Progression of cognitive dysfunction in elderly chronic kidney disease patients in a veteran's institution in central Taiwan: a 3-year longitudinal study.
OBJECTIVE
A strong positive correlation between estimated glomerular filtration rate (eGFR) multiplied by follow-up time and memory function has been demonstrated previously. The purpose of this study was to investigate the factors affecting progression of cognitive dysfunction in the elderly with different levels of kidney function.


METHODS
In April 2002, a prospective study on progression of cognitive function was conducted on 356 elderly people. All participants received a comprehensive geriatric assessment, serum biochemical test, homeostasis model assessment (HOMA), and a genetic polymorphism study, including polymorphism of apolipoprotein E (APOE), Cystatin, C-reactive protein (CRP) and tumor necrosis factor (TNF). Lean body mass-adjusted eGFR was used to evaluate severity of chronic kidney disease (CKD), and a clinical dementia rating scale was used to assess cognitive dysfunction. Patients were stratified according to eGFR (≥49 mL/min and <49 mL/min).


RESULTS
Using multivariate logistic regression models, older age (OR=1.27, 95% CI=1.00-1.61) was associated with a high risk for progression of cognitive function in patients with a relatively low eGFR. In patients with lower eGFR, higher mini-mental state examination (MMSE) scores (OR=0.23, 95% CI=0.10-0.54) were correlated with a low risk for progression of cognition, while in patients with higher eGFR, higher MMSE scores (OR=0.39, 95% CI=0.23-0.65) were less correlated with cognitive dysfunction. However, elevated serum plasminogen activator inhibitor-1 (PA1-1) was associated with a high risk for cognitive dysfunction (OR=1.06, 95% CI=1.01-1.11) in patients with a better eGFR.


CONCLUSIONS
Age, MMSE score and serum PAI-1 were found to be factors that predicted cognitive dysfunction at different functional levels of CKD.
Center of Geriatrics and Gerontology, Taichung Veterans General Hospital, Taiwan.
Shuo-Chun
SC
Weng
Kuo-Hsiung
KH
Shu
Yih-Jing
YJ
Tang
Wayne Huey-Herng
WH
Sheu
Der-Cherng
DC
Tarng
Ming-Ju
MJ
Wu
Yi-Ming
YM
Chen
Ya-Wen
YW
Chuang
D000368:Aged; D000369:Aged, 80 and over; D001057:Apolipoproteins E / Q000235:genetics; D001483:Base Sequence; D002097:C-Reactive Protein / Q000235:genetics; D003072:Cognition Disorders / Q000209:etiology* / Q000235:genetics / Q000503:physiopathology; D015891:Cystatins / Q000235:genetics; D018450:Disease Progression; D005919:Glomerular Filtration Rate; D006801:Humans; D016015:Logistic Models; D008137:Longitudinal Studies; D008297:Male; D008609:Mental Status Schedule; D015999:Multivariate Analysis; D017395:Plasminogen Activator Inhibitor 1 / Q000097:blood; D020641:Polymorphism, Single Nucleotide; D011446:Prospective Studies; D051436:Renal Insufficiency, Chronic / Q000150:complications* / Q000235:genetics / Q000503:physiopathology / Q000523:psychology*; D012307:Risk Factors; D013624:Taiwan; D014409:Tumor Necrosis Factor-alpha / Q000235:genetics
D001057:Apolipoproteins E; D015891:Cystatins; D017395:Plasminogen Activator Inhibitor 1; C051321:SERPINE1 protein, human; D014409:Tumor Necrosis Factor-alpha; D002097:C-Reactive Protein