Simple Urine Test May Help Identify Individuals with Diabetes at Risk for Cognitive Decline

Highlights• Diabetics with persistent protein in the urine over four to five years had greater declines in cognitive function than diabetics without protein in the urine.• The decline was subtle; however, over 10 to 15 years it could translate into noticeable impairment.People with type 2 diabetes have a 50% to 60% increased risk of experiencing cognitive impairment than people without diabetes.

Newswise — Washington, DC (August 29, 2013) — The presence of protein in the urine may be a marker of risk for future cognitive decline in patients with type 2 diabetes and normal kidney function, according to a study appearing in an upcoming issue of the Clinical Journal of the American Society of Nephrology (CJASN). The finding suggests that urinary protein may be an early warning sign regarding patients’ cognitive abilities.

Individuals with diabetes have an increased risk of experiencing cognitive impairment, especially impairment due to vascular causes. Joshua Barzilay, MD (Kaiser Permanente of Georgia/Emory School of Medicine), Lenore Launer, PhD (National Institute on Aging) and their colleagues evaluated whether albuminuria—a kidney complication that is common in people with diabetes and is characterized by protein excretion in the urine—predicts cognitive decline in older adults with diabetes.

The researchers studied 2977 diabetics with an average age of 62 years. Patients were recruited between August 2003 and December 2005 and were followed until June 2009. Participants underwent three neuropsychological tests: at the start of the study and again at 20 and 40 months. Tests included information processing speed, verbal memory, and executive function.

People with persistent albuminuria over four to five years had greater percent declines on information processing speed than participants without albuminuria. Persistent and progressive albuminuria were linked with a greater than 5% decline in information processing speed scores but not with verbal memory or executive function performance.“Our finding was a subtle change in cognition; however, were this decline to continue over 10 to 15 years it could translate into noticeable cognitive decline by the age of 75 to 80 years, when cognitive impairment generally becomes clinically evident,” said Dr. Barzilay. “Given how common albuminuria and diabetes are in the older population, these findings have a great deal of importance from a population point of view. Moreover, albuminuria is also common among older people with hypertension without diabetes.”

Study co-authors include James Lovato, MS, Anne Murray, MD, MS, Jeff Williamson, MD, Faramaz Ismail-Beigi, MD, PhD, Diane Karl, MD, and Vasilios Papademetriou, MD.

Disclosures: The authors reported no financial disclosures. The work was funded by the National Institutes of Health and the National Institute on Aging.

The article, entitled “Albuminuria and Cognitive Decline in People With Diabetes and Normal Renal Function,” will appear online at http://cjasn.asnjournals.org/ on August 29, 2013, doi: 10.2215/CJN.11321112.

The content of this article does not reflect the views or opinions of The American Society of Nephrology (ASN). Responsibility for the information and views expressed therein lies entirely with the author(s). ASN does not offer medical advice. All content in ASN publications is for informational purposes only, and is not intended to cover all possible uses, directions, precautions, drug interactions, or adverse effects. This content should not be used during a medical emergency or for the diagnosis or treatment of any medical condition. Please consult your doctor or other qualified health care provider if you have any questions about a medical condition, or before taking any drug, changing your diet or commencing or discontinuing any course of treatment. Do not ignore or delay obtaining professional medical advice because of information accessed through ASN. Call 911 or your doctor for all medical emergencies.

Founded in 1966, and with more than 14,000 members, the American Society of Nephrology (ASN) leads the fight against kidney disease by educating health professionals, sharing new knowledge, advancing research, and advocating the highest quality care for patients.

# # #