This study will investigate why the risk of developing dementia is higher in adults with kidney disease. Chronic kidney disease (CKD) is a rising global health burden affecting 1 in 10 people worldwide with greater prevalence rates in older people and in disadvantaged and minority groups. Our goal is to investigate whether long-term blood pressure control and prior stroke disease explain the relationship between CKD and cognitive decline.
CKD is associated with a high risk of developing cognitive decline and dementia. The reasons for this relationship are not well-understood. It may relate to the fact that people with CKD have a lot of traditional cardiovascular risk factors including high blood pressure, diabetes, and prior stroke. However, others propose that the accumulation of toxins or inflammation in kidney disease may contribute.
To understand the relationship between CKD and cognitive decline, we will use the Framingham Heart Study. Framingham is a longitudinal cohort study, a type of epidemiological study that follows a group of individuals over time to determine the natural history of certain diseases, explore the behavior of those diseases, and identify the factors that might explain their development. Over 2000 participants in this study have had multiple blood pressure readings over time, serial cognitive assessments (memory tests) and magnetic resonance (MR) brain imaging.
We will study their imaging to determine the degree, if any, of prior stroke disease present. We will then analyze to what extent the relationship between CKD and cognitive decline are mediated by blood pressure control and prior stroke disease. Better understanding the mechanisms underpinning this relationship may help us improve the prevention and treatment of dementia in this high-risk, vulnerable group. Given that CKD is so common in the ageing population, by focusing on kidney health and its downstream consequences, we may discover novel ways to approach dementia prevention and treatment. We hope that our research will inform brain health policies more broadly with greater recognition for the interdependence of kidney and brain health.