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Kidney Function and Cognitive and Functional Decline in Elderly Adults: Findings from the Singapore Longitudinal Aging Study
Author(s) -
Feng Liang,
Yap Keng Bee,
Yeoh Lee Ying,
Ng Tze Pin
Publication year - 2012
Publication title -
journal of the american geriatrics society
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 1.992
H-Index - 232
eISSN - 1532-5415
pISSN - 0002-8614
DOI - 10.1111/j.1532-5415.2012.04043.x
Subject(s) - medicine , confounding , odds ratio , cognitive decline , renal function , kidney disease , prospective cohort study , gerontology , confidence interval , cohort study , cohort , activities of daily living , demography , physical therapy , disease , dementia , sociology
Objectives To investigate whether lower estimated glomerular filtration rate ( eGFR ) or chronic kidney disease ( CKD ) was associated with subsequent cognitive and instrumental activity of daily living ( IADL ) decline in a prospective cohort study. Design Prospective cohort study, followed for up to 4 years. Setting General community. Participants One thousand three hundred fifteen adults aged 55 and older from the S ingapore L ongitudinal A ging S tudy. Measurements Baseline data included eGFR levels, presence of CKD ( eGFR < 60 m L /min per 1.73 m 2 ), and known confounders. Cognitive decline was defined as a drop of 2 or more points on the M ini‐ M ental S tate E xamination ( MMSE ) and functional decline as a drop of 2 or more points in IADL score. Results Decreasing levels of eGFR and the presence of CKD were associated with greater odds of cognitive decline at follow‐up independent of confounding risk factors in multivariate analyses: estimated 14% increment in odds of cognitive decline per 10 mL/min/1.73 m 2 decrease in e GFR (odds ratio = 1.94, 95% confidence interval = 1.23–3.05; P = .004 for CKD vs non‐ CKD ). Similar associations were found in a cognitively normal subgroup ( MMSE > 23) at baseline. In the whole sample, CKD , but not e GFR , was found to be significantly associated with higher risk of IADL decline. Conclusion CKD in older persons was significantly associated with cognitive and functional decline. Future research should target the development and evaluation of strategies to delay or prevent cognitive decline and physical disability in elderly adults with impaired kidney function.