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Serum Sodium and Cognition in Older Community-Dwelling Men.
Clin J Am Soc Nephrol. 2018 03 07; 13(3):366-374.CJ

Abstract

BACKGROUND AND OBJECTIVES

Mild hyponatremia is a common finding in older adults; however, the association of lower serum sodium with cognition in older adults is currently unknown. We determined whether lower normal serum sodium is associated with cognitive impairment and risk of cognitive decline in community-dwelling older men.

DESIGN, SETTING, PARTICIPANTS, & MEASUREMENTS

Five thousand four hundred thirty-five community-dwelling men aged ≥65 years who participated in Osteoporotic Fractures in Men, a cohort study with a median follow-up for cognitive function of 4.6 years, were included in this analysis. Multivariable logistic regression was used to examine the association between baseline fasting serum sodium levels and the odds of prevalent cognitive impairment (cross-sectional analysis; modified Mini-Mental Status [3MS] score <1.5 SD [<84] below or Trail Making Test Part B time >1.5 SD above the mean [>223 seconds]) and cognitive decline (prospective analysis [n=3611]; decrease in follow-up 3MS score or increase in Trails B time >1.5 SD of the mean score/time change [>9 or >67 seconds]).

RESULTS

Participants were aged 74±6 years with a fasting mean serum sodium level of 141±3 mmol/L. Fifteen percent (n=274), 12% (n=225), and 13% (n=242) had prevalent cognitive impairment in tertiles 1, 2, and 3, respectively. After adjustment, lower serum sodium was associated with prevalent cognitive impairment (tertile 1 [126-140 mmol/L] versus tertile 2 [141-142 mmol/L], odds ratio [OR], 1.30; 95% confidence interval [95% CI], 1.06 to 1.61). Fourteen percent (n=159), 10% (n=125), and 13% (n=159) had cognitive decline in tertiles 1, 2, and 3, respectively. Lower serum sodium was also associated with cognitive decline (tertile 1 versus tertile 2, OR, 1.37; 95% CI, 1.06 to 1.77). Tertile 3 (143-153 mmol/L) was additionally associated with cognitive decline. Results were similar in sensitivity analyses according to clinical cut-offs and by quartiles.

CONCLUSIONS

In community-dwelling older men, serum sodium between 126-140, and 126-140 or 143-153 mmol/L, are independently associated with prevalent cognitive impairment and cognitive decline, respectively.

Authors+Show Affiliations

Division of Renal Diseases and Hypertension, University of Colorado Anschutz Medical Campus, Aurora, Colorado; Kristen.Nowak@ucdenver.edu.Departments of Psychiatry, Neurology, and Epidemiology, University of California San Francisco, San Francisco, California.Bone and Mineral Unit, Oregon Health and Science University, Portland, Oregon.Divisions of Nephrology and Preventative Medicine, University of California San Diego, San Diego, California. Nephrology Section, Veterans Affairs San Diego Healthcare System, San Diego, California.Division of Renal Diseases and Hypertension, University of Colorado Anschutz Medical Campus, Aurora, Colorado.Division of Epidemiology, Department of Family Medicine and Public Health, University of California San Diego, La Jolla, California; and.Division of Endocrinology, Gerontology and Metabolism, Stanford University, Stanford, California.Division of Renal Diseases and Hypertension, University of Colorado Anschutz Medical Campus, Aurora, Colorado.

Pub Type(s)

Journal Article
Research Support, N.I.H., Extramural
Research Support, Non-U.S. Gov't

Language

eng

PubMed ID

29439092

Citation

Nowak, Kristen L., et al. "Serum Sodium and Cognition in Older Community-Dwelling Men." Clinical Journal of the American Society of Nephrology : CJASN, vol. 13, no. 3, 2018, pp. 366-374.
Nowak KL, Yaffe K, Orwoll ES, et al. Serum Sodium and Cognition in Older Community-Dwelling Men. Clin J Am Soc Nephrol. 2018;13(3):366-374.
Nowak, K. L., Yaffe, K., Orwoll, E. S., Ix, J. H., You, Z., Barrett-Connor, E., Hoffman, A. R., & Chonchol, M. (2018). Serum Sodium and Cognition in Older Community-Dwelling Men. Clinical Journal of the American Society of Nephrology : CJASN, 13(3), 366-374. https://doi.org/10.2215/CJN.07400717
Nowak KL, et al. Serum Sodium and Cognition in Older Community-Dwelling Men. Clin J Am Soc Nephrol. 2018 03 7;13(3):366-374. PubMed PMID: 29439092.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Serum Sodium and Cognition in Older Community-Dwelling Men. AU - Nowak,Kristen L, AU - Yaffe,Kristine, AU - Orwoll,Eric S, AU - Ix,Joachim H, AU - You,Zhiying, AU - Barrett-Connor,Elizabeth, AU - Hoffman,Andrew R, AU - Chonchol,Michel, Y1 - 2018/02/08/ PY - 2017/07/13/received PY - 2017/11/29/accepted PY - 2018/2/14/pubmed PY - 2019/10/15/medline PY - 2018/2/14/entrez KW - Aging KW - Cognition KW - Cognitive Dysfunction KW - Cross-Sectional Studies KW - Fasting KW - Follow-Up Studies KW - Independent Living KW - Logistic Models KW - Osteoporotic Fractures KW - Prevalence KW - Prospective Studies KW - Sodium KW - Trail Making Test KW - cognitive KW - electrolytes KW - hyponatremia SP - 366 EP - 374 JF - Clinical journal of the American Society of Nephrology : CJASN JO - Clin J Am Soc Nephrol VL - 13 IS - 3 N2 - BACKGROUND AND OBJECTIVES: Mild hyponatremia is a common finding in older adults; however, the association of lower serum sodium with cognition in older adults is currently unknown. We determined whether lower normal serum sodium is associated with cognitive impairment and risk of cognitive decline in community-dwelling older men. DESIGN, SETTING, PARTICIPANTS, & MEASUREMENTS: Five thousand four hundred thirty-five community-dwelling men aged ≥65 years who participated in Osteoporotic Fractures in Men, a cohort study with a median follow-up for cognitive function of 4.6 years, were included in this analysis. Multivariable logistic regression was used to examine the association between baseline fasting serum sodium levels and the odds of prevalent cognitive impairment (cross-sectional analysis; modified Mini-Mental Status [3MS] score <1.5 SD [<84] below or Trail Making Test Part B time >1.5 SD above the mean [>223 seconds]) and cognitive decline (prospective analysis [n=3611]; decrease in follow-up 3MS score or increase in Trails B time >1.5 SD of the mean score/time change [>9 or >67 seconds]). RESULTS: Participants were aged 74±6 years with a fasting mean serum sodium level of 141±3 mmol/L. Fifteen percent (n=274), 12% (n=225), and 13% (n=242) had prevalent cognitive impairment in tertiles 1, 2, and 3, respectively. After adjustment, lower serum sodium was associated with prevalent cognitive impairment (tertile 1 [126-140 mmol/L] versus tertile 2 [141-142 mmol/L], odds ratio [OR], 1.30; 95% confidence interval [95% CI], 1.06 to 1.61). Fourteen percent (n=159), 10% (n=125), and 13% (n=159) had cognitive decline in tertiles 1, 2, and 3, respectively. Lower serum sodium was also associated with cognitive decline (tertile 1 versus tertile 2, OR, 1.37; 95% CI, 1.06 to 1.77). Tertile 3 (143-153 mmol/L) was additionally associated with cognitive decline. Results were similar in sensitivity analyses according to clinical cut-offs and by quartiles. CONCLUSIONS: In community-dwelling older men, serum sodium between 126-140, and 126-140 or 143-153 mmol/L, are independently associated with prevalent cognitive impairment and cognitive decline, respectively. SN - 1555-905X UR - https://www.unboundmedicine.com/medline/citation/29439092/Serum_Sodium_and_Cognition_in_Older_Community_Dwelling_Men_ L2 - http://cjasn.asnjournals.org/cgi/pmidlookup?view=long&amp;pmid=29439092 DB - PRIME DP - Unbound Medicine ER -