NASHVILLE—Chronic kidney disease is associated with increased signs of brain aging and is a predictor of cognitive decline two years after stroke or transient ischemic attack (TIA), according to data described at the 2015 International Stroke Conference. “Chronic kidney disease may contribute to cerebral small vessel disease that underlies post-stroke cognitive decline, suggesting a new target for early intervention,” said Natan Bornstein, PhD, MD, Director of the Neurology Unit at Tel-Aviv Medical Center.
Few studies have analyzed the relationship between chronic kidney disease and post-stroke cognitive impairment. Dr. Bornstein and colleagues examined a prospective cohort of patients with mild to moderate ischemic stroke or TIA to evaluate the effect of impaired renal function on markers of cerebral small vessel disease, brain pathology, and cognitive decline.
The investigators performed 3-T MRI for all participants and measured the volume and integrity of pre-existing white matter hyperintensity, ischemic lesions, and brain atrophy. Using the Montreal Cognitive Assessment and a computerized cognitive testing battery, the researchers assessed patients’ cognitive function at hospital admission and at six, 12, and 24 months following stroke. In addition, the researchers estimated participants’ renal function at admission using the Cockcroft Gault creatinine clearance (CCl) equation.
Baseline data were available for 462 individuals. The population’s mean age was 67.4, and 60.4% of participants were males. People with a CCl of less than 60 mL/min performed significantly worse on all cognitive tests over time than participants with a CCl of greater than 60 mL/min. Chronic kidney disease also was associated with enlarged white matter hyperintensity volume, cortical atrophy, and smaller hippocampal volume.
After the two-year follow-up, 16% of the study population developed cognitive impairment. Multiple logistic regression analysis controlling for traditional risk factors, including cardiovascular risk factors, showed a significant association between CCl of less than 60 mL/min at baseline and development of cognitive impairment at the end of follow-up.