Chronic Kidney Disease and Subclinical Brain Infarction Increase the Risk of Vascular Cognitive Impairment: The Sefuri Study.
OBJECTIVE
The purpose of this study was to determine the complex associations among chronic kidney disease (CKD), subclinical brain infarction (SBI), and cognitive impairment.


METHODS
We used structural equation modeling (SEM) to examine the complex relationships among CKD, SBI, and cognitive function with Mini-Mental State Examination (MMSE; global function) and modified Stroop test (executive function) in a population-based cohort of 560 non-demented elderly subjects.


RESULTS
Path analysis based on SEM revealed that the direct paths from estimated glomerular filtration rate (eGFR) to SBI and from SBI to executive function were significant (β = -.10, P = .027, and β = .16, P < .001, respectively). Furthermore, the direct path from eGFR to executive function was also significant (β = -.12, P = .006), indicating that the effects of CKD on executive function are independent of SBI. The direct paths from age and education to global cognitive function were highly significant (β = -.17 and .22, respectively, P < .001), whereas the direct path from eGFR to MMSE was not significant.


CONCLUSIONS
Our findings indicate that CKD confers a risk of vascular cognitive impairment or executive dysfunction through mechanisms dependent and independent of SBI. Treating CKD may be a potential strategy to protect against vascular cognitive impairment or executive dysfunction in healthy elderly subjects.
Center for Emotional and Behavioral Disorders, National Hospital Organization Hizen Psychiatric Center, Kanzaki, Saga, Japan. Electronic address: rinkenyao@abelia.ocn.ne.jp.
Hiroshi
H
Yao
Graduate School of Integrated Science and Technology, Shizuoka University, Hamamatsu, Japan.
Yuko
Y
Araki
Center for Emotional and Behavioral Disorders, National Hospital Organization Hizen Psychiatric Center, Kanzaki, Saga, Japan.
Yuki
Y
Takashima
Department of Diagnostic Radiology, Saitama Medical University International Medical Center, Saitama, Japan.
Akira
A
Uchino
Center for Emotional and Behavioral Disorders, National Hospital Organization Hizen Psychiatric Center, Kanzaki, Saga, Japan.
Takefumi
T
Yuzuriha
Center for Emotional and Behavioral Disorders, National Hospital Organization Hizen Psychiatric Center, Kanzaki, Saga, Japan.
Manabu
M
Hashimoto
D000368:Aged; D001921:Brain / Q000000981:diagnostic imaging; D020520:Brain Infarction / Q000150:complications* / Q000000981:diagnostic imaging / Q000453:epidemiology*; D059345:Cerebral Small Vessel Diseases / Q000150:complications / Q000000981:diagnostic imaging / Q000453:epidemiology; D060825:Cognitive Dysfunction / Q000150:complications* / Q000000981:diagnostic imaging / Q000453:epidemiology*; D015331:Cohort Studies; D003430:Cross-Sectional Studies; D056344:Executive Function; D005260:Female; D005919:Glomerular Filtration Rate; D006801:Humans; D007564:Japan; D008279:Magnetic Resonance Imaging; D008297:Male; D008609:Mental Status Schedule; D015233:Models, Statistical; D009483:Neuropsychological Tests; D051436:Renal Insufficiency, Chronic / Q000150:complications* / Q000000981:diagnostic imaging / Q000453:epidemiology*; D012306:Risk
Small vessel disease; executive function; glomerular filtration rate; magnetic resonance imaging; silent stroke; vascular cognitive impairment