Abstract：
BACKGROUND: Cognitive impairment (CI) is common in older adults, especially those with renal dysfunction. We aimed to investigate the complex relationships among renal function, nutritional status, and CI in older people free from late chronic kidney disease (CKD) and severe CI.
METHODS: A study of older people (≥60 years old) with an estimated glomerular filtration rate (eGFR) of >30 mL/min/1.73 m2 and Montreal Cognitive Assessment (MoCA) scores of >10 (n = 237) was conducted at Beijing Tongren Hospital. Their eGFR was determined using the CKD-EPI-cr-Cysc equation. Cognitive function was evaluated with the MoCA. We tested the relationship between eGFR and MoCA scores using Spearman correlation analysis and multivariate logistic regression analysis. We then conducted a mediation analysis to figure out the mediating roles of nutritional indicators (Mini Nutritional Assessment-Short Form (MNA-SF) scores, albumin (ALB), and haemoglobin (HGB)) between the eGFR and MoCA scores.
RESULTS: The incidence of CI was 48.5% (115/237) in older people. Spearman correlation analysis revealed that the better the kidney function, the better the cognitive function (R = 0.297, P < 0.001). Multivariate logistic regression analysis revealed that eGFR decrease per 15 mL/min/1.73 m2 (OR: 1.415, 95% confidence interval: 1.055-1.896, P = 0.020) was related to CI after adjusting for age and sex. However, the eGFR was not associated with cognitive decline after adjusting for nutritional indicators, behavioural risk factors, other biomarkers, and chronic conditions, suggesting that eGFR is not independently associated with CI. Mediation analysis revealed that the MNA-SF scores (a*b = 0.006 (0.0002-0.012)) and HGB (a*b = 0.008 (0.001-0.017)) were mediating factors between the eGFR and MoCA scores.
CONCLUSIONS: A decline in renal function can directly lead to CI and can also exacerbate cognitive deficits through intermediary factors such as MNA-SF scores and HGB. Therefore, correcting anaemia and improving nutritional status are significantly important for enhancing cognitive function in older patients, especially those with renal dysfunction.
METHODS: A study of older people (≥60 years old) with an estimated glomerular filtration rate (eGFR) of >30 mL/min/1.73 m2 and Montreal Cognitive Assessment (MoCA) scores of >10 (n = 237) was conducted at Beijing Tongren Hospital. Their eGFR was determined using the CKD-EPI-cr-Cysc equation. Cognitive function was evaluated with the MoCA. We tested the relationship between eGFR and MoCA scores using Spearman correlation analysis and multivariate logistic regression analysis. We then conducted a mediation analysis to figure out the mediating roles of nutritional indicators (Mini Nutritional Assessment-Short Form (MNA-SF) scores, albumin (ALB), and haemoglobin (HGB)) between the eGFR and MoCA scores.
RESULTS: The incidence of CI was 48.5% (115/237) in older people. Spearman correlation analysis revealed that the better the kidney function, the better the cognitive function (R = 0.297, P < 0.001). Multivariate logistic regression analysis revealed that eGFR decrease per 15 mL/min/1.73 m2 (OR: 1.415, 95% confidence interval: 1.055-1.896, P = 0.020) was related to CI after adjusting for age and sex. However, the eGFR was not associated with cognitive decline after adjusting for nutritional indicators, behavioural risk factors, other biomarkers, and chronic conditions, suggesting that eGFR is not independently associated with CI. Mediation analysis revealed that the MNA-SF scores (a*b = 0.006 (0.0002-0.012)) and HGB (a*b = 0.008 (0.001-0.017)) were mediating factors between the eGFR and MoCA scores.
CONCLUSIONS: A decline in renal function can directly lead to CI and can also exacerbate cognitive deficits through intermediary factors such as MNA-SF scores and HGB. Therefore, correcting anaemia and improving nutritional status are significantly important for enhancing cognitive function in older patients, especially those with renal dysfunction.
摘要：
背景：认知障碍（CI）在老年人中很常见，尤其是那些肾功能不全的人.我们的目的是探讨肾功能之间的复杂关系，营养状况,无晚期慢性肾脏病（CKD）和严重CI的老年人。
方法：在北京同仁医院进行了一项研究，研究对象为肾小球滤过率（eGFR）>30mL/min/1.73m2且蒙特利尔认知评估（MoCA）评分>10（n=237）的老年人（≥60岁）。使用CKD-EPI-cr-Cysc方程确定它们的eGFR。使用MoCA评估认知功能。我们使用Spearman相关分析和多变量逻辑回归分析来检验eGFR和MoCA评分之间的关系。然后，我们进行了中介分析，以找出营养指标的中介作用(迷你营养评估-简表(MNA-SF)评分，白蛋白（ALB），eGFR和MoCA评分之间的血红蛋白（HGB））。
结果：老年人中CI的发生率为48.5%（115/237）。Spearman相关分析显示,肾功能越好,认知功能越好(R=0.297,P<0.001)。多因素logistic回归分析显示，校正年龄和性别后，eGFR每15mL/min/1.73m2下降（OR：1.415，95%置信区间：1.055-1.896，P=0.020）与CI相关。然而,调整营养指标后，eGFR与认知能力下降无关，行为危险因素，其他生物标志物,和慢性病，这表明eGFR与CI不是独立相关的。中介分析显示，MNA-SF得分（a*b=0.006（0.0002-0.012））和HGB（a*b=0.008（0.001-0.017））是eGFR和MoCA得分之间的中介因素。
结论：肾功能下降可直接导致CI，还可通过MNA-SF评分和HGB等中介因素加剧认知缺陷。因此,纠正贫血和改善营养状况对增强老年患者的认知功能非常重要，尤其是那些肾功能不全的人.
方法：在北京同仁医院进行了一项研究，研究对象为肾小球滤过率（eGFR）>30mL/min/1.73m2且蒙特利尔认知评估（MoCA）评分>10（n=237）的老年人（≥60岁）。使用CKD-EPI-cr-Cysc方程确定它们的eGFR。使用MoCA评估认知功能。我们使用Spearman相关分析和多变量逻辑回归分析来检验eGFR和MoCA评分之间的关系。然后，我们进行了中介分析，以找出营养指标的中介作用(迷你营养评估-简表(MNA-SF)评分，白蛋白（ALB），eGFR和MoCA评分之间的血红蛋白（HGB））。
结果：老年人中CI的发生率为48.5%（115/237）。Spearman相关分析显示,肾功能越好,认知功能越好(R=0.297,P<0.001)。多因素logistic回归分析显示，校正年龄和性别后，eGFR每15mL/min/1.73m2下降（OR：1.415，95%置信区间：1.055-1.896，P=0.020）与CI相关。然而,调整营养指标后，eGFR与认知能力下降无关，行为危险因素，其他生物标志物,和慢性病，这表明eGFR与CI不是独立相关的。中介分析显示，MNA-SF得分（a*b=0.006（0.0002-0.012））和HGB（a*b=0.008（0.001-0.017））是eGFR和MoCA得分之间的中介因素。
结论：肾功能下降可直接导致CI，还可通过MNA-SF评分和HGB等中介因素加剧认知缺陷。因此,纠正贫血和改善营养状况对增强老年患者的认知功能非常重要，尤其是那些肾功能不全的人.
