title: Association of chronic kidney disease and cerebral small vessel disease with cognitive impairment in elderly patients with type 2 diabetes.
abstract: OBJECTIVE
  In recent years, the relationship between chronic kidney disease (CKD) and cognitive impairment has been attracting attention. Cerebral small vessel disease (SVD) is also associated with an increased risk of cognitive impairment. However, it is still unknown whether CKD markers are associated with cognitive impairment independently of SVD in elderly diabetic patients.
  
  
  METHODS
  Seventy-nine type 2 diabetic patients (mean age, 76.0 years) were enrolled in the present study. CKD was defined as the presence of albuminuria and/or a low estimated glomerular filtration rate (eGFR <60 ml/min/1.73 m(2)). SVD was evaluated by the presence and severity of silent brain infarcts (SBIs) and white matter lesions (WMLs) on brain magnetic resonance imaging. Neuropsychological tests were assessed using four validated cognitive instruments.
  
  
  RESULTS
  In multiple linear regression analyses, albuminuria was associated with worse modified Stroop Color Word scores (β = 0.284, p = 0.017) and low eGFR was associated with reduced Digit Symbol Substitution scores (β = -0.224, p = 0.026) after adjustment for age, sex, education years, diabetes duration, hypertension, multiple SBIs, and advanced WMLs. In contrast, there were no significant associations between CKD markers and Mini-Mental State Examination or Word Recall scores.
  
  
  CONCLUSIONS
  Our findings suggest that albuminuria and low eGFR are associated with frontal lobe dysfunction independently of SVD in elderly type 2 diabetic patients.
authors.affiliation: Department of Neurology, Chubu Rosai Hospital, Nagoya, Japan.
authors.forename: Toshitaka
authors.initials: T
authors.lastname: Umemura
authors.forename: Takahiko
authors.initials: T
authors.lastname: Kawamura
authors.forename: Hiroyuki
authors.initials: H
authors.lastname: Umegaki
authors.forename: Naoko
authors.initials: N
authors.lastname: Kawano
authors.forename: Shinichi
authors.initials: S
authors.lastname: Mashita
authors.forename: Toshimasa
authors.initials: T
authors.lastname: Sakakibara
authors.forename: Nigishi
authors.initials: N
authors.lastname: Hotta
authors.forename: Gen
authors.initials: G
authors.lastname: Sobue
keywords: Albuminuria; Cerebral small vessel disease; Chronic kidney disease; Cognitive impairment; Diabetes; Elderly; Glomerular filtration rate; Magnetic resonance imaging