Kidney Function and Cognitive Performance and Decline in Older Men

Authors

  • Yelena Slinin MD, MS,

    1. From the aCenter for Chronic Disease Outcomes Research, Veterans Affairs Medical Center, Minneapolis, MinnesotabDepartment of Medicine, and cDivision of Epidemiology and Community Health, University of Minnesota, Minneapolis, Minnesota; Departments of dPsychiatry, eNeurology, and fEpidemiology and Biostatistics, University of California at San Francisco, San Francisco, CaliforniagVeterans Affairs Medical Center, San Francisco, CaliforniahDepartment of Medicine, Geriatrics Division, Hennepin County Medical Center, Minneapolis, MinnesotaiBone and Mineral Unit, Oregon Health & Science University, Portland, OregonjCalifornia Pacific Medical Center Research Institute, San Francisco, CaliforniakDivision of Epidemiology, Department of Family and Preventive Medicine, and lDepartment of Medicine, University of California at San Diego, La Jolla, California.
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  • ab Misti L. Paudel MPH,

    1. From the aCenter for Chronic Disease Outcomes Research, Veterans Affairs Medical Center, Minneapolis, MinnesotabDepartment of Medicine, and cDivision of Epidemiology and Community Health, University of Minnesota, Minneapolis, Minnesota; Departments of dPsychiatry, eNeurology, and fEpidemiology and Biostatistics, University of California at San Francisco, San Francisco, CaliforniagVeterans Affairs Medical Center, San Francisco, CaliforniahDepartment of Medicine, Geriatrics Division, Hennepin County Medical Center, Minneapolis, MinnesotaiBone and Mineral Unit, Oregon Health & Science University, Portland, OregonjCalifornia Pacific Medical Center Research Institute, San Francisco, CaliforniakDivision of Epidemiology, Department of Family and Preventive Medicine, and lDepartment of Medicine, University of California at San Diego, La Jolla, California.
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  • ac Areef Ishani MD, MS,

    1. From the aCenter for Chronic Disease Outcomes Research, Veterans Affairs Medical Center, Minneapolis, MinnesotabDepartment of Medicine, and cDivision of Epidemiology and Community Health, University of Minnesota, Minneapolis, Minnesota; Departments of dPsychiatry, eNeurology, and fEpidemiology and Biostatistics, University of California at San Francisco, San Francisco, CaliforniagVeterans Affairs Medical Center, San Francisco, CaliforniahDepartment of Medicine, Geriatrics Division, Hennepin County Medical Center, Minneapolis, MinnesotaiBone and Mineral Unit, Oregon Health & Science University, Portland, OregonjCalifornia Pacific Medical Center Research Institute, San Francisco, CaliforniakDivision of Epidemiology, Department of Family and Preventive Medicine, and lDepartment of Medicine, University of California at San Diego, La Jolla, California.
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  • ab Brent C. Taylor PhD, MPH,

    1. From the aCenter for Chronic Disease Outcomes Research, Veterans Affairs Medical Center, Minneapolis, MinnesotabDepartment of Medicine, and cDivision of Epidemiology and Community Health, University of Minnesota, Minneapolis, Minnesota; Departments of dPsychiatry, eNeurology, and fEpidemiology and Biostatistics, University of California at San Francisco, San Francisco, CaliforniagVeterans Affairs Medical Center, San Francisco, CaliforniahDepartment of Medicine, Geriatrics Division, Hennepin County Medical Center, Minneapolis, MinnesotaiBone and Mineral Unit, Oregon Health & Science University, Portland, OregonjCalifornia Pacific Medical Center Research Institute, San Francisco, CaliforniakDivision of Epidemiology, Department of Family and Preventive Medicine, and lDepartment of Medicine, University of California at San Diego, La Jolla, California.
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  • abc Kristine Yaffe MD,

    1. From the aCenter for Chronic Disease Outcomes Research, Veterans Affairs Medical Center, Minneapolis, MinnesotabDepartment of Medicine, and cDivision of Epidemiology and Community Health, University of Minnesota, Minneapolis, Minnesota; Departments of dPsychiatry, eNeurology, and fEpidemiology and Biostatistics, University of California at San Francisco, San Francisco, CaliforniagVeterans Affairs Medical Center, San Francisco, CaliforniahDepartment of Medicine, Geriatrics Division, Hennepin County Medical Center, Minneapolis, MinnesotaiBone and Mineral Unit, Oregon Health & Science University, Portland, OregonjCalifornia Pacific Medical Center Research Institute, San Francisco, CaliforniakDivision of Epidemiology, Department of Family and Preventive Medicine, and lDepartment of Medicine, University of California at San Diego, La Jolla, California.
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  • defg Anne M. Murray MD,

    1. From the aCenter for Chronic Disease Outcomes Research, Veterans Affairs Medical Center, Minneapolis, MinnesotabDepartment of Medicine, and cDivision of Epidemiology and Community Health, University of Minnesota, Minneapolis, Minnesota; Departments of dPsychiatry, eNeurology, and fEpidemiology and Biostatistics, University of California at San Francisco, San Francisco, CaliforniagVeterans Affairs Medical Center, San Francisco, CaliforniahDepartment of Medicine, Geriatrics Division, Hennepin County Medical Center, Minneapolis, MinnesotaiBone and Mineral Unit, Oregon Health & Science University, Portland, OregonjCalifornia Pacific Medical Center Research Institute, San Francisco, CaliforniakDivision of Epidemiology, Department of Family and Preventive Medicine, and lDepartment of Medicine, University of California at San Diego, La Jolla, California.
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  • bh Howard A. Fink MD, MPH,

    1. From the aCenter for Chronic Disease Outcomes Research, Veterans Affairs Medical Center, Minneapolis, MinnesotabDepartment of Medicine, and cDivision of Epidemiology and Community Health, University of Minnesota, Minneapolis, Minnesota; Departments of dPsychiatry, eNeurology, and fEpidemiology and Biostatistics, University of California at San Francisco, San Francisco, CaliforniagVeterans Affairs Medical Center, San Francisco, CaliforniahDepartment of Medicine, Geriatrics Division, Hennepin County Medical Center, Minneapolis, MinnesotaiBone and Mineral Unit, Oregon Health & Science University, Portland, OregonjCalifornia Pacific Medical Center Research Institute, San Francisco, CaliforniakDivision of Epidemiology, Department of Family and Preventive Medicine, and lDepartment of Medicine, University of California at San Diego, La Jolla, California.
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  • abc Eric S. Orwoll MD,

    1. From the aCenter for Chronic Disease Outcomes Research, Veterans Affairs Medical Center, Minneapolis, MinnesotabDepartment of Medicine, and cDivision of Epidemiology and Community Health, University of Minnesota, Minneapolis, Minnesota; Departments of dPsychiatry, eNeurology, and fEpidemiology and Biostatistics, University of California at San Francisco, San Francisco, CaliforniagVeterans Affairs Medical Center, San Francisco, CaliforniahDepartment of Medicine, Geriatrics Division, Hennepin County Medical Center, Minneapolis, MinnesotaiBone and Mineral Unit, Oregon Health & Science University, Portland, OregonjCalifornia Pacific Medical Center Research Institute, San Francisco, CaliforniakDivision of Epidemiology, Department of Family and Preventive Medicine, and lDepartment of Medicine, University of California at San Diego, La Jolla, California.
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  • i Steven R. Cummings MD,

    1. From the aCenter for Chronic Disease Outcomes Research, Veterans Affairs Medical Center, Minneapolis, MinnesotabDepartment of Medicine, and cDivision of Epidemiology and Community Health, University of Minnesota, Minneapolis, Minnesota; Departments of dPsychiatry, eNeurology, and fEpidemiology and Biostatistics, University of California at San Francisco, San Francisco, CaliforniagVeterans Affairs Medical Center, San Francisco, CaliforniahDepartment of Medicine, Geriatrics Division, Hennepin County Medical Center, Minneapolis, MinnesotaiBone and Mineral Unit, Oregon Health & Science University, Portland, OregonjCalifornia Pacific Medical Center Research Institute, San Francisco, CaliforniakDivision of Epidemiology, Department of Family and Preventive Medicine, and lDepartment of Medicine, University of California at San Diego, La Jolla, California.
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  • j Elizabeth Barrett-Connor MD,

    1. From the aCenter for Chronic Disease Outcomes Research, Veterans Affairs Medical Center, Minneapolis, MinnesotabDepartment of Medicine, and cDivision of Epidemiology and Community Health, University of Minnesota, Minneapolis, Minnesota; Departments of dPsychiatry, eNeurology, and fEpidemiology and Biostatistics, University of California at San Francisco, San Francisco, CaliforniagVeterans Affairs Medical Center, San Francisco, CaliforniahDepartment of Medicine, Geriatrics Division, Hennepin County Medical Center, Minneapolis, MinnesotaiBone and Mineral Unit, Oregon Health & Science University, Portland, OregonjCalifornia Pacific Medical Center Research Institute, San Francisco, CaliforniakDivision of Epidemiology, Department of Family and Preventive Medicine, and lDepartment of Medicine, University of California at San Diego, La Jolla, California.
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  • k Simerjot Jassal MD,

    1. From the aCenter for Chronic Disease Outcomes Research, Veterans Affairs Medical Center, Minneapolis, MinnesotabDepartment of Medicine, and cDivision of Epidemiology and Community Health, University of Minnesota, Minneapolis, Minnesota; Departments of dPsychiatry, eNeurology, and fEpidemiology and Biostatistics, University of California at San Francisco, San Francisco, CaliforniagVeterans Affairs Medical Center, San Francisco, CaliforniahDepartment of Medicine, Geriatrics Division, Hennepin County Medical Center, Minneapolis, MinnesotaiBone and Mineral Unit, Oregon Health & Science University, Portland, OregonjCalifornia Pacific Medical Center Research Institute, San Francisco, CaliforniakDivision of Epidemiology, Department of Family and Preventive Medicine, and lDepartment of Medicine, University of California at San Diego, La Jolla, California.
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  • l Kristine E. Ensrud MD, MPH,

    1. From the aCenter for Chronic Disease Outcomes Research, Veterans Affairs Medical Center, Minneapolis, MinnesotabDepartment of Medicine, and cDivision of Epidemiology and Community Health, University of Minnesota, Minneapolis, Minnesota; Departments of dPsychiatry, eNeurology, and fEpidemiology and Biostatistics, University of California at San Francisco, San Francisco, CaliforniagVeterans Affairs Medical Center, San Francisco, CaliforniahDepartment of Medicine, Geriatrics Division, Hennepin County Medical Center, Minneapolis, MinnesotaiBone and Mineral Unit, Oregon Health & Science University, Portland, OregonjCalifornia Pacific Medical Center Research Institute, San Francisco, CaliforniakDivision of Epidemiology, Department of Family and Preventive Medicine, and lDepartment of Medicine, University of California at San Diego, La Jolla, California.
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  • and abc for the Osteoporotic Fractures in Men Study Group

    1. From the aCenter for Chronic Disease Outcomes Research, Veterans Affairs Medical Center, Minneapolis, MinnesotabDepartment of Medicine, and cDivision of Epidemiology and Community Health, University of Minnesota, Minneapolis, Minnesota; Departments of dPsychiatry, eNeurology, and fEpidemiology and Biostatistics, University of California at San Francisco, San Francisco, CaliforniagVeterans Affairs Medical Center, San Francisco, CaliforniahDepartment of Medicine, Geriatrics Division, Hennepin County Medical Center, Minneapolis, MinnesotaiBone and Mineral Unit, Oregon Health & Science University, Portland, OregonjCalifornia Pacific Medical Center Research Institute, San Francisco, CaliforniakDivision of Epidemiology, Department of Family and Preventive Medicine, and lDepartment of Medicine, University of California at San Diego, La Jolla, California.
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Address correspondence to Yelena Slinin, MD, MS, One Veterans Drive (111J), Minneapolis, MN 55417. E-mail: slini001@umn.edu

Abstract

OBJECTIVES: To examine the association between kidney function and cognitive impairment and decline in elderly men.

DESIGN: Observational prospective cohort.

SETTING: Community based.

PARTICIPANTS: Five thousand five hundred twenty-nine community dwelling men aged 65 and older (mean age 73.6 ± 5.9).

MEASUREMENTS: Estimated glomerular filtration rate (eGFR) calculated using the standardized Modification of Diet in Renal Disease (MDRD) equation; cognitive function assessed using the Modified Mini-Mental State Examination (3MS) and Trail Making Test B (Trails B).

RESULTS: At baseline, 148 (2.7%) and 494 (9.1%) men were classified as cognitively impaired and, in the 5-year prospective analysis, 931 (23%) and 432 (11.6%) met the criteria for cognitive decline at follow-up defined according to 3MS and Trails B performance, respectively. In unadjusted analysis, the odds of prevalent cognitive impairment and risk of cognitive decline were significantly higher in men with an eGFR less than 45 and 45 to 59 mL/min per 1.73 m2 than in men with an eGFR 60 mL/min per 1.73 m2 or greater. Differences in age, race, and education between eGFR categories largely explained these associations, with the exception of the association between poorer renal function and higher odds of impairment based on Trails B test score, which persisted despite adjustment for multiple potential confounders.

CONCLUSION: This study found evidence of an independent association between mild to moderate reductions in kidney function and poor executive function at baseline but not with global cognitive impairment or risk of cognitive decline in older men.

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