Skip to main content
Top
Published in: BMC Geriatrics 1/2019

Open Access 01-12-2019 | Research article

Impaired kidney function is associated with lower cognitive function in the elder general population. Results from the Good Aging in Skåne (GÅS) cohort study

Authors: Tomas Månsson, Marieclaire Overton, Mats Pihlsgård, Sölve Elmståhl

Published in: BMC Geriatrics | Issue 1/2019

Login to get access

Abstract

Background

A possible connection on vascular basis between impaired kidney function and cognitive dysfunction has been suggested in previous studies. Contradictory results regarding specific cognitive domains have been reported. The aim for this study was to investigate the association between kidney function and specific cognitive domains.

Methods

In this cross-sectional design, data from the general population based cohort study “Good aging in Skåne” (GÅS) was used. The sample included 2931 subjects ages 60 to 93 randomly selected from the southern part of Sweden. Estimated glomerular filtration rate (eGFR) for both creatinine and cystatine C was calculated using the chronic kidney disease epidemiology collaboration (CKD-EPI) equation. The subjects underwent a test battery of neuropsychological tests assessing global cognitive function, learning and memory, language, complex attention, executive function, perceptual motor and meta-memory. Adjustments were made for age, sex, education and country of origin.

Results

After adjustment for demographic variables, impaired kidney function was associated with 0.41 points worse result in MMSE, 0.56 points worse result in recognition, 0.66 points worse result in word fluency, 0.45 points worse result in digit cancellation, 0.99 points worse result in pattern comparison, and 3.71 s longer time to finish TMT B-A. Associations to cognitive function was also noted for mildly impaired kidney function defined as eGFR 45- < 60 ml/min/1,73m2. No association was found between kidney function and meta-memory.

Conclusions

Impaired kidney function as well as the severity of impaired kidney function is associated with impairment in learning and memory, language, complex attention, executive function and global cognitive function, but not meta-memory.
Appendix
Available only for authorised users
Literature
1.
go back to reference Zhang QL, Rothenbacher D. Prevalence of chronic kidney disease in population-based studies: systematic review. BMC Public Health. 2008;8:117.CrossRef Zhang QL, Rothenbacher D. Prevalence of chronic kidney disease in population-based studies: systematic review. BMC Public Health. 2008;8:117.CrossRef
2.
go back to reference de Souza-Talarico JN, de Carvalho AP, Brucki SM, Nitrini R, Ferretti-Rebustini RE. Dementia and cognitive impairment prevalence and associated factors in indigenous populations: a systematic review. Alzheimer Dis Assoc Disord. 2016;30:281–7.CrossRef de Souza-Talarico JN, de Carvalho AP, Brucki SM, Nitrini R, Ferretti-Rebustini RE. Dementia and cognitive impairment prevalence and associated factors in indigenous populations: a systematic review. Alzheimer Dis Assoc Disord. 2016;30:281–7.CrossRef
3.
go back to reference Alexander M, Perera G, Ford L, Arrighi HM, Foskett N, Debove C, et al. Age-stratified prevalence of mild cognitive impairment and dementia in European populations: a systematic review. J Alzheimer’s Dis : JAD. 2015;48:355–9.CrossRef Alexander M, Perera G, Ford L, Arrighi HM, Foskett N, Debove C, et al. Age-stratified prevalence of mild cognitive impairment and dementia in European populations: a systematic review. J Alzheimer’s Dis : JAD. 2015;48:355–9.CrossRef
4.
go back to reference National KF. K/DOQI clinical practice guidelines for chronic kidney disease: evaluation, classification, and stratification. Am J Kidney Dis : Official J Natl Kidney Found. 2002;39(2 Suppl 1):S1–266. National KF. K/DOQI clinical practice guidelines for chronic kidney disease: evaluation, classification, and stratification. Am J Kidney Dis : Official J Natl Kidney Found. 2002;39(2 Suppl 1):S1–266.
5.
go back to reference Disease K. Improving Global Outcomes (KDIGO) CKD Work Group. KDIGO 2012 Clinical Practice Guideline for the Evaluation and Management of Chronic Kidney Disease. Kidney Inter, Suppl. 2013;3:1–150.CrossRef Disease K. Improving Global Outcomes (KDIGO) CKD Work Group. KDIGO 2012 Clinical Practice Guideline for the Evaluation and Management of Chronic Kidney Disease. Kidney Inter, Suppl. 2013;3:1–150.CrossRef
6.
go back to reference Werner KB, Elmstahl S, Christensson A, Pihlsgard M. Male sex and vascular risk factors affect cystatin C-derived renal function in older people without diabetes or overt vascular disease. Age Ageing. 2014;43:411–7.CrossRef Werner KB, Elmstahl S, Christensson A, Pihlsgard M. Male sex and vascular risk factors affect cystatin C-derived renal function in older people without diabetes or overt vascular disease. Age Ageing. 2014;43:411–7.CrossRef
7.
go back to reference Shen Z, Ruan Q, Yu Z, Sun Z. Chronic kidney disease-related physical frailty and cognitive impairment: a systemic review. Geriatr Gerontol Int. 2016. Shen Z, Ruan Q, Yu Z, Sun Z. Chronic kidney disease-related physical frailty and cognitive impairment: a systemic review. Geriatr Gerontol Int. 2016.
8.
go back to reference Etgen T, Chonchol M, Forstl H, Sander D. Chronic kidney disease and cognitive impairment: a systematic review and meta-analysis. Am J Nephrol. 2012;35:474–82.CrossRef Etgen T, Chonchol M, Forstl H, Sander D. Chronic kidney disease and cognitive impairment: a systematic review and meta-analysis. Am J Nephrol. 2012;35:474–82.CrossRef
9.
go back to reference Go AS, Chertow GM, Fan D, McCulloch CE, Hsu CY. Chronic kidney disease and the risks of death, cardiovascular events, and hospitalization. N Engl J Med. 2004;351:1296–305.CrossRef Go AS, Chertow GM, Fan D, McCulloch CE, Hsu CY. Chronic kidney disease and the risks of death, cardiovascular events, and hospitalization. N Engl J Med. 2004;351:1296–305.CrossRef
10.
go back to reference Kapasi A, Schneider JA. Vascular contributions to cognitive impairment, clinical Alzheimer’s disease, and dementia in older persons. Biochim Biophys Acta. 1862;2016:878–86. Kapasi A, Schneider JA. Vascular contributions to cognitive impairment, clinical Alzheimer’s disease, and dementia in older persons. Biochim Biophys Acta. 1862;2016:878–86.
11.
go back to reference Drew DA, Weiner DE. Cognitive impairment in chronic kidney disease: keep vascular disease in mind. Kidney Int. 2014;85:505–7.CrossRef Drew DA, Weiner DE. Cognitive impairment in chronic kidney disease: keep vascular disease in mind. Kidney Int. 2014;85:505–7.CrossRef
12.
go back to reference Elias MF, Dore GA, Davey A. Kidney disease and cognitive function. Contrib Nephrol. 2013;179:42–57.CrossRef Elias MF, Dore GA, Davey A. Kidney disease and cognitive function. Contrib Nephrol. 2013;179:42–57.CrossRef
13.
go back to reference 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;30:357–66.CrossRef 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;30:357–66.CrossRef
14.
go back to reference Smith E. Vascular Cognitive Impairment. Continuum. 2016;22 2 Dementia:490–509. Smith E. Vascular Cognitive Impairment. Continuum. 2016;22 2 Dementia:490–509.
15.
go back to reference Sachdev PS, Blacker D, Blazer DG, Ganguli M, Jeste DV, Paulsen JS, et al. Classifying neurocognitive disorders: the DSM-5 approach. Nat Rev Neurol. 2014;10:634–42.CrossRef Sachdev PS, Blacker D, Blazer DG, Ganguli M, Jeste DV, Paulsen JS, et al. Classifying neurocognitive disorders: the DSM-5 approach. Nat Rev Neurol. 2014;10:634–42.CrossRef
16.
go back to reference Ekström H, Elmståhl S. Pain and fractures are independently related to lower walking speed and grip strength: Results from the population study “Good Ageing in Skåne” / Pain and fractures are independently related to lower walking speed and grip strength: Results from the population study “Good Ageing in Skåne.” Acta Orthopaedica. 2006;:902.CrossRef Ekström H, Elmståhl S. Pain and fractures are independently related to lower walking speed and grip strength: Results from the population study “Good Ageing in Skåne” / Pain and fractures are independently related to lower walking speed and grip strength: Results from the population study “Good Ageing in Skåne.” Acta Orthopaedica. 2006;:902.CrossRef
17.
go back to reference Legrand H, Werner K, Christensson A, Pihlsgård M, Elmståhl S. Prevalence and determinants of differences in cystatin C and creatinine-based estimated glomerular filtration rate in community-dwelling older adults: a cross-sectional study. BMC Nephrol. 2017;18:350.CrossRef Legrand H, Werner K, Christensson A, Pihlsgård M, Elmståhl S. Prevalence and determinants of differences in cystatin C and creatinine-based estimated glomerular filtration rate in community-dwelling older adults: a cross-sectional study. BMC Nephrol. 2017;18:350.CrossRef
18.
go back to reference Levey AS, Stevens LA, Schmid CH, Zhang YL, Castro AF, Feldman HI, et al. A new equation to estimate glomerular filtration rate. Ann Intern Med. 2009;150:604–12.CrossRef Levey AS, Stevens LA, Schmid CH, Zhang YL, Castro AF, Feldman HI, et al. A new equation to estimate glomerular filtration rate. Ann Intern Med. 2009;150:604–12.CrossRef
19.
go back to reference Inker LA, Schmid CH, Tighiouart H, Eckfeldt JH, Feldman HI, Greene T, et al. Estimating glomerular filtration rate from serum creatinine and cystatin C. N Engl J Med. 2012;367:20–9.CrossRef Inker LA, Schmid CH, Tighiouart H, Eckfeldt JH, Feldman HI, Greene T, et al. Estimating glomerular filtration rate from serum creatinine and cystatin C. N Engl J Med. 2012;367:20–9.CrossRef
20.
go back to reference American Psychiatric Association, American Psychiatric Association. DSM-5 Task Force. Neurocognitive disorders. In: Diagnostic and statistical manual of mental disorders : DSM-5. 5th edition. Washington, D.C: American Psychiatric Association; 2013. p. 591–643. American Psychiatric Association, American Psychiatric Association. DSM-5 Task Force. Neurocognitive disorders. In: Diagnostic and statistical manual of mental disorders : DSM-5. 5th edition. Washington, D.C: American Psychiatric Association; 2013. p. 591–643.
21.
go back to reference Folstein MF, Folstein SE, McHugh PR. “Mini-mental state”. A practical method for grading the cognitive state of patients for the clinician. J Psychiatr Res. 1975;12:189–98.CrossRef Folstein MF, Folstein SE, McHugh PR. “Mini-mental state”. A practical method for grading the cognitive state of patients for the clinician. J Psychiatr Res. 1975;12:189–98.CrossRef
22.
go back to reference Lezak MD. A compendium of tests and assessment techniques. In: Neuropsychological assessment. 4th ed. New York: Oxford University Press; 2004. p. 335–74. Lezak MD. A compendium of tests and assessment techniques. In: Neuropsychological assessment. 4th ed. New York: Oxford University Press; 2004. p. 335–74.
23.
go back to reference Gardiner JM, Java RI. Recognising and remembering. In: Theories of memory. Hillsdale, NJ, US: Lawrence Erlbaum Associates, Inc; 1993. p. 163–188.CrossRef Gardiner JM, Java RI. Recognising and remembering. In: Theories of memory. Hillsdale, NJ, US: Lawrence Erlbaum Associates, Inc; 1993. p. 163–188.CrossRef
24.
go back to reference Zazzo R. Test des deux barrages. Actualités Pédagogiques et Psychologiques. Delachaux & Niestlé: Neuchâtel, Switzerland; 1974. Zazzo R. Test des deux barrages. Actualités Pédagogiques et Psychologiques. Delachaux & Niestlé: Neuchâtel, Switzerland; 1974.
25.
go back to reference Salthouse TA, Babcock RL. Decomposing adult age differences in working memory. Dev Psychol. 1991;27:763–77.CrossRef Salthouse TA, Babcock RL. Decomposing adult age differences in working memory. Dev Psychol. 1991;27:763–77.CrossRef
26.
go back to reference Sanchez-Cubillo I, Perianez JA, Adrover-Roig D, Rodriguez-Sanchez JM, Rios-Lago M, Tirapu J, et al. Construct validity of the trail making test: role of task-switching, working memory, inhibition/interference control, and visuomotor abilities. J Int Neuropsychol Soc : JINS. 2009;15:438–50.CrossRef Sanchez-Cubillo I, Perianez JA, Adrover-Roig D, Rodriguez-Sanchez JM, Rios-Lago M, Tirapu J, et al. Construct validity of the trail making test: role of task-switching, working memory, inhibition/interference control, and visuomotor abilities. J Int Neuropsychol Soc : JINS. 2009;15:438–50.CrossRef
27.
go back to reference Kaplan E. WAIS-NI : manual : WAIS-R as a neuropsychological instrument. San Antonio: Psychological Corp, Harcourt Brace Jovanovich; 1991. Kaplan E. WAIS-NI : manual : WAIS-R as a neuropsychological instrument. San Antonio: Psychological Corp, Harcourt Brace Jovanovich; 1991.
28.
go back to reference Vandenberg SG, Kuse AR. Mental rotations, a group test of three-dimensional spatial visualization. Percept Mot Skills. 1978;47:599–604.CrossRef Vandenberg SG, Kuse AR. Mental rotations, a group test of three-dimensional spatial visualization. Percept Mot Skills. 1978;47:599–604.CrossRef
29.
go back to reference Shepard RN, Metzler J. Mental rotation of three-dimensional objects. Science. 1971;171:701–3.CrossRef Shepard RN, Metzler J. Mental rotation of three-dimensional objects. Science. 1971;171:701–3.CrossRef
30.
go back to reference Dahl M, Allwood CM, Hagberg B. The realism in older people’s confidence judgments of answers to general knowledge questions. Psychol Aging. 2009;24:234–8.CrossRef Dahl M, Allwood CM, Hagberg B. The realism in older people’s confidence judgments of answers to general knowledge questions. Psychol Aging. 2009;24:234–8.CrossRef
31.
go back to reference McDermott LM, Ebmeier KP. A meta-analysis of depression severity and cognitive function. J Affect Disord. 2009;119:1–8.CrossRef McDermott LM, Ebmeier KP. A meta-analysis of depression severity and cognitive function. J Affect Disord. 2009;119:1–8.CrossRef
32.
go back to reference Montgomery SA, Asberg M. A new depression scale designed to be sensitive to change. Br J Psychiatry : J Ment Sci. 1979;134:382–9.CrossRef Montgomery SA, Asberg M. A new depression scale designed to be sensitive to change. Br J Psychiatry : J Ment Sci. 1979;134:382–9.CrossRef
33.
go back to reference Elmstahl S, Widerstrom E. Orthostatic intolerance predicts mild cognitive impairment: incidence of mild cognitive impairment and dementia from the Swedish general population cohort good aging in Skane. Clin Interv Aging. 2014;9:1993–2002.CrossRef Elmstahl S, Widerstrom E. Orthostatic intolerance predicts mild cognitive impairment: incidence of mild cognitive impairment and dementia from the Swedish general population cohort good aging in Skane. Clin Interv Aging. 2014;9:1993–2002.CrossRef
34.
go back to reference Diagnostic and statistical manual of mental disorders: DSM-IV. Washington (DC): American Psychiatric Association; 1994. Diagnostic and statistical manual of mental disorders: DSM-IV. Washington (DC): American Psychiatric Association; 1994.
35.
go back to reference Lumley T, Diehr P, Emerson S, Chen L. The importance of the normality assumption in large public health data sets. Annu Rev Public Health. 2002;23:151–69.CrossRef Lumley T, Diehr P, Emerson S, Chen L. The importance of the normality assumption in large public health data sets. Annu Rev Public Health. 2002;23:151–69.CrossRef
36.
go back to reference Shi Y, Wardlaw JM. Update on cerebral small vessel disease: a dynamic whole-brain disease. Stroke Vasc Neurol. 2016;1:83–92.CrossRef Shi Y, Wardlaw JM. Update on cerebral small vessel disease: a dynamic whole-brain disease. Stroke Vasc Neurol. 2016;1:83–92.CrossRef
37.
go back to reference Overton M, Pihlsgård M, Elmståhl S. Test administrator effects on cognitive performance in a longitudinal study of ageing. Cogent Psychol. 2016;3:N.PAG-N.PAG. Overton M, Pihlsgård M, Elmståhl S. Test administrator effects on cognitive performance in a longitudinal study of ageing. Cogent Psychol. 2016;3:N.PAG-N.PAG.
38.
go back to reference Kurella M, Yaffe K, Shlipak MG, Wenger NK, Chertow GM. Chronic kidney disease and cognitive impairment in menopausal women. Am J Kidney Dis. 2005;45:66–76.CrossRef Kurella M, Yaffe K, Shlipak MG, Wenger NK, Chertow GM. Chronic kidney disease and cognitive impairment in menopausal women. Am J Kidney Dis. 2005;45:66–76.CrossRef
39.
go back to reference Slinin Y, Paudel ML, Ishani A, Taylor BC, Yaffe K, Murray AM, et al. Kidney function and cognitive performance and decline in older men. J Am Geriatr Soc. 2008;56:2082–8.CrossRef Slinin Y, Paudel ML, Ishani A, Taylor BC, Yaffe K, Murray AM, et al. Kidney function and cognitive performance and decline in older men. J Am Geriatr Soc. 2008;56:2082–8.CrossRef
Metadata
Title
Impaired kidney function is associated with lower cognitive function in the elder general population. Results from the Good Aging in Skåne (GÅS) cohort study
Authors
Tomas Månsson
Marieclaire Overton
Mats Pihlsgård
Sölve Elmståhl
Publication date
01-12-2019
Publisher
BioMed Central
Published in
BMC Geriatrics / Issue 1/2019
Electronic ISSN: 1471-2318
DOI
https://doi.org/10.1186/s12877-019-1381-y

Other articles of this Issue 1/2019

BMC Geriatrics 1/2019 Go to the issue