Serum sodium and cognition in older community-dwelling men

Kristen L. Nowak, Kristine Yaffe, Eric Orwoll, Joachim H. Ix, Zhiying You, Elizabeth Barrett-Connor, Andrew R. Hoffman, Michel Chonchol

Research output: Contribution to journalArticle

6 Citations (Scopus)

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 7466 years with a fasting mean serum sodium level of 14163 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.

Original languageEnglish (US)
Pages (from-to)366-374
Number of pages9
JournalClinical Journal of the American Society of Nephrology
Volume13
Issue number3
DOIs
StatePublished - Mar 7 2018

Fingerprint

Independent Living
Cognition
Sodium
Serum
Fasting
Cognitive Dysfunction
Odds Ratio
Confidence Intervals
Trail Making Test
Social Adjustment
Osteoporotic Fractures
Hyponatremia
Cohort Studies
Cross-Sectional Studies
Logistic Models

Keywords

  • Aging
  • Cognition
  • Cognitive
  • Cognitive Dysfunction
  • Cross-Sectional Studies
  • Electrolytes
  • Fasting
  • Follow-Up Studies
  • Hyponatremia
  • Independent Living
  • Logistic Models
  • Osteoporotic Fractures
  • Prevalence
  • Prospective Studies
  • Prospective Studies
  • Sodium
  • Trail Making Test

ASJC Scopus subject areas

  • Epidemiology
  • Critical Care and Intensive Care Medicine
  • Nephrology
  • Transplantation

Cite this

Nowak, K. L., Yaffe, K., Orwoll, E., Ix, J. H., You, Z., Barrett-Connor, E., ... Chonchol, M. (2018). Serum sodium and cognition in older community-dwelling men. Clinical Journal of the American Society of Nephrology, 13(3), 366-374. https://doi.org/10.2215/CJN.07400717

Serum sodium and cognition in older community-dwelling men. / Nowak, Kristen L.; Yaffe, Kristine; Orwoll, Eric; Ix, Joachim H.; You, Zhiying; Barrett-Connor, Elizabeth; Hoffman, Andrew R.; Chonchol, Michel.

In: Clinical Journal of the American Society of Nephrology, Vol. 13, No. 3, 07.03.2018, p. 366-374.

Research output: Contribution to journalArticle

Nowak, KL, Yaffe, K, Orwoll, E, Ix, JH, You, Z, Barrett-Connor, E, Hoffman, AR & Chonchol, M 2018, 'Serum sodium and cognition in older community-dwelling men', Clinical Journal of the American Society of Nephrology, vol. 13, no. 3, pp. 366-374. https://doi.org/10.2215/CJN.07400717
Nowak, Kristen L. ; Yaffe, Kristine ; Orwoll, Eric ; Ix, Joachim H. ; You, Zhiying ; Barrett-Connor, Elizabeth ; Hoffman, Andrew R. ; Chonchol, Michel. / Serum sodium and cognition in older community-dwelling men. In: Clinical Journal of the American Society of Nephrology. 2018 ; Vol. 13, No. 3. pp. 366-374.
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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 7466 years with a fasting mean serum sodium level of 14163 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.",
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T1 - Serum sodium and cognition in older community-dwelling men

AU - Nowak, Kristen L.

AU - Yaffe, Kristine

AU - Orwoll, Eric

AU - Ix, Joachim H.

AU - You, Zhiying

AU - Barrett-Connor, Elizabeth

AU - Hoffman, Andrew R.

AU - Chonchol, Michel

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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 7466 years with a fasting mean serum sodium level of 14163 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.

AB - 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 7466 years with a fasting mean serum sodium level of 14163 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.

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KW - Cognitive Dysfunction

KW - Cross-Sectional Studies

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KW - Follow-Up Studies

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KW - Independent Living

KW - Logistic Models

KW - Osteoporotic Fractures

KW - Prevalence

KW - Prospective Studies

KW - Prospective Studies

KW - Sodium

KW - Trail Making Test

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