Top

BMC Geriatrics

Published in:

Open Access 01-12-2020 | Alzheimer's Disease | Research article

Effects of kidney function, serum albumin and hemoglobin on dementia severity in the oldest old people with newly diagnosed Alzheimer’s disease in a residential aged care facility: a cross-sectional study

Authors: Jia-Jyun Wu, Shuo-Chun Weng, Chih-Kuang Liang, Chu-Sheng Lin, Tsuo-Hung Lan, Shih-Yi Lin, Yu-Te Lin

Published in: BMC Geriatrics | Issue 1/2020

Abstract

Background

Chronic kidney disease (CKD), low serum albumin, and anemia are known risk factors for cognitive decline in older people. We investigated the association between kidney function and cognitive impairment severity in oldest-old people with a diagnosis of Alzheimer’s disease (AD).

Methods

A cross-sectional study of patients aged 80 years and older was conducted at a veterans’ home in Taiwan between 2012 and 2016. Their estimated glomerular filtration rate (eGFR) was determined using the Modification of Diet in Renal Diseases (MDRD) equation. Cognitive function was evaluated with the Mini-Mental State Examination (MMSE) and Clinical Dementia Rating (CDR).

Results

A total of 84 patients (age mean ± SD, 86.6 ± 3.9 years) had MMSE scores of 10.1 ± 6.7, and CDR scores of 1.6 ± 0.7. The average eGFR was 61.7 ± 21.5 mL/min/1.73m². The mean hemoglobin concentration was 12.7 ± 1.7 g/dl, and the mean albumin concentration was 4.5 ± 4.8 g/dl. Multivariate regression analyses showed that scores of CDR were significantly correlated with eGFR after adjustment for potential confounders. The scores of MMSE were significantly correlated with serum albumin and hemoglobin after adjustment for potential confounders.

Conclusions

We found dementia severity was significantly associated with kidney function, serum albumin, and hemoglobin in the oldest-old with AD. We recommend that oldest-old people with a diagnosis of AD be evaluated to determine kidney function, as well as nutritional and hematological status. Further study is needed to establish whether prevention of CKD deterioration, and correction of malnutrition and anemia may help to slow cognitive decline in oldest-old people with dementia.

Kurella Tamura M, Wadley V, Yaffe K, McClure LA, Howard G, Go R, Allman RM, Warnock DG, McClellan W. Kidney function and cognitive impairment in US adults: the reasons for geographic and racial differences in stroke (REGARDS) study. Am J Kidney Dis. 2008;52(2):227–34. https://doi.org/10.1053/j.ajkd.2008.05.004.CrossRefPubMedPubMedCentral

Arnold R, Issar T, Krishnan AV, Pussell BA. Neurological complications in chronic kidney disease. JRSM Cardiovasc Dis. 2016;5:2048004016677687.PubMedPubMedCentral

Zammit AR, Katz MJ, Bitzer M, Lipton RB. Cognitive impairment and dementia in older adults with chronic kidney disease: a review. Alzheimer Dis Assoc Disord. 2016;30(4):357–66.CrossRef

Cho EB, Seo SW, Kim H, Lee JM, Yoon U, Im K, Kim GH, Noh Y, Cho H, Yoon CW, Kim HJ, Na DL. Effect of kidney dysfunction on cortical thinning in patients with probable Alzheimer's disease dementia. J Alzheimers Dis. 2013;33(4):961–8. https://doi.org/10.3233/JAD-2012-121180.CrossRefPubMed

Seliger SL, Siscovick DS, Stehman-Breen CO, Gillen DL, Fitzpatrick A, Bleyer A, Kuller LH. Moderate renal impairment and risk of dementia among older adults: the cardiovascular health cognition study. J Am Soc Nephrol. 2004;15(7):1904–11.CrossRef

Ng TP, Niti M, Feng L, Kua EH, Yap KB. Albumin, apolipoprotein E-epsilon4 and cognitive decline in community-dwelling Chinese older adults. J Am Geriatr Soc. 2009;57(1):101–6. https://doi.org/10.1111/j.1532-5415.2008.02086.x.CrossRefPubMed

Ng TP, Feng L, Niti M, Yap KB. Albumin, haemoglobin, BMI and cognitive performance in older adults. Age Ageing. 2008 Jul;37(4):423–9. https://doi.org/10.1093/ageing/afn102.CrossRefPubMed

Hong CH, Falvey C, Harris TB, Simonsick EM, Satterfield S, Ferrucci L, Metti AL, Patel KV, Yaffe K. Anemia and risk of dementia in older adults: findings from the health ABC study. Neurology. 2013 Aug 6;81(6):528–33. https://doi.org/10.1212/WNL.0b013e31829e701d.CrossRefPubMedPubMedCentral

Gardner RC, Valcour V, Yaffe K. Dementia in the oldest old: a multi-factorial and growing public health issue. Alzheimers Res Ther. 2013 Jul 1;5(4):27. https://doi.org/10.1186/alzrt181.CrossRefPubMedPubMedCentral

10.

Ng A, Jion YI, Zainal NH, Kandiah N. Renal dysfunction contributes to episodic memory deficits and medial temporal atrophy in Alzheimer's disease: a pilot study. J Am Geriatr Soc. 2014;62(10):1981–2. https://doi.org/10.1111/jgs.13034.CrossRefPubMed

11.

James BD, Bennett DA, Boyle PA, Leurgans S, Schneider JA. Dementia from Alzheimer disease and mixed pathologies in the oldest old. JAMA. 2012;307(17):1798–800. https://doi.org/10.1001/jama.2012.3556.CrossRefPubMedPubMedCentral

12.

Sun Y, Lee HJ, Yang SC, Chen TF, Lin KN, Lin CC, Wang PN, Tang LY, Chiu MJ. A nationwide survey of mild cognitive impairment and dementia, including very mild dementia, in Taiwan. PLoS One. 2014;9(6):e100303. https://doi.org/10.1371/journal.pone.0100303.CrossRefPubMedPubMedCentral

13.

Bullain SS, Corrada MM. Dementia in the oldest old. Continuum (Minneap Minn). 2013(2 Dementia):457–469. doi: 10.1212/01.

14.

Chen LY, Lin YT, Chen LK, Loh CH. Person-centered dementia care for older veterans with dementia in Taiwan: past, present and future. Geriatr Gerontol Int. 2017;17(Suppl 1):4–6. https://doi.org/10.1111/ggi.13042.CrossRefPubMed

15.

Chen TB, Weng SC, Chou YY, Lee YS, Liang CK, Lin CS, Lan TH, Lin SY, Lin YT. Predictors of mortality in the oldest old patients with newly diagnosed Alzheimer disease in a residential aged care facility. Dement Geriatr Cogn Disord. 2019;48(1–2):93–104. https://doi.org/10.1159/000503059.CrossRefPubMed

16.

Chang HT, Liu LF, Chen CK, Hwang SJ, Chen LK, Lu FH. Correlates of institutionalized senior veterans’ quality of life in Taiwan. Health Qual Life Outcome. 2010;8:70. https://doi.org/10.1186/1477-7525-8-70.CrossRef

17.

McKhann G, Drachman D, Folstein M, Katzman R, Price D, Stadlan EM. Clinical diagnosis of Alzheimer's disease: report of the NINCDS-ADRDA work group under the auspices of Department of Health and Human Services Task Force on Alzheimer's disease. Neurology. 1984;34(7):939–44.CrossRef

18.

Chen LI, Guh JY, Wu KD, Chen YM, Kuo MC, Hwang SJ, Chen TH, Chen HC. Modification of diet in renal disease (MDRD) study and CKD epidemiology collaboration (CKD-EPI) equations for Taiwanese adults. PLoS One. 2014;9(6):e99645. https://doi.org/10.1371/journal.pone.0099645.CrossRefPubMedPubMedCentral

19.

Mandelli S, Riva E, Tettamanti M, Detoma P, Giacomin A, Lucca U. Mortality prediction in the oldest old with five different equations to estimate glomerular filtration rate: the health and Anemia population-based study. PLoS One. 2015;10(8):e0136039. https://doi.org/10.1371/journal.pone.0136039.CrossRefPubMedPubMedCentral

20.

Crum RM, Anthony JC, Bassett SS, Folstein MF. Population-based norms for the mini-mental state examination by age and educational level. JAMA. 1993;269(18):2386–91.CrossRef

21.

Morris JC. The clinical dementia rating (CDR): current version and scoring rules. Neurology. 1993;43(11):2412–4.CrossRef

22.

Cheng TM. Reflections on the 20^th anniversary of Taiwan’s signle-payer National Health Insurance System. Health Aff (Millwood). 2015;34(3):502–10. https://doi.org/10.1377/hlthaff.2014.1332.CrossRef

23.

Bowling CB, Inker LA, Gutiérrez OM, Allman RM, Warnock DG, McClellan W, Muntner P. Age-specific associations of reduced estimated glomerular filtration rate with concurrent chronic kidney disease complications. Clin J Am Soc Nephrol. 2011;6(12):2822–8. https://doi.org/10.2215/CJN.06770711.CrossRefPubMedPubMedCentral

24.

Wang H, Liu T, Cai YY, Jiang H, Liu HX, Lin C. Kidney function and cognitive impairment in people aged 80 years and over with untreated hypertension: a cross-sectional survey. Kidney Blood Press Res. 2016;41(1):70–7. https://doi.org/10.1159/000368550.CrossRefPubMed

25.

Bai K, Pan Y, Lu F, Zhao Y, Wang J, Zhang L. Kidney function and cognitive decline in an oldest-old Chinese population. Clin Interv Aging. 2017;12:1049–54.CrossRef

26.

Coppolino G, Bolignano D, Gareri P, Ruberto C, Andreucci M, Ruotolo G, Rocca M, Castagna A. Kidney function and cognitive decline in frail elderly: two faces of the same coin? Int Urol Nephrol. 2018;50(8):1505–10. https://doi.org/10.1007/s11255-018-1900-3.CrossRef

27.

Wang H, Fang C, Cai L, Dong B, Deng J. Chronic kidney disease and cognitive impairment among the very old in China. Aging Clin Exp Res. 2016 Jun;28(3):475–82. https://doi.org/10.1007/s40520-015-0433-1.CrossRefPubMed

28.

Mandelli S, Riva E, Tettamanti M, Detoma P, Giacomin A, Lucca U. Association of renal function with cognition, functional ability and mood in the oldest-old: the 'Health and Anemia study'. Nephrology (Carlton). 2020;25(1):48–54. https://doi.org/10.1111/nep.13579.CrossRef

29.

Melissa J. Slavin, Henry Brodaty, Perminder S Sachdev Challenges of diagnosing dementia in the oldest old population. J Gerontol A, Volume 68, Issue 9, 2013, Pages 1103–1111, https://doi.org/https://doi.org/10.1093/gerona/glt051.

30.

Lee KS, Na DL, Seo SW, Kim JH, Choi SH, Oh BH, Son SJ, Hong CH. Lower glomerular filtration rate associated with white matter hyperintensities more in vascular dementia than in Alzheimer's disease. J Am Geriatr Soc. 2015;63(1):182–3. https://doi.org/10.1111/jgs.13227.CrossRefPubMed

31.

An H, Choi B, Son SJ, Cho EY, Kim SO, Cho S, Kang DH, Lee C, Kim SY. Alzheimer's disease neuroimaging initiative. Renal function affects hippocampal volume and cognition: the role of vascular burden and amyloid deposition. Geriatr Gerontol Int. 2017;17(11):1899–906. https://doi.org/10.1111/ggi.12985.CrossRefPubMed

32.

Chen LW. Age, neuropathology, and dementia. N Engl J Med. 2009;361(11):1118. https://doi.org/10.1056/NEJMc091346.CrossRefPubMed

33.

White L. Brain lesions at autopsy in older Japanese-American men as related to cognitive impairment and dementia in the final years of life: a summary report from the Honolulu-Asia aging study. J Alzheimers Dis. 2009;18(3):713–25. https://doi.org/10.3233/JAD-2009-1178.CrossRefPubMed

34.

Pfeifer LA, White LR, Ross GW, Petrovitch H, Launer LJ. Cerebral amyloid angiopathy and cognitive function: the HAAS autopsy study. Neurology. 2002;58(11):1629–34.CrossRef

35.

Chien S-C, Chen C-Y, Lin C-F, Yeh H-I. Critical appraisal of the role of serum albumin in cardiovascular disease. Biomark Res. 2017;5:31.CrossRef

36.

Holmes C, Cunningham C, Zotova E, Woolford J, Dean C, Kerr S, Culliford D, Perry VH. Systemic inflammation and disease progression in Alzheimer disease. Neurology. 2009;73(10):768–74. https://doi.org/10.1212/WNL.CrossRefPubMedPubMedCentral

37.

Atti A, Palmer K, Volpato S, Zuliani G, Winblad B, Fratiglioni L. Anaemia increases the risk of dementia in cognitively intact elderly. Neurobiol Aging. 2006:278–84. https://doi.org/10.1016/j.neurobiolaging.2005.02.007.

38.

Peters R, Burch L, Warner J, Beckett N, Poulter R, Bulpitt C. Haemoglobin, anaemia, dementia and cognitive decline in the elderly, a systematic review. BMC Geriatr. 2008;8:18. https://doi.org/10.1186/1471-2318-8-18.CrossRefPubMedPubMedCentral

39.

Sachdev PS, Lipnicki DM, Crawford J, Reppermund S, Kochan NA, Trollor JN, Draper B, Slavin MJ, Kang K, Lux O, Mather KA. Brodaty H; Sydney memory and ageing study team. Risk profiles for mild cognitive impairment vary by age and sex: the Sydney memory and ageing study. Am J Geriatr Psychiatry. 2012;20(10):854–65. https://doi.org/10.1097/JGP.0b013e31825461b0.CrossRefPubMed

40.

Peltz CB, Corrada MM, Berlau DJ, Kawas CH. Cognitive impairment in nondemented oldest-old: prevalence and relationship to cardiovascular risk factors. Alzheimers Dement. 2012;8(2):87–94. https://doi.org/10.1016/j.jalz.2011.02.008.CrossRefPubMed

41.

Li G, Rhew IC, Shofer JB, Kukull WA, Breitner JC, Peskind E, Bowen JD, McCormick W, Teri L, Crane PK, Larson EB. Age-varying association between blood pressure and risk of dementia in those aged 65 and older: a community-based prospective cohort study. J Am Geriatr Soc. 2007;55(8):1161–7.CrossRef

42.

Ruitenberg A, Skoog I, Ott A, Aevarsson O, Witteman JC, Lernfelt B, van Harskamp F, Hofman A, Breteler MM. Blood pressure and risk of dementia: results from the Rotterdam study and the Gothenburg H-70 study. Dement Geriatr Cogn Disord. 2001;12(1):33–9.CrossRef

43.

Martyr A, Clare L. Executive function and activities of daily living in Alzheimer's disease: a correlational meta-analysis. Dement Geriatr Cogn Disord. 2012;33(2–3):189–203. https://doi.org/10.1159/000338233.CrossRefPubMed

44.

Swanberg MM, Tractenberg RE, Mohs R, Thal LJ, Cummings JL. Executive dysfunction in Alzheimer disease. Arch Neurol. 2004;61(4):556–60.CrossRef

45.

Lai SW, Lin CH, Liao KF, Su LT, Sung FC, Lin CC. Association between polypharmacy and dementia in older people: a population-based case-control study in Taiwan. Geriatr Gerontol Int. 2012;12(3):491–8.CrossRef

46.

Alessandra C, Pietro G, Gianfranco P, Francesca F, Roberto L, Alberto C, Valeria GLM, Rosanna C, Amalia CB. Somatic comorbidities and Alzheimer’s disease treatment. Neurol Sci. 2013;34(9):1581–9. https://doi.org/10.1007/s10072-013-1290-3.CrossRef

47.

Yang Z, Slavin MJ, Sachdev PS. Dementia in the oldest old. Nat Rev Neurol. 2013 Jul;9(7):382–93. https://doi.org/10.1038/nrneurol.2013.105.CrossRefPubMed

48.

Cahill S, Diaz-Ponce AM, Coen RF, Walsh C. The under detection of cognitive impairment in nursing homes in the Dublin area. The need for on-going cognitive assessment. Age Ageing. 2010. https://doi.org/10.1093/ageing/afp198.

49.

Xu S, Jin X, Liu C, Jin Y, Xu Y, Chen L, Xu S, Tang H, Yan J. vestigating the prevalence of dementia and its associated risk factors in a Chinese nursing home. J Clin Neurol. 2017;13:10–4.CrossRef

50.

Magsi H, Malloy T. Underrecognition of cognitive impairment in assisted living facilities. J Am GeriatrSoc. 2005;53:295–8.CrossRef

51.

Köhler L, Weyerer S, Schäufele M. Proxy screening tools improve the recognition of dementia in old-age homes: results of a validation study. Age Ageing. 2007;36(5):549–54.CrossRef

52.

Berggren R, Nilsson J, Lövdén M. Education does not affect cognitive decline in aging: a bayesian assessment of the association between education and change in cognitive performance. Front Psychol. 2018;9:1138.CrossRef

53.

Cobb JL, Wolf PA, Au R, White R, D'Agostino RB. The effect of education on the incidence of dementia and Alzheimer's disease in the Framingham study. Neurology. 1995;45(9):1707–12.CrossRef

54.

Li NC, Lee A, Whitmer RA, Kivipelto M, Lawler E, Kazis LE, Wolozin B. Use of angiotensin receptor blockers and risk of dementia in a predominantly male population: prospective cohort analysis. BMJ. 2010;340:b5465. https://doi.org/10.1136/bmj.b5465.CrossRefPubMedPubMedCentral

55.

Royea J, Zhang L, Tong XK, Hamel E. Angiotensin IV receptors mediate the cognitive and cerebrovascular benefits of losartan in a mouse model of Alzheimer's disease. J Neurosci. 2017;37(22):5562–73. https://doi.org/10.1523/JNEUROSCI.0329-17.CrossRefPubMedPubMedCentral

56.

Allen VJ, Methven L, Gosney MA. Use of nutritional complete supplements in older adults with dementia: systematic review and meta-analysis of clinical outcomes. Clin Nutr. 2013;32(6):950–7. https://doi.org/10.1016/j.clnu.2013.03.015.CrossRefPubMed

57.

Shaker AM, Mohamed OM, Mohamed MF, El-Khashaba SO. Impact of correction of anemia in end-stage renal disease patients on cerebral circulation and cognitive functions. Saudi J Kidney Dis Transpl. 2018;29(6):1333–41. https://doi.org/10.4103/1319-2442.248306.CrossRefPubMed

58.

Garasto S, Fusco S, Corica F, Rosignuolo M, Marino A, Montesanto A, De Rango F, Maggio M, Mari V, Corsonello A, Lattanzio F. Estimating glomerular filtration rate in older people. Biomed Res Int. 2014;2014:916542. https://doi.org/10.1155/2014/916542.CrossRefPubMedPubMedCentral

Title: Effects of kidney function, serum albumin and hemoglobin on dementia severity in the oldest old people with newly diagnosed Alzheimer’s disease in a residential aged care facility: a cross-sectional study
Authors: Jia-Jyun Wu
Shuo-Chun Weng
Chih-Kuang Liang
Chu-Sheng Lin
Tsuo-Hung Lan
Shih-Yi Lin
Yu-Te Lin
Publication date: 01-12-2020
Publisher: BioMed Central
Keywords: Alzheimer's Disease
Dementia
Alzheimer's Disease
Dementia
Chronic Kidney Disease
Published in: BMC Geriatrics / Issue 1/2020
Electronic ISSN: 1471-2318
DOI: https://doi.org/10.1186/s12877-020-01789-0

Live Webinar | 27-06-2024 | 18:00 (CEST)

Keynote webinar | Spotlight on medication adherence

Reserve your place

Live: Thursday 27th June 2024, 18:00-19:30 (CEST)

WHO estimates that half of all patients worldwide are non-adherent to their prescribed medication. The consequences of poor adherence can be catastrophic, on both the individual and population level.

Join our expert panel to discover why you need to understand the drivers of non-adherence in your patients, and how you can optimize medication adherence in your clinics to drastically improve patient outcomes.

Prof. Kevin Dolgin

Prof. Florian Limbourg

Prof. Anoop Chauhan

Developed by: Springer Medicine

Obesity Clinical Trial Summary

At a glance: The STEP trials

A round-up of the STEP phase 3 clinical trials evaluating semaglutide for weight loss in people with overweight or obesity.

Developed by: Springer Medicine

Highlights from the ACC 2024 Congress

Year in Review: Pediatric cardiology

Pediatric Cardiology Video

Watch Dr. Anne Marie Valente present the last year's highlights in pediatric and congenital heart disease in the official ACC.24 Year in Review session.

Year in Review: Pulmonary vascular disease

Cardiopulmonary Comorbidity Video

The last year's highlights in pulmonary vascular disease are presented by Dr. Jane Leopold in this official video from ACC.24.

Year in Review: Valvular heart disease

Valvular Heart Disease Video

Watch Prof. William Zoghbi present the last year's highlights in valvular heart disease from the official ACC.24 Year in Review session.

Year in Review: Heart failure and cardiomyopathies

Heart Failure Video

Watch this official video from ACC.24. Dr. Biykem Bozkurt discusses last year's major advances in heart failure and cardiomyopathies.

ACC 2024 Congress Coverage

Year in Review: Heart failure and cardiomyopathies

Heart Failure Video

Watch this official video from ACC.24. Dr. Biykem Bozkurt discusses last year's major advances in heart failure and cardiomyopathies.

Watch now

Semaglutide benefits people with type 2 diabetes and obesity-related heart failure

16-04-2024 Type 2 Diabetes News

Incentivised to exercise

11-04-2024 Lifestyle Modifications News

New intervention for STEMI-related cardiogenic shock

10-04-2024 Myocardial Infarction News

» View more highlights on the ACC 2024 congress hub page

Image Credits

Illustration of figure on mountain summit/© Orapun / Stock.adobe.com, STEP AAG HeroTeaserCollection image/© Tarek / Generated with AI / Stock.adobe.com, ACC 2024 Pediatric and Congenital Heart Disease: Year in Review/© 2024 American College of Cardiology, ACC 2024 Pulmonary Vascular Disease: Year in Review/© 2024 American College of Cardiology, ACC 2024 Valvular Heart Disease: Year in Review/© 2024 American College of Cardiology, ACC 2024 HF and Cardiomyopathies: Year in Review/© 2024 American College of Cardiology, Woman out walking/© Seventyfour / stock.adobe.com (symbolic image with model), Woman checking smartwatch /© saltdium / stock.adobe.com (symbolic image with model), Cardiac catheterization/© Damian / stock.adobe.com

Keynote webinar | Spotlight on medication adherence

Springer Medicine

Abstract

Background

Methods

Results

Conclusions

Please log in to get access to this content

Other articles of this Issue 1/2020

Memory complaints and depressive symptoms over time: a construct-level replication analysis

Perceived availability of future care and depressive symptoms among older adults in China: evidence from CHARLS

Prevalence and characteristics of older adults with a persistent death wish without severe illness: a large cross-sectional survey

Healthy aging through the lens of community-based practitioners: a focus group study

Mortality is not increased with Diabetes in hospitalised very old adults: a multi-site review

Revisiting the hypothesis of syndromic frailty: a cross-sectional study of the structural validity of the frailty phenotype

Live: Thursday 27th June 2024, 18:00-19:30 (CEST)

Highlights from the ACC 2024 Congress

ACC 2024 Congress Coverage