Chronic Kidney Disease and Subclinical Brain Infarction Increase the Risk of Vascular Cognitive Impairment: The Sefuri Study

• Published in: Journal of stroke and cerebrovascular diseases Vol. 26; no. 2; pp. 420 - 424
• Main Authors: Yao, Hiroshi, MD, PhD, Araki, Yuko, PhD, Takashima, Yuki, MD, PhD, Uchino, Akira, MD, PhD, Yuzuriha, Takefumi, MD, PhD, Hashimoto, Manabu, MD, PhD
• Format: Journal Article
• Language: English
• Published: United States Elsevier Inc 01.02.2017
• Subjects: Aged; Brain - diagnostic imaging; Brain Infarction - complications; Brain Infarction - diagnostic imaging; Brain Infarction - epidemiology; Cardiovascular; Cerebral Small Vessel Diseases - complications; Cerebral Small Vessel Diseases - diagnostic imaging; Cerebral Small Vessel Diseases - epidemiology; Cognitive Dysfunction - complications; Cognitive Dysfunction - diagnostic imaging; Cognitive Dysfunction - epidemiology; Cohort Studies; Cross-Sectional Studies; Executive Function; Female; Glomerular Filtration Rate; Humans; Japan; Magnetic Resonance Imaging; Male; Mental Status Schedule; Models, Statistical; Neurology; Neuropsychological Tests; Renal Insufficiency, Chronic - complications; Renal Insufficiency, Chronic - diagnostic imaging; Renal Insufficiency, Chronic - epidemiology; Risk; silent stroke; Small vessel disease; vascular cognitive impairment; vascular cognitive impairment; silent stroke; magnetic resonance imaging; Small vessel disease; glomerular filtration rate; executive function
• ISSN: 1052-3057; 1532-8511
• DOI: 10.1016/j.jstrokecerebrovasdis.2016.10.002

Background and Purpose 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.