title: Impaired renal function is associated with brain atrophy and poststroke cognitive decline.
abstract: To evaluate the interrelationship among impaired renal function, brain pathology on imaging, and cognitive decline in a longitudinal poststroke cohort.
  
  
  
  The Tel Aviv Brain Acute Stroke Cohort study is a prospective cohort of mild-moderate ischemic stroke/TIA survivors without dementia who underwent a 3T MRI and were cognitively assessed at admission and for 24 months following stroke. Renal function was evaluated at admission by creatinine clearance (CCl) estimation. The volumes of ischemic lesions and preexisting white matter hyperintensities (WMH), brain atrophy, and microstructural changes of the normal-appearing white matter tissue were measured using previously validated methods.
  
  
  
  Baseline data were available for 431 participants. Participants with a CCl <60 mL/min at baseline performed significantly worse in all cognitive tests over time (p = 0.001) than those with a CCl ≥60 mL/min and had larger WMH volume and cortical atrophy and smaller hippocampal volume (all p < 0.001). After 2 years, 15.5% of the participants were diagnosed with cognitive impairment. Multiple logistic regression analysis, controlling for traditional risk factors, suggested CCl <60 mL/min at baseline as a significant predictor for the development of cognitive impairment 2 years after the index stroke (odds ratio 2.01 [95% confidence interval 1.03-3.92], p = 0.041).
  
  
  
  Impaired renal function is associated with increased WMH volume and cortical atrophy, known biomarkers of the aging brain, and is a predictor for cognitive decline 2 years after stroke/TIA. Decreased renal function may be associated with cerebral small vessel disease underlying poststroke cognitive decline, suggesting a new target for early intervention.
authors.affiliation: From the Department of Neurology (E.A., E.K., S.S.-T., J.M., S.B., I.S., L.S., O.T., N.M.B., E.B.A.) and Functional Brain Center (D.B.-B.), Tel Aviv Sourasky Medical Center; Sackler Faculty of Medicine (E.A., E.K., S.B., I.S., D.B.-B., N.M.B.), Tel Aviv University, Israel; and Department of Neurology (G.A.R.), University of New Mexico Health Sciences Center, Albuquerque. eitanman1@gmail.com.
authors.forename: Eitan
authors.initials: E
authors.lastname: Auriel
authors.affiliation: From the Department of Neurology (E.A., E.K., S.S.-T., J.M., S.B., I.S., L.S., O.T., N.M.B., E.B.A.) and Functional Brain Center (D.B.-B.), Tel Aviv Sourasky Medical Center; Sackler Faculty of Medicine (E.A., E.K., S.B., I.S., D.B.-B., N.M.B.), Tel Aviv University, Israel; and Department of Neurology (G.A.R.), University of New Mexico Health Sciences Center, Albuquerque.
authors.forename: Efrat
authors.initials: E
authors.lastname: Kliper
authors.affiliation: From the Department of Neurology (E.A., E.K., S.S.-T., J.M., S.B., I.S., L.S., O.T., N.M.B., E.B.A.) and Functional Brain Center (D.B.-B.), Tel Aviv Sourasky Medical Center; Sackler Faculty of Medicine (E.A., E.K., S.B., I.S., D.B.-B., N.M.B.), Tel Aviv University, Israel; and Department of Neurology (G.A.R.), University of New Mexico Health Sciences Center, Albuquerque.
authors.forename: Shani
authors.initials: S
authors.lastname: Shenhar-Tsarfaty
authors.affiliation: From the Department of Neurology (E.A., E.K., S.S.-T., J.M., S.B., I.S., L.S., O.T., N.M.B., E.B.A.) and Functional Brain Center (D.B.-B.), Tel Aviv Sourasky Medical Center; Sackler Faculty of Medicine (E.A., E.K., S.B., I.S., D.B.-B., N.M.B.), Tel Aviv University, Israel; and Department of Neurology (G.A.R.), University of New Mexico Health Sciences Center, Albuquerque.
authors.forename: Jeremy
authors.initials: J
authors.lastname: Molad
authors.affiliation: From the Department of Neurology (E.A., E.K., S.S.-T., J.M., S.B., I.S., L.S., O.T., N.M.B., E.B.A.) and Functional Brain Center (D.B.-B.), Tel Aviv Sourasky Medical Center; Sackler Faculty of Medicine (E.A., E.K., S.B., I.S., D.B.-B., N.M.B.), Tel Aviv University, Israel; and Department of Neurology (G.A.R.), University of New Mexico Health Sciences Center, Albuquerque.
authors.forename: Shlomo
authors.initials: S
authors.lastname: Berliner
authors.affiliation: From the Department of Neurology (E.A., E.K., S.S.-T., J.M., S.B., I.S., L.S., O.T., N.M.B., E.B.A.) and Functional Brain Center (D.B.-B.), Tel Aviv Sourasky Medical Center; Sackler Faculty of Medicine (E.A., E.K., S.B., I.S., D.B.-B., N.M.B.), Tel Aviv University, Israel; and Department of Neurology (G.A.R.), University of New Mexico Health Sciences Center, Albuquerque.
authors.forename: Itzhak
authors.initials: I
authors.lastname: Shapira
authors.affiliation: From the Department of Neurology (E.A., E.K., S.S.-T., J.M., S.B., I.S., L.S., O.T., N.M.B., E.B.A.) and Functional Brain Center (D.B.-B.), Tel Aviv Sourasky Medical Center; Sackler Faculty of Medicine (E.A., E.K., S.B., I.S., D.B.-B., N.M.B.), Tel Aviv University, Israel; and Department of Neurology (G.A.R.), University of New Mexico Health Sciences Center, Albuquerque.
authors.forename: Dafna
authors.initials: D
authors.lastname: Ben-Bashat
authors.affiliation: From the Department of Neurology (E.A., E.K., S.S.-T., J.M., S.B., I.S., L.S., O.T., N.M.B., E.B.A.) and Functional Brain Center (D.B.-B.), Tel Aviv Sourasky Medical Center; Sackler Faculty of Medicine (E.A., E.K., S.B., I.S., D.B.-B., N.M.B.), Tel Aviv University, Israel; and Department of Neurology (G.A.R.), University of New Mexico Health Sciences Center, Albuquerque.
authors.forename: Ludmila
authors.initials: L
authors.lastname: Shopin
authors.affiliation: From the Department of Neurology (E.A., E.K., S.S.-T., J.M., S.B., I.S., L.S., O.T., N.M.B., E.B.A.) and Functional Brain Center (D.B.-B.), Tel Aviv Sourasky Medical Center; Sackler Faculty of Medicine (E.A., E.K., S.B., I.S., D.B.-B., N.M.B.), Tel Aviv University, Israel; and Department of Neurology (G.A.R.), University of New Mexico Health Sciences Center, Albuquerque.
authors.forename: Oren
authors.initials: O
authors.lastname: Tene
authors.affiliation: From the Department of Neurology (E.A., E.K., S.S.-T., J.M., S.B., I.S., L.S., O.T., N.M.B., E.B.A.) and Functional Brain Center (D.B.-B.), Tel Aviv Sourasky Medical Center; Sackler Faculty of Medicine (E.A., E.K., S.B., I.S., D.B.-B., N.M.B.), Tel Aviv University, Israel; and Department of Neurology (G.A.R.), University of New Mexico Health Sciences Center, Albuquerque.
authors.forename: Gary A
authors.initials: GA
authors.lastname: Rosenberg
authors.affiliation: From the Department of Neurology (E.A., E.K., S.S.-T., J.M., S.B., I.S., L.S., O.T., N.M.B., E.B.A.) and Functional Brain Center (D.B.-B.), Tel Aviv Sourasky Medical Center; Sackler Faculty of Medicine (E.A., E.K., S.B., I.S., D.B.-B., N.M.B.), Tel Aviv University, Israel; and Department of Neurology (G.A.R.), University of New Mexico Health Sciences Center, Albuquerque.
authors.forename: Natan M
authors.initials: NM
authors.lastname: Bornstein
authors.affiliation: From the Department of Neurology (E.A., E.K., S.S.-T., J.M., S.B., I.S., L.S., O.T., N.M.B., E.B.A.) and Functional Brain Center (D.B.-B.), Tel Aviv Sourasky Medical Center; Sackler Faculty of Medicine (E.A., E.K., S.B., I.S., D.B.-B., N.M.B.), Tel Aviv University, Israel; and Department of Neurology (G.A.R.), University of New Mexico Health Sciences Center, Albuquerque.
authors.forename: Einor
authors.initials: E
authors.lastname: Ben Assayag
mesh_terms: D000368:Aged; D001284:Atrophy; D001921:Brain / Q000000981:diagnostic imaging*; D002545:Brain Ischemia / Q000150:complications* / Q000000981:diagnostic imaging / Q000453:epidemiology / Q000503:physiopathology; D060825:Cognitive Dysfunction / Q000000981:diagnostic imaging / Q000453:epidemiology / Q000209:etiology* / Q000503:physiopathology; D003401:Creatine / Q000097:blood; D056324:Diffusion Tensor Imaging; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D007668:Kidney / Q000503:physiopathology*; D016015:Logistic Models; D008279:Magnetic Resonance Imaging; D008297:Male; D008875:Middle Aged; D009483:Neuropsychological Tests; D011379:Prognosis; D011446:Prospective Studies; D020521:Stroke / Q000150:complications* / Q000000981:diagnostic imaging / Q000453:epidemiology / Q000503:physiopathology; D066127:White Matter / Q000000981:diagnostic imaging
chemical_list: D003401:Creatine