Cognitive and renal dysfunction in the elderly

Carmo, Francisco Souza do; Pires, Sueli Luciano; Gorzoni, Milton Luiz; Miorin, Luiz Antonio

doi:10.1590/S1980-57642013DN74000007

ABSTRACT

Cognitive impairment has been associated with several diseases and organic disturbances but few studies have explored the relationship between renal function and cognition.

Objective:

The aim of this study was to compare the renal function of elderly patients with and without Alzheimer's disease, and to identify potential associated comorbidities, as well as the presence of microalbuminuria.

Methods:

A group of 60 patients with dementia syndrome and probable Alzheimer's disease, and 20 patients without dementias, followed at the Geriatric outpatient unit of the Santa Casa de São Paulo Hospital, were selected for this study.

Results:

The results showed that the groups studied differed in terms of age, gender and Mini-Mental State Exam score, but no statistical difference was found for the presence of comorbidities (diabetes mellitus, dyslipidemia and systemic arterial hypertension). A significant difference in estimated creatinine clearance was observed between the two groups, with the Alzheimer's disease patients presenting significantly lower values than control subjects. Similarly, analysis of a portion of the two groups for the presence of microalbuminuria revealed a statistically significant difference between the two groups.

Conclusion:

The study conclusions were that patients with Alzheimer's disease had lower glomerular filtration and a higher incidence of microalbuminuria, yet without having more classic risk factors for Alzheimer's disease such as systemic arterial hypertension, diabetes mellitus or dyslipidemia.

Key words:
elderly; Alzheimer's disease; dementia; renal function; albuminuria.

RESUMO

Alterações cognitivas são associadas a diversas doenças e distúrbios orgânicos, mas poucos estudos exploram a relação entre a função renal e a cognição.

Objetivo:

Este estudo buscou comparar a função renal de pacientes com e sem demência de Alzheimer, além de identificar possíveis comorbidades associadas e a presença de microalbuminúria.

Métodos:

Foram selecionados 60 pacientes com síndrome demencial, provável doença de Alzheimer e 20 pacientes sem qualquer demência, que estavam em acompanhamento no ambulatório de Geriatria da Santa Casa de São Paulo.

Resultados:

Os resultados mostraram que os grupos estudados diferiram em relação à idade, sexo e mini-exame do estado mental, mas não houve diferença estatística quanto à presença de comorbidades (diabetes mellitus, dislipidemia e hipertensão arterial sistêmica). Em relação ao clearance de creatinina observou-se uma diferença significativa entre os grupos, o com doença de Alzheimer apresentou um valor significativamente menor que o controle. Também a análise da presença de microalbuminúria entre uma parte dos dois grupos estudados, mostrou uma diferença estatística significante.

Conclusão:

Concluiu-se que os pacientes com doença de Alzheimer tiveram menor filtração glomerular e maior percentual de microalbuminúria, mesmo sem apresentarem mais fatores de riscos clássicos para a doença de Alzheimer, como hipertensão arterial sistêmica, diabetes mellitus e dislipidemia.

Palavras-chave:
idoso; doença de Alzheimer; demência; função renal e albuminúria.

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Full text available only in PDF format.

REFERENCES

¹
Herrera Jr E, Caramelli P, Nitrini R. Estudo epidemiológico populacional de demência na cidade de Catanduva - estado de São Paulo - Brasil. Rev Psiq Clin 1998;25:70-73.
²
Kalache A, Veras RP, Ramos LR. O envelhecimento da população mundial. Um novo desafio, Rev Saude Publ 1987;21:200-210.
³
Cummings JL. Alzheimer's disease. N Engl J Med 2004; 351:56-67.
⁴
Luchsinger J, Reitz C, Honig LS, Tang MX, Shea S, Mayeux R. Aggregation of vascular risk factors and risk of incident Alzheimer's disease. Neurology 2005;65:545-551.
⁵
Duron E, Hanon O. Vascular risk factors, cognitive decline, and dementia. Vasc Health Risk Manag 2008;4:363-381.
⁶
Lindeman RD, Tobin J, Shock NW. Longitudinal studies on the rate decline in renal function with age. J Am Geriatr Soc 1985;33:278-285.
⁷
Oreopoulos DG, Dimkovic N. Geriatric Nephrology is coming of age. J Am Soc Nephrol 2003;14:1099-1101.
⁸
Barzilay JI, Fitzpatrick AL, Luchsinger J, et al. Albuminuria and Dementia in the Elderly: A Community Study. Am J Kidney Dis 2008;52:216-226. 9.. Bertollucci PH, Brucki SM, Campacci SR, Juliano Y. The Mini-Mental State Examination in a general population: impact of educational status. Arq Neuropsiquiatr 1994;52:1-7.
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¹⁰
Nitrini R, Caramelli P, Bottino CMC, Damasceno BP, Brucki SMD, Anghinah R. Diagnóstico da doença de Alzheimer no Brasil. Critérios diagnósticos e exames complementares. Recomendações do departamento cientifico de neurologia e do envelhecimento da academia brasileira de neurologia. Arq Neuropsiquiatr 2005;63:713-719.
¹¹
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 the Department of Health and Human Services Task Force on Alzheimer's disease. Neurology 1984;34:939-944.
¹²
American Psychiatric Association - Diagnostic and Statistical Manual of Mental Disorders, 4 ed., American Psychiatric Association; Washington DC; 1994.
¹³
Cockcroft DW, Gault MH. Prediction of creatinina clearance from serum creatinine. Nephron 1976;16:31-41.
¹⁴
National Kidney Foundation, K/DOQI Clinical Practice Guidelines for chronic kidney disease: evaluation, Classification and Stratification. Am J Kidney Dis 2002;39:S1-S266.
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¹⁶
Rosner B. Fundamentals of Biostatistics, 2nd ed., PWS Publishers, Boston; 1986.
¹⁷
Madan P, Kalra OP, Agarwal S, Tandon OP. Cognitive impairment in chronic kidney disease. Nephrol Dial Transplant 2007;22:440-444.
¹⁸
Brookmeyer R, Johnson E, Ziegler-Graham K, Arrighi HM. Forecasting the global burden of Alzheimer's disease. Alzheimers Dement 2007;3: 186-191.
¹⁹
Barker WW, Luis CA, Kashuba A, Luis M, et al. Relative frequencies of Alzheimer disease, Lewy body, vascular and frontotemporal dementia, and hippocampal sclerosis in the State of Florida Brain Bank. Alzheimer Dis Assoc Disord 2002;16:203-212.
²⁰
Cação JC, Souza DRS, Tognola WA, Godoy MRP, Pinhel MAS. Polimorfismo da apolipoproteína e nos familiares em primeiro grau de pacientes com doença de Alzheimer familial ou esporádica, Arq Neuropsiquiatr 2007;65:1-6.
²¹
Chaimowicz F. A saúde dos idosos brasileiros às vésperas do século XXI: problemas, projeções e alternativas. Rev Saúde Publica 1997;31: 184-200.
²²
Algotsson A, Winbland B. The integrity of the blood-brain barrier in Alzheimer's disease. Acta Neurol Scand 2007;115:403-408.
²³
Kurella M, Chertow GM, Fried LF, et al., Chronic Kidney Disease and Cognitive Impairment in the Elderly: The Health, Aging, and Body Composition Study. J Am Soc Nephrol 2005;16:2127-2133.
²⁴
VI Diretrizes Brasileiras de Hipertensão, Rev Bras Hipertensão 2010; 17:7-60.

Publication Dates

Publication in this collection
Dec 2013

History

Received
06 Sept 2013
Accepted
12 Nov 2013

This is an open-access article distributed under the terms of the Creative Commons Attribution License

[1] ¹
Herrera Jr E, Caramelli P, Nitrini R. Estudo epidemiológico populacional de demência na cidade de Catanduva - estado de São Paulo - Brasil. Rev Psiq Clin 1998;25:70-73.

[2] ²
Kalache A, Veras RP, Ramos LR. O envelhecimento da população mundial. Um novo desafio, Rev Saude Publ 1987;21:200-210.

[3] ³
Cummings JL. Alzheimer's disease. N Engl J Med 2004; 351:56-67.

[4] ⁴
Luchsinger J, Reitz C, Honig LS, Tang MX, Shea S, Mayeux R. Aggregation of vascular risk factors and risk of incident Alzheimer's disease. Neurology 2005;65:545-551.

[5] ⁵
Duron E, Hanon O. Vascular risk factors, cognitive decline, and dementia. Vasc Health Risk Manag 2008;4:363-381.

[6] ⁶
Lindeman RD, Tobin J, Shock NW. Longitudinal studies on the rate decline in renal function with age. J Am Geriatr Soc 1985;33:278-285.

[7] ⁷
Oreopoulos DG, Dimkovic N. Geriatric Nephrology is coming of age. J Am Soc Nephrol 2003;14:1099-1101.

[8] ⁸
Barzilay JI, Fitzpatrick AL, Luchsinger J, et al. Albuminuria and Dementia in the Elderly: A Community Study. Am J Kidney Dis 2008;52:216-226. 9.. Bertollucci PH, Brucki SM, Campacci SR, Juliano Y. The Mini-Mental State Examination in a general population: impact of educational status. Arq Neuropsiquiatr 1994;52:1-7.

[9] ⁹
. Bertollucci PH, Brucki SM, Campacci SR, Juliano Y. The Mini-Mental State Examination in a general population: impact of educational status. Arq Neuropsiquiatr 1994;52:1-7.

[10] ¹⁰
Nitrini R, Caramelli P, Bottino CMC, Damasceno BP, Brucki SMD, Anghinah R. Diagnóstico da doença de Alzheimer no Brasil. Critérios diagnósticos e exames complementares. Recomendações do departamento cientifico de neurologia e do envelhecimento da academia brasileira de neurologia. Arq Neuropsiquiatr 2005;63:713-719.

[11] ¹¹
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 the Department of Health and Human Services Task Force on Alzheimer's disease. Neurology 1984;34:939-944.

[12] ¹²
American Psychiatric Association - Diagnostic and Statistical Manual of Mental Disorders, 4 ed., American Psychiatric Association; Washington DC; 1994.

[13] ¹³
Cockcroft DW, Gault MH. Prediction of creatinina clearance from serum creatinine. Nephron 1976;16:31-41.

[14] ¹⁴
National Kidney Foundation, K/DOQI Clinical Practice Guidelines for chronic kidney disease: evaluation, Classification and Stratification. Am J Kidney Dis 2002;39:S1-S266.

[15] 15. Haahr M. Random.org. [online] True random number service, (accessed nov 30, 2009] Available from: http://www.random.org/integers

[16] ¹⁶
Rosner B. Fundamentals of Biostatistics, 2nd ed., PWS Publishers, Boston; 1986.

[17] ¹⁷
Madan P, Kalra OP, Agarwal S, Tandon OP. Cognitive impairment in chronic kidney disease. Nephrol Dial Transplant 2007;22:440-444.

[18] ¹⁸
Brookmeyer R, Johnson E, Ziegler-Graham K, Arrighi HM. Forecasting the global burden of Alzheimer's disease. Alzheimers Dement 2007;3: 186-191.

[19] ¹⁹
Barker WW, Luis CA, Kashuba A, Luis M, et al. Relative frequencies of Alzheimer disease, Lewy body, vascular and frontotemporal dementia, and hippocampal sclerosis in the State of Florida Brain Bank. Alzheimer Dis Assoc Disord 2002;16:203-212.

[20] ²⁰
Cação JC, Souza DRS, Tognola WA, Godoy MRP, Pinhel MAS. Polimorfismo da apolipoproteína e nos familiares em primeiro grau de pacientes com doença de Alzheimer familial ou esporádica, Arq Neuropsiquiatr 2007;65:1-6.

[21] ²¹
Chaimowicz F. A saúde dos idosos brasileiros às vésperas do século XXI: problemas, projeções e alternativas. Rev Saúde Publica 1997;31: 184-200.

[22] ²²
Algotsson A, Winbland B. The integrity of the blood-brain barrier in Alzheimer's disease. Acta Neurol Scand 2007;115:403-408.

[23] ²³
Kurella M, Chertow GM, Fried LF, et al., Chronic Kidney Disease and Cognitive Impairment in the Elderly: The Health, Aging, and Body Composition Study. J Am Soc Nephrol 2005;16:2127-2133.

[24] ²⁴
VI Diretrizes Brasileiras de Hipertensão, Rev Bras Hipertensão 2010; 17:7-60.

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