02589nas a2200361 4500008004100000022001400041245009100055210006900146260001600215300001000231490000800241520158100249653000901830653002801839653001401867653002401881653001501905653001101920653003101931653001801962653001101980653001101991653002002002653000902022653002902031100002002060700002402080700002002104700001602124700002802140700002302168856003602191 2014 eng d a1476-625600aKidney function and cognitive health in older adults: the Cardiovascular Health Study.0 aKidney function and cognitive health in older adults the Cardiov c2014 Jul 01 a68-750 v1803 a

Recent evidence has demonstrated the importance of kidney function in healthy aging. We examined the association between kidney function and change in cognitive function in 3,907 participants in the Cardiovascular Health Study who were recruited from 4 US communities and studied from 1992 to 1999. Kidney function was measured by cystatin C-based estimated glomerular filtration rate (eGFRcys). Cognitive function was assessed using the Modified Mini-Mental State Examination and the Digit Symbol Substitution Test, which were administered up to 7 times during annual visits. There was an association between eGFRcys and change in cognitive function after adjustment for confounders; persons with an eGFRcys of less than 60 mL/minute/1.73 m(2) had a 0.64 (95% confidence interval: 0.51, 0.77) points/year faster decline in Modified Mini-Mental State Examination score and a 0.42 (95% confidence interval: 0.28, 0.56) points/year faster decline in Digit Symbol Substitution Test score compared with persons with an eGFRcys of 90 or more mL/minute/1.73 m(2). Additional adjustment for intermediate cardiovascular events modestly affected these associations. Participants with an eGFRcys of less than 60 mL/minute/1.73 m(2) had fewer cognitive impairment-free life-years on average compared with those with eGFRcys of 90 or more mL/minute/1.73 m(2), independent of confounders and mediating cardiovascular events (mean difference = -0.44, 95% confidence interval: -0.62, -0.26). Older adults with lower kidney function are at higher risk of worsening cognitive function.

10aAged10aCardiovascular Diseases10aCognition10aCognition Disorders10aCystatin C10aFemale10aGlomerular Filtration Rate10aHealth Status10aHumans10aKidney10aKidney Diseases10aMale10aNeuropsychological Tests1 aDarsie, Brendan1 aShlipak, Michael, G1 aSarnak, Mark, J1 aKatz, Ronit1 aFitzpatrick, Annette, L1 aOdden, Michelle, C uhttps://chs-nhlbi.org/node/636403103nas a2200337 4500008004100000022001400041245013200055210006900187260001300256300001200269490000700281520211200288653000902400653002202409653001402431653002802445653001102473653001102484653000902495653002902504653002702533100001902560700002402579700002002603700002302623700002302646700001802669700002002687700002202707856003602729 2015 eng d a1532-541500aMicrovascular and Macrovascular Abnormalities and Cognitive and Physical Function in Older Adults: Cardiovascular Health Study.0 aMicrovascular and Macrovascular Abnormalities and Cognitive and  c2015 Sep a1886-930 v633 a

OBJECTIVES: To evaluate and compare the associations between microvascular and macrovascular abnormalities and cognitive and physical function

DESIGN: Cross-sectional analysis of the Cardiovascular Health Study (1998-1999).

SETTING: Community.

PARTICIPANTS: Individuals with available data on three or more of five microvascular abnormalities (brain, retina, kidney) and three or more of six macrovascular abnormalities (brain, carotid artery, heart, peripheral artery) (N = 2,452; mean age 79.5).

MEASUREMENTS: Standardized composite scores derived from three cognitive tests (Modified Mini-Mental State Examination, Digit-Symbol Substitution Test, Trail-Making Test (TMT)) and three physical tests (gait speed, grip strength, 5-time sit to stand)

RESULTS: Participants with high microvascular and macrovascular burden had worse cognitive (mean score difference = -0.30, 95% confidence interval (CI) = -0.37 to -0.24) and physical (mean score difference = -0.32, 95% CI = -0.38 to -0.26) function than those with low microvascular and macrovascular burden. Individuals with high microvascular burden alone had similarly lower scores than those with high macrovascular burden alone (cognitive function: -0.16, 95% CI = -0.24 to -0.08 vs -0.13, 95% CI = -0.20 to -0.06; physical function: -0.15, 95% CI = -0.22 to -0.08 vs -0.12, 95% CI = -0.18 to -0.06). Psychomotor speed and working memory, assessed using the TMT, were only impaired in the presence of high microvascular burden. Of the 11 vascular abnormalities considered, white matter hyperintensity, cystatin C-based glomerular filtration rate, large brain infarct, and ankle-arm index were independently associated with cognitive and physical function.

CONCLUSION: Microvascular and macrovascular abnormalities assessed using noninvasive tests of the brain, kidney, and peripheral artery were independently associated with poor cognitive and physical function in older adults. Future research should evaluate the usefulness of these tests in prognostication.

10aAged10aAged, 80 and over10aCognition10aCross-Sectional Studies10aFemale10aHumans10aMale10aNeuropsychological Tests10aVascular Malformations1 aKim, Dae, Hyun1 aGrodstein, Francine1 aNewman, Anne, B1 aChaves, Paulo, H M1 aOdden, Michelle, C1 aKlein, Ronald1 aSarnak, Mark, J1 aLipsitz, Lewis, A uhttps://chs-nhlbi.org/node/6852