How common are neurocognitive disorders in patients with chronic kidney disease and diabetes? Results from a cross-sectional study in a community cohort of patients in North Wales, UK

Abstract

ObjectiveChronic kidney disease (CKD) affects nearly 9% of global populations and is strongly associated with older age. Neurocognitive disorders (NCDs), which include mild cognitive impairment and dementia, are rising as a result of ageing populations throughout the world. This investigation’s aim is to report the frequency of mild to major NCD in a clinical cohort of adults with mild to moderate CKD and diabetes.SettingGlan Clwyd District general Hospital, North Wales, UK.ParticipantsWe enrolled 178 patients with CKD and diabetes, aged 55 years and over with an estimated glomerular filtration rate <60 >15 mL/min/1.73 m2, attending a specialist renal and diabetic outpatient clinic.Outcome measuresFrequency of mild and major NCD and the association with the stage of CKD was assessed in all patients attending the specialist clinic. The diagnosis of NCD was based on patient and informant interview, case note review, neuropsychological assessment and application of Diagnostic and Statistical Manual of Mental Disorders version 5.ResultsThis investigation found 86/178 (48%) of the cohort with an NCD ranging from mild (n=49) to major symptoms (n=37). No association was found with NCD and the stage of CKD. Mild and major NCD was associated poorer outcomes in several cognitive domains, including, language, executive, memory, fluency and attention function (p<0.05).ConclusionsThis is the first UK investigation to report that cognitive changes occur in a significant number of older adults with CKD and diabetes. The unexpected finding was that prior to cognitive assessment, not any of the cohort had a pre-existing diagnosis of cognitive impairment, suggesting that the current prevalence and incidence rates of NCD in the general population are possibly significantly underestimated. Our findings also suggest that the cognitive function of patients with CKD should be screened and monitored routinely as part of their overall care management.

Berberine for prevention of dementia associated with diabetes and its comorbidities: A systematic review

“…Diabetic nephropathy is a major complication and a common cause for chronic kidney disease (CKD) [189], which is significantly associated with cognitive impairment [190,191]. Between 16% and 38% of dialysis patients have cognitive impairment, which is approximately threefold higher than age-matched controls [192]; VaD seems more prominent in CKD than other types of dementias, such as AD [193].…”

Cognitive Impairment and Associated Factors Among Chronic Kidney Disease Patients: A Comparative Cross-Sectional Study

“…11 The prevalence of cognitive impairment in CKD patients ranges from 17% to 87% depending on severity. [12][13][14][15][16] Its prevalence among CKD patients is 20% in the United Kingdom, 17 75.5% in China, 18 and 53.8% in India. 19 A comparative cross-sectional study in Nigeria showed that the prevalence of cognitive impairment CKD patients is 35.3% whereas for the control group it is 6%.…”

Risk Factors and Clinical Outcomes of Cognitive Impairment in Diabetic Patients Undergoing Peritoneal Dialysis

“…Of the few studies in diabetic patients with CKD, Liao et al [22] demonstrated that 35% of patients undergoing PD had CI, but the cognitive function was comparable between diabetic patients without retinopathy and nondiabetic patients. Another cohort study showed that 48% of diabetic patients with CKD stage 3 or 4 had neurocognitive disorders [23]. In the general population with DM, a longitudinal cohort study conducted in northern Manhattan reported that 42.5% of diabetic patients had incident CI [15].…”