title: Chronic kidney disease is associated with dementia independent of cerebral small-vessel disease.
abstract: OBJECTIVE
  To determine whether chronic kidney disease (CKD) is associated with incident dementia independent of cerebral small-vessel disease (SVD) in patients with vascular risk factors.
  
  
  METHODS
  Using data from a Japanese cohort of participants with vascular risk factors in an ongoing observational study from 2001, we evaluated the association between CKD at baseline and incident dementia. Baseline brain MRI was used to determine SVD (lacunar infarction, white matter hyperintensities), medial-temporal atrophy, and subcortical atrophy. Cox proportional hazards analyses were performed for predictors of dementia adjusting for age, sex, APOE ε4 allele, educational level, baseline Mini-Mental State Examination score, cerebrovascular events, vascular risk factors, and MRI findings.
  
  
  RESULTS
  Of the 600 subjects (mean age 68 ± 8.3 years, 57% male, 12.8 ± 2.6 years of education; CKD: 29%), 50 patients with incident dementia (Alzheimer disease: 24; vascular dementia: 18; mixed-type dementia: 5; other types: 3) were diagnosed during the median 7.5-year follow-up. CKD at baseline was associated with an increased risk of all-cause dementia in models adjusted for age, sex, educational level, and APOE ε4 allele. The associations of CKD at baseline remained significant even after additional adjusting for MRI findings and confounding variables (hazard ratio: 1.96 [1.08-3.58], p = 0.026).
  
  
  CONCLUSIONS
  CKD is independently related to the risk of all-cause dementia in patients with vascular risk factors. Our results reinforce the hypothesis that CKD exerts deleterious effects on dementia incidence.
authors.affiliation: From the Department of Neurology and Stroke Center, Osaka University Graduate School of Medicine, Japan.
authors.forename: Kaori
authors.initials: K
authors.lastname: Miwa
authors.forename: Makiko
authors.initials: M
authors.lastname: Tanaka
authors.forename: Shuhei
authors.initials: S
authors.lastname: Okazaki
authors.forename: Shigetaka
authors.initials: S
authors.lastname: Furukado
authors.forename: Yoshiki
authors.initials: Y
authors.lastname: Yagita
authors.forename: Manabu
authors.initials: M
authors.lastname: Sakaguchi
authors.forename: Hideki
authors.initials: H
authors.lastname: Mochizuki
authors.forename: Kazuo
authors.initials: K
authors.lastname: Kitagawa
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D000544:Alzheimer Disease / Q000175:diagnosis / Q000453:epidemiology / Q000235:genetics; D053327:Apolipoprotein E4 / Q000235:genetics; D001284:Atrophy; D059345:Cerebral Small Vessel Diseases / Q000175:diagnosis* / Q000453:epidemiology; D054022:Cerebrum / Q000473:pathology*; D015897:Comorbidity; D003704:Dementia / Q000175:diagnosis* / Q000453:epidemiology / Q000235:genetics; D015140:Dementia, Vascular / Q000175:diagnosis / Q000453:epidemiology / Q000235:genetics; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D007564:Japan / Q000453:epidemiology; D008279:Magnetic Resonance Imaging; D008297:Male; D009483:Neuropsychological Tests; D051436:Renal Insufficiency, Chronic / Q000175:diagnosis* / Q000453:epidemiology; D012307:Risk Factors
chemical_list: D053327:Apolipoprotein E4