future research is urged to focus on the longitudinal association between specific domains of cognitive function, including executive function and memory and CKD; to develop screening tools fit for every CKD stage in elderly individuals, and lastly, to use imaging methods that may help clarify the underlying mechanisms connecting the kidney and the brain.

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Association Between Renal Function and Cognitive Ability Domains in the Einstein Aging Study: A Cross-Sectional Analysis

Abstract: Low eGFR is associated with reduced performance on executive function. Individuals with poor renal function should be assessed for cognitive impairment. Potential mechanisms are discussed.

Cited by 26 publications

References 48 publications

Estimated Glomerular Filtration Rate is not Associated with Alzheimer’s Disease in a Northern Ireland Cohort

Estimated Glomerular Filtration Rate is not Associated with Alzheimer’s Disease in a Northern Ireland Cohort

The Brain in Kidney Disease (BRINK) Cohort Study: Design and Baseline Cognitive Function

Cognitive Impairment and Dementia in Older Adults With Chronic Kidney Disease

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