Neurocognition and Functional Performance in Older Veterans with CKD

患有 CKD 的老年退伍军人的神经认知和功能表现

• 批准号: 8857396
• 负责人: Leslie I. Katzel
• 金额: --
• 依托单位: BALTIMORE VA MEDICAL CENTER
• 依托单位国家: 美国
• 财政年份: 2010
• 资助国家: 美国
• 起止时间: 2010-07-01 至 2013-06-30
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/8857396
• 关键词: Accounting; Address; Adverse effects; Aerobic; Affect; Age; Albumins; Albuminuria; Atrophic; Biological Markers; Blood Vessels; Brain; Brain Diseases; Brain Pathology; Brain imaging; Cardiovascular Diseases; Cephalic; Cerebrovascular Circulation; Cerebrum; Chronic Kidney Failure; Clinical; Cognition; Cognitive; Cognitive deficits; Cohort Studies; Communities; Comorbidity; Control Groups; Dementia; Detection; Diabetes Mellitus; Dialysis procedure; Diffusion Magnetic Resonance Imaging; Disease; Elderly; Equation; Equilibrium; Evaluation; Excretory function; Exhibits; Frequencies; Functional disorder; Gait; Geriatrics; Health Personnel; Heart Diseases; High Prevalence; Hypertension; Image Analysis; Impairment; Individual; Infarction; Investigation; Kidney; Kidney Diseases; Laboratories; Link; Lower Extremity; Magnetic Resonance Imaging; Measurement; Measures; Mediating; Mediator of activation protein; Methods; Modeling; Monitor; Motor; Multivariate Analysis; Nephrology; Neurocognition; Neurocognitive; Neuropsychological Tests; Neuropsychology; Patient Self-Report; Patients; Pattern; Performance; Perfusion Weighted MRI; Physical Function; Population; Renal function; Research; Research Personnel; Risk; Risk Factors; Serum; Severities; Speed; Staging; Stroke; Structure; Symptoms; Testing; Upper Extremity; Urine; Vascular Diseases; Veterans; White Matter Hyperintensity; adverse outcome; aged; cerebral atrophy; cognitive function; executive function; frailty; high risk; hypoperfusion; method development; neuroimaging; older patient; post gamma-globulins; prevent; risk sharing; screening; white matter

DESCRIPTION (provided by applicant): Project Summary Chronic Kidney Disease (CKD) affects 1 out of 5 older adults in the US including more than 400,000 older veterans yet is often unrecognized by affected individuals and even their healthcare providers. Older adults with CKD suffer from a markedly higher risk of cognitive and physical dysfunction, including a 40% greater risk of dementia and a 75% greater risk of physical frailty. The factors which account for this risk are unclear; however, recent neuroimaging investigations suggest a greatly increased burden of covert brain pathology in association with CKD and reduced kidney function. Outside the context of CKD, these neuroimaging findings of subclinical ischemic brain disease - silent brain infarcts, white matter hyperintensities, atrophy, and hypoperfusion - are associated with reduced cognitive and physical function. However, there has been no formal statistical evaluation of subclinical ischemic brain disease as a mediator of the relations of CKD to physical and cognitive function, nor any investigations of the patterns of cognitive and physical dysfunction in older adults with CKD. We hypothesize that older veterans with CKD suffer from a greater burden of subclinical ischemic disease of the brain, which results in impaired neurocognition and physical function. In this revised proposal, we will conduct an observational cohort study of stroke-free community-dwelling older veterans (ages 60-85) with CKD not requiring dialysis (N=150, evenly distributed among mild, moderate and severe CKD), and a control group without CKD but frequency-matched on the common co-morbid conditions diabetes, hypertension and cardiac disease (N=50). We will obtain quantitative measurements of 1) kidney disease and function (including albuminuria and the renal biomarker cystatin C), 2) ischemic brain disease using MRI, 3) physical function and performance, and 4) multiple domains of neurocognitive function. The overall aims are to estimate the association of CKD and renal function measures with MRI-defined subclinical ischemic brain disease and cognitive and physical function. Multivariate analyses will be employed to identify patterns of functional deficits and alterations of brain structure in CKD. Structural equations models (SEM) will examine whether subclinical ischemic brain disease mediates the relations of CKD and associated renal function measures to neurocognition and physical function after accounting for major co-morbid conditions including hypertension, diabetes, and cardiac disease. Results of this investigation will be of critical importance in the development of methods to detect and ultimately prevent functional deficits among older adults with CKD, a highly prevalent and rapidly growing population.

描述（由申请人提供）： 项目摘要慢性肾脏疾病（CKD）影响了美国5名老年人中的1个，其中包括40万名老年退伍军人，但经常被影响的个体甚至其医疗保健提供者所认识到。患有CKD的老年人患有认知和身体功能障碍的风险明显更高，包括痴呆症风险增加40％和身体虚弱的风险增加了75％。考虑到这种风险的因素尚不清楚；但是，最近的神经影像学调查表明，与CKD相关的秘密脑病理学负担大大增加了，肾功能降低。在CKD的背景下，这些神经影像学发现了亚临床缺血性脑疾病的发现 - 沉默的脑梗塞，白质超强度，萎缩和灌注不足 - 与认知和身体功能降低有关。但是，没有正式评估亚临床缺血性脑疾病，作为CKD与身体和认知功能关系的中介，也没有对CKD老年人认知和身体功能障碍的模式进行任何研究。我们假设患有CKD的老年退伍军人承受着大脑亚临床缺血性疾病的负担，这会导致神经认知和身体机能受损。在这项修订的提案中，我们将对无需透析的CKD的无中风居民老年退伍军人（60-85岁）进行观察队列研究（n = 150，在轻度，中度和重度CKD中均匀分布）和A没有CKD的对照组，但在常见的合并症状况上进行了频率匹配的糖尿病，高血压和心脏病（n = 50）。我们将获得1）肾脏疾病和功能的定量测量值（包括蛋白尿和肾脏生物标志物胱抑素C），2）使用MRI使用MRI，3）身体功能和性能，以及4）神经认知功能的多个领域。总体目的是估计CKD和肾功能测量与MRI定义的亚临床缺血性脑疾病以及认知和身体机能的关联。将采用多元分析来识别CKD中大脑结构的功能缺陷模式。结构方程模型（SEM）将检查亚临床缺血性脑疾病是否介导了CKD和相关的肾功能指标与神经认知和身体机能的关系是否考虑到包括高血压，糖尿病和心脏疾病在内的主要合并症。这项调查的结果将在开发检测和最终防止CKD老年人（高度普遍且快速增长的人口）的方法中的方法中至关重要。