title: Kidney disease and cognitive function: African American-diabetes heart study MIND.
abstract: OBJECTIVE
  Albuminuria and reduced estimated glomerular filtration rate (eGFR) are linked with poorer cognitive performance in European-ancestry populations with advanced nephropathy; relationships in African Americans (AAs) with type 2 diabetes (T2D) are less clear. Tests of cognitive performance, urine albumin:creatinine ratio (UACR), and CKD-EPI eGFR were performed in unrelated AAs with T2D to determine relationships.
  
  
  METHODS
  Cross-sectional analysis of 263 unrelated AAs with T2D recruited in the African American-Diabetes Heart Study (AA-DHS) MIND. Global cognitive function (mini-mental state exam [3MSE] and Montreal Cognitive Assessment [MoCA]), memory (Rey Auditory Verbal Learning Test [RAVLT]), executive function (Stroop, verbal fluency for animals, and Digit Symbol Copy [DSC]), UACR, and eGFR were determined. Relationships between cognitive tests and renal parameters were assessed using multivariate models, adjusted for age, gender, body mass index, hemoglobin A1c, level of education, hypertension, and LDL cholesterol.
  
  
  RESULTS
  Participants had a mean ± SD age of 60.2 ± 9.7 years, 62.7% were female, T2D duration was 14.3 ± 8.9 years, eGFR 86.0 ± 23.2 ml/min/1.73 m(2), and UACR 155.8 ± 542.1 (median 8.1) mg/g. In adjusted models, higher UACR was associated with worse 3MSE (p = 0.014), MoCA (p = 0.0089), DSC (p = 0.0004), Stroop performance time (p = 0.003), Stroop errors (p = 0.032), and Stroop interference (p = 0.026). Higher eGFR was associated with better performance on DSC (p = 0.0071).
  
  
  CONCLUSIONS
  In AAs with T2D, albuminuria and eGFR were associated with cognitive function, even in mild kidney disease. These data stress the need for interventions to prevent cognitive decline well before the late stages of kidney disease.
authors.affiliation: Department of Biochemistry, Wake Forest School of Medicine, Winston-Salem, N.C., USA.
authors.forename: Nicholette D
authors.initials: ND
authors.lastname: Palmer
authors.forename: Kaycee M
authors.initials: KM
authors.lastname: Sink
authors.forename: Susan Carrie
authors.initials: SC
authors.lastname: Smith
authors.forename: Jianzhao
authors.initials: J
authors.lastname: Xu
authors.forename: Donald W
authors.initials: DW
authors.lastname: Bowden
authors.forename: Christina E
authors.initials: CE
authors.lastname: Hugenschmidt
authors.forename: Christopher T
authors.initials: CT
authors.lastname: Whitlow
authors.forename: Jeff D
authors.initials: JD
authors.lastname: Williamson
authors.forename: Joseph A
authors.initials: JA
authors.lastname: Maldjian
authors.forename: Jasmin
authors.initials: J
authors.lastname: Divers
authors.forename: Barry I
authors.initials: BI
authors.lastname: Freedman
mesh_terms: D001741:Black or African American; D000368:Aged; D000418:Albumins / Q000032:analysis; D000419:Albuminuria / Q000150:complications; D003071:Cognition; D003072:Cognition Disorders / Q000150:complications* / Q000208:ethnology / Q000503:physiopathology; D003404:Creatinine / Q000652:urine; D003430:Cross-Sectional Studies; D048909:Diabetes Complications / Q000208:ethnology / Q000503:physiopathology; D003924:Diabetes Mellitus, Type 2 / Q000208:ethnology / Q000503:physiopathology; D005260:Female; D005919:Glomerular Filtration Rate; D006331:Heart Diseases / Q000150:complications / Q000208:ethnology / Q000503:physiopathology; D006801:Humans; D007676:Kidney Failure, Chronic / Q000150:complications* / Q000208:ethnology / Q000503:physiopathology; D007677:Kidney Function Tests; D008297:Male; D008875:Middle Aged; D009483:Neuropsychological Tests; D057190:Stroop Test
chemical_list: D000418:Albumins; D003404:Creatinine