Cognitive Dysfunction and Gait Abnormalities in CKD | JoVE Visualize

Area of Science:

Nephrology
Neurology
Geriatrics

Background:

Cognitive impairment is a significant cause of morbidity in individuals with chronic kidney disease (CKD).
Gait abnormalities are increasingly recognized as a potential indicator of underlying health issues in older adults.
A specific gait phenotype has been recently defined and linked to CKD.

Purpose of the Study:

To investigate the association between a specific gait phenotype and cognitive function in older adults with CKD.
To determine if gait abnormalities share a common pathogenesis with cognitive dysfunction in CKD.
To assess the risk of developing mild cognitive impairment (MCI) associated with this gait phenotype in CKD patients.

Main Methods:

Gait assessments and comprehensive neuropsychological testing (Repeatable Battery for the Assessment of Neuropsychological Status - RBANS) were conducted in 312 community-dwelling older adults (≥65 years).
Magnetic resonance imaging (MRI) was performed on a subset (n=115) to examine brain structure.
Statistical analyses included multivariable linear regression, nearest-neighbor matching, and Cox proportional hazards models to assess cognitive outcomes and MCI risk.

Main Results:

Lower estimated glomerular filtration rate (eGFR) was associated with lower RBANS scores specifically among participants exhibiting the gait phenotype.
Participants with both CKD and the gait phenotype showed significantly lower adjusted RBANS scores (5.4 points lower) and poorer performance in memory and executive functions compared to those without either condition.
Neuroimaging revealed a common pattern of gray matter atrophy in brain regions critical for cognition, affecting both CKD patients and those with the gait phenotype.
The gait phenotype was independently associated with a higher risk of developing mild cognitive impairment (MCI) (HR=3.91) regardless of eGFR.

Conclusions:

A distinct gait phenotype is significantly associated with poorer cognitive function across multiple domains in older adults with CKD.
This gait phenotype independently predicts incident mild cognitive impairment (MCI) in older adults, even after accounting for kidney function (eGFR).
Shared gray matter atrophy patterns in specific brain regions suggest a common underlying pathophysiology linking CKD, the gait phenotype, and cognitive impairment.