Original InvestigationPathogenesis and Treatment of Kidney DiseaseAlbuminuria, Cognitive Functioning, and White Matter Hyperintensities in Homebound Elders
Section snippets
Study Population
Detailed methods for the Nutrition, Aging, and Memory in Elders (NAME) Study have been described.17 Between 2003 and 2007, participants were recruited at 4 Boston-area home care agencies that provide services to make home living possible for elders. Eligible individuals were at least 60 years old and had low income (determined by the state), diminished ability to perform activities of daily living, and an unmet need in a critical area including food or personal care. NAME exclusion criteria
Results
For 335 participants, mean age was 73.4 ± 8.1 years (Table 1). Median ACR was 11.6 mg/g (25% to 75%, 5.9 to 46.3 mg/g). There were 212 (63.3%), 103 (30.8%), and 20 (6.0%) with ACR within ranges consistent with normoalbuminuria, microalbuminuria, and macroalbuminuria. Overall, participants had substantial physical impairment, with 71.3% having at least “some difficulty” on 1 or more activity of daily living.
Discussion
The findings in the present study show that the presence of albumin in urine, even at levels consistent with microalbuminuria, is independently associated with cognitive impairment. Specifically, albuminuria is associated with impaired executive functioning, manifest by impaired mental processing speed, planning and sequencing of events, and ability to complete unstructured tasks. This type of deficit is consistent with pathological states in subcortical brain pathways and may result from
Acknowledgements
Preliminary data from this study were presented in abstract form at the Annual Meeting of the American Society of Nephrology, November 1-5, 2007, in San Francisco, CA. The authors thank the entire NAME team, particularly the researchers who visited Boston elders in their homes to perform the cognitive testing, the home care agencies that allowed us access to their clients, and the contributions of Arema Pereira, MD, Panagiotis Vlagopolous, MD, MS, and Jennifer Buell, PhD, without whom the
References (32)
- et al.
Subcortical ischaemic vascular dementia
Lancet Neurol
(2002) - et al.
Brain MRI findings and cognitive impairment in patients undergoing chronic hemodialysis treatment
J Neurol Sci
(1995) - et al.
High prevalence of leukoaraiosis in cerebral magnetic resonance images of patients on peritoneal dialysis
Am J Kidney Dis
(2007) - et al.
Kidney function and cognitive impairment in US adults: The REGARDS Study
Am J Kidney Dis
(2008) - et al.
Cardiovascular outcomes and all-cause mortality: Exploring the interaction between CKD and cardiovascular disease
Am J Kidney Dis
(2006) The neuropsychology of vascular cognitive impairment: Is there a specific cognitive deficit?
J Neurol Sci
(2004)- et al.
Albuminuria and dementia in the elderly: A community study
Am J Kidney Dis
(2008) - et al.
Prevalence of chronic kidney disease and decreased kidney function in the adult US population: Third National Health and Nutrition Examination Survey
Am J Kidney Dis
(2003) - et al.
Microalbuminuria and all-cause mortality in 2,089 apparently healthy individuals: A 4.4-year follow-up studyThe Nord-Trondelag Health Study (HUNT), Norway
Am J Kidney Dis
(2003) - et al.
Brain infarction and the clinical expression of Alzheimer diseaseThe Nun Study
JAMA
(1997)
Subcortical cognitive impairment in dialysis patients
Hemodial Int
Cognitive impairment in hemodialysis patients is common
Neurology
Chronic kidney disease and cognitive impairment in the elderly: The Health, Aging, and Body Composition Study
J Am Soc Nephrol
Moderate renal impairment and risk of dementia among older adults: The Cardiovascular Health Cognition Study
J Am Soc Nephrol
Chronic kidney disease is associated with white matter hyperintensity volume: The Northern Manhattan Study (NOMAS)
Stroke
Cystatin C and subclinical brain infarction
J Am Soc Nephrol
Cited by (136)
Resting state EEG rhythms in different stages of chronic kidney disease with mild cognitive impairment
2023, Neurobiology of AgingIntensive blood pressure control on dementia in patients with chronic kidney disease: Potential reduction in disease burden
2022, European Journal of Internal Medicine
Because an author of this manuscript is an editor for AJKD, the peer-review and decision-making processes were handled entirely by an Associate Editor (Katherine Tuttle, MD, Sacred Heart Medical Center) who served as Acting Editor-in-Chief. Details of the journal's procedures for potential editor conflicts are given in the Editorial Policies section of the AJKD website.
Originally published online as doi:10.1053/j.ajkd.2008.08.022 on December 15, 2008.