and cognitive impairment compared to the general population, in part due to accelerated vasculardisease. Although the majority of reports have focused on risk factors and outcomes associated withcPartdieiancts dwisiethasre,nathl edyismfupnactioonf ascucfefelerrafrtoemd evxatsrcauolradrinadrisileyasheighonracterseborfovmaosrctauliatyr aonudtcomaerksedamfuonncgtionthaelsepatients are not well defined and may contribute significantly to their marked cognitive impairment.Although a few studies have reported an increased risk of stroke among patients with renal dysfunction,risk factors and outcomes associated with clinical and subclinical stroke have not been identified.We hypothesize that patients with renal dysfunction, through factors which promote accelerated vasculardisease, are at a higher risk of clinical and subclinical stroke, which contributes to a high prevalence ofcognitive dysfunction and dementia in patients with renal disease. The overall objectives of this study areto determine the association between renal dysfunction and risk of clinical and subclinical stroke, identifyspecific stroke risk factors, and quantify the associated cognitive dysfunction among patients with chronicrenal insufficiency (CRI) and end-stage renal disease (ESRD).The proposed research will involve a series of observational studies. First, the association between renaldysfunction and clinical stroke will be estimated and stroke risk factors among CRI and ESRD pts will beidentified, using data from multicenter prospective cohort studies. Next, using MRI and neuropsychiatricdata collected as part of one these studies, we will determine whether patients with CRI are at higher riskfor subclinical brain infarcts, and whether this contributes to a higher risk of dementia. Finally, MRIimaging and longitudinal measurements of cognitive function will be performed on hemodialysis patients,to determine risk factors for subclinical brain infarcts and define the relationship between these infarctsand cognitive decline. These studies, by clarifying associated risk factors and adverse outcomes ofstroke, could result in the development of new strategies to diagnose and prevent ischemic brain diseasein patients with renal disease, ultimately leading to an improved prognosis for these patients.
| Seliger, Stephen L; Wendell, Carrington R; Waldstein, Shari R et al. (2015) Renal function and long-term decline in cognitive function: the Baltimore Longitudinal Study of Aging. Am J Nephrol 41:305-12 |
| Roshanravan, Baback; Robinson-Cohen, Cassianne; Patel, Kushang V et al. (2013) Association between physical performance and all-cause mortality in CKD. J Am Soc Nephrol 24:822-30 |
| Spencer, Robert J; Wendell, Carrington R; Giggey, Paul P et al. (2013) Judgment of Line Orientation: an examination of eight short forms. J Clin Exp Neuropsychol 35:160-6 |
| Seliger, Stephen L; Longstreth Jr, W T; Katz, Ronit et al. (2005) Cystatin C and subclinical brain infarction. J Am Soc Nephrol 16:3721-7 |
| Seliger, Stephen L; Siscovick, David S; Stehman-Breen, Catherine O et al. (2004) Moderate renal impairment and risk of dementia among older adults: the Cardiovascular Health Cognition Study. J Am Soc Nephrol 15:1904-11 |
| Seliger, Stephen L; Gillen, Daniel L; Tirschwell, David et al. (2003) Risk factors for incident stroke among patients with end-stage renal disease. J Am Soc Nephrol 14:2623-31 |
