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From the Rush Alzheimer’s Disease Center (A.S.B., P.A.B., R.C.S., S.E.L., D.A.B.), Department of Neurological Sciences (A.S.B., S.E.L., D.A.B.), Department of Behavioral Science (P.A.B.), and Department of Family Medicine (R.C.S.), Rush University Medical Center, Chicago, IL; and Department of Neurology (D.T.), Sheba Medical Center, Tel Hashomer, Israel.
Address correspondence and reprint requests to Dr. Aron S. Buchman, Rush Alzheimer’s Disease Center, Rush University Medical Center, Armour Academic Facility, Suite 1038, 600 South Paulina St., Chicago, IL 60612 Aron_S_Buchman{at}rush.edu
Objective: We tested the hypothesis that impaired kidney function in the elderly is associated with a more rapid rate of cognitive decline.
Methods: Baseline serum was used to calculate estimated glomerular filtration rate (eGFR), using the Modification of Diet in Renal Disease formula, for 886 elderly without dementia participating in the Rush Memory and Aging Project, a prospective, observational cohort study. Kidney function was also dichotomized into impairment or no impairment based on eGFR < or 
60 mL/min/1.73 m2. Structured cognitive testing was performed at baseline and at annual evaluations, using a battery of 19 cognitive tests summarized into global cognition and 5 cognitive domains.
Results: In mixed-effects models adjusted for age, sex, and education, a lower eGFR at baseline was associated with a more rapid rate of cognitive decline (estimate 0.0008, SE <0.001, p = 0.017). The increased rate of cognitive decline associated with a 15-mL/min/1.73 m2 lower eGFR at baseline (approximately 1 SD) was similar to the effect of being 3 years older at baseline. Impaired kidney function at baseline was associated with a more rapid rate of cognitive decline (estimate –0.028, SE <0.009, p = 0.003). The increased rate of cognitive decline associated with impaired kidney function at baseline was approximately 75% the effect of ApoE4 allele on the rate of cognitive decline. Baseline kidney function was associated with declines in semantic memory, episodic memory, and working memory but not visuospatial abilities or perceptual speed.
Conclusion: Impaired kidney function is associated with a more rapid rate of cognitive decline in old age.
Abbreviations: AD = Alzheimer disease; BMI = body mass index; CRN = creatinine; eGFR = estimated glomerular filtration rate.
Supplemental data at www.neurology.org
Editorial, page 916
e-Pub ahead of print on August 5, 2009, at www.neurology.org.
Supported by the National Institute on Aging grants R01AG17917 and R01AG24480, the Illinois Department of Public Health, and the Robert C. Borwell Endowment Fund.
Disclosure: Author disclosures are provided at the end of the article.
Received January 28, 2009. Accepted in final form June 18, 2009.
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Neurology 2009 73: 916-917.
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  A. M. Murray The brain and the kidney connection: A model of accelerated vascular cognitive impairment Neurology, September 22, 2009; 73(12): 916 - 917. [Full Text] [PDF]
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