Reduced Kidney Function is Associated with Poorer Domain‐Specific Cognitive Performance in Community‐Dwelling Older Adults

Adam H Dyer, Eamon Laird, Leane Hoey, Catherine F Hughes, Helene McNulty, Mary Ward, JJ Strain, Maurice O’Kane, Fergal Tracey, Anne M Molloy, Conal Cunningham, Donal J Sexton, Kevin McCarroll

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Abstract

Objectives: Whilst chronic kidney disease has been associated with cognitive impairment, the association between reduced estimated Glomerular Filtration Rate (eGFR) and domain-specific cognitive performance is less clear and may represent an important target for the promotion of optimal brain health in older adults. Methods: Participants aged >60 years from the Trinity-Ulster-Department of Agriculture study underwent detailed cognitive assessment using the Mini-Mental State Examination (Mini-Mental State Examination (MMSE)), Frontal Assessment Battery (FAB) and Repeatable Battery for Assessment of Neuropsychological Status (RBANS). Poisson and linear regression models assessed the relationship between eGFR strata and cognitive performance. Results: In 4887 older adults (73.9 ± 8.3 years; 67.7% female), declining eGFR strata was associated with greater likelihood of error on the MMSE/FAB and poorer overall performance on the RBANS. Following robust covariate adjustment, findings were greatest for GFR <45 ml/ml/1.73 m 2 (Incidence Rate Ratio: 1.17; 95% CI 1.08, 1.27; p < 0.001 for MMSE; IRR: 1.13; 95% CI 1.04, 1.13; p < 0.001 for FAB; β: −3.66; 95% CI −5.64, −1.86; p < 0.001 for RBANS). Additionally, eGFR <45 ml/ml/1.73 m 2 was associated with poorer performance on all five RBANS domains, with greatest effect sizes for immediate memory, delayed memory and attention. Associations were strongest in those aged 60–70, with no associations observed in those >80 years. Conclusions: Reduced kidney function was associated with poorer global and domain-specific neuropsychological performance. Associations were strongest with eGFR <45 ml/min/1.73 m 2 and in those aged 60–70 years, suggesting that this population may potentially benefit from potential multi-domain interventions aimed at promoting optimal brain health in older adults.

Original languageEnglish
Number of pages11
JournalInternational Journal of Geriatric Psychiatry
Volume37
Issue number7
Early online date8 Jun 2022
DOIs
Publication statusPublished - 19 Jun 2022

Bibliographical note

Funding Information:
The Trinity, Ulster and Department of Agriculture (TUDA) study was supported by government funding from the Irish Department of Agriculture, Food and the Marine and Health Research Board (under the Food Institutional Research Measure, to Helene McNulty) and from the Northern Ireland Department for Employment and Learning (under its Strengthening the All-Island Research Base initiative). The authors wish to acknowledge all of the TUDA study participants. AHDis additionally supported by the Wellcome-HRB Clinical Research Facility at St James's Hospital, Dublin, Ireland and has been awarded an Irish Clinical Academic Training (ICAT) Fellowship the Irish Clinical Academic Training (ICAT) Programme, supported by the Wellcome Trust and the Health Research Board (Grant Number 203930/B/16/Z), the Health Service Executive, National Doctors Training and Planning and the Health and Social Care, Research and Development Division, Northern Ireland. Open access funding provided by IReL.

Publisher Copyright:
© 2022 The Authors. International Journal of Geriatric Psychiatry published by John Wiley & Sons Ltd.

Keywords

  • cognition
  • chronic kidney disease (CKD)
  • older adults

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