Research Project

Exercise Training and Cognitive Function in Kidney Disease

Principal Investigator
Bronas, Ulf
Funding Source
Midwest Roybal Center for Health Promotion

Abstract

Chronic kidney disease (CKD), affects over 45% of all individuals over 70 years of age. Patients with moderate CKD have more than a two-fold increased risk of cognitive impairment than those without CKD; furthermore, as many as 20-70% of patients with CKD have established cognitive impairment and overt dementia. The burden of cognitive impairment and dementia leads to functional decline and accelerated loss of independence, contributing to the tremendous individual, societal, and economic burden of CKD (i.e., 20% of Medicare expenditures in adults >65 years of age). There is no recommended treatment to prevent cognitive decline in CKD patients, and the few medications available for cognitive impairment have only short term modest effects. There is a critical need to evaluate therapies to forestall cognitive impairment, and maintain or improve cognitive functioning in older patients with CKD. To address this need, we will test the hypothesis that older patients with moderate/severe CKD and pre-clinical cognitive impairment randomized to a 6-month home-based exercise program will improve cognitive function and MRI measured brain structure, compared to a usual care control group. We are focusing on patients with pre-clinical cognitive impairment in order to capture a therapeutic window in the disease process, which will allow us to possibly prevent dementia before brain atrophy becomes irreversible. Our central hypothesis is that the accelerated cognitive decline in CKD results from a vascular dysfunctioninduced reduction in the integrity of the brain white matter and that exercise training provides a cerebro-protective effect by improving cerebral vascular health. We will combine an assessment of cognition with MR imaging techniques to fully evaluate brain structure, blood flow, and behavior relationships at a level previously not conducted in this population. This pilot study will provide the necessary pilot data for submission of a large scale randomized controlled trial (R01) to the NIH responding to PA-15-017 ?Biobehavioral Interventions to Attenuate Cognitive Decline?. This study is designed to improve or forestall cognitive decline in CKD patients by establishing an intervention that is implemented individually in the community, and will provide the first step in providing an effective treatment designed to delay physical and cognitive function-related loss of independence, and curb the escalating costs in the growing CKD population. This is a population with accelerated brain aging and a high prevalence of cognitive impairment, making the potential clinical impact tremendous.