Increased Presence of Cognitive Impairment in Hemodialysis Patients in the Absence of Neurological Events

Abstract

Background/Aims: Cognitive impairment (CI) is highly prevalent among hemodialysis (HD) patients and is associated with increased morbidity and mortality. The aim was to compare cognitive function in HD patients with no history of stroke or dementia and well-matched controls. Studies are required to determine the impact of HD and chronic kidney disease-specific risks on CI. Methods: 76 outpatients (50 receiving outpatient HD and 26 with normal kidney function matched for age and comorbidity) underwent a cross-sectional observational study. HD patients were well dialyzed and had optimal hemoglobin levels. A battery of eight neuropsychological tests was used. Outcomes included assessment scores of neurocognitive testing and prevalence and subtype of CI. Results: Compared to controls, HD subjects had significantly lower composite scores for each tested cognitive domain. In each domain except memory, the percentage of subjects with impairment was significantly higher in HD subjects than controls. Differences between the groups were independent of vascular and dementia risk factors. 82% of HD subjects met criteria for CI versus 50% of controls. Non-amnestic subtype of CI was more prevalent in both groups. Conclusion: Well-dialyzed HD patients with optimized hemoglobin levels and with no history of stroke or dementia performed significantly worse on multiple measures of cognition compared to controls. A higher prevalence of non-memory impairment may suggest an underlying vascular versus neurodegenerative mechanism. HD and chronic kidney disease-specific risk factors may contribute to early CI not readily detected by routine screening methods.

Comprehensive geriatric assessment: comparison of elderly hemodialysis patients and primary care patients

“…The results showed no significant difference between HD patients and patients from primary care in contrast to the findings obtained elsewhere. 9,36 This could be explained by differences in comorbidities of the patients examined and the use of different instruments for cognitive function assessment in these studies and ours. In order to determine the functional ability of patients, two instruments were used: the Katz ADL scale for assessment of basic ADL and the Lawton IADL scale for assessment of IADL.…”

“…Cognitive impairment is common in dialysis patients 9,[35][36][37] but normal healthy aging is also accompanied by a decline in cognitive function. 38 Although there are several screening tests for assessing cognitive dysfunction, in the present study the Mini-Cognitive Assessment Instrument was used as a suitable test for the family physician.…”

Executive Functioning in Children, Adolescents, and Young Adults with Chronic Kidney Disease

“…Notably, executive dysfunction has been documented in a wide variety of clinical populations, including patients with traumatic brain injury, 1,2 CHARGE syndrome, 3 central nervous system disorders, 4 Spina Bifida, 5,6 Nephropathic Cystanosis, 7 Muscular Dystrophy, 8 Epilepsy, 9,10 liver transplants, 11 Multiple Sclerosis, 12 Neurofibromatosis, 13 and Chronic Kidney Disease (CKD). [14][15][16][17][18][19][20][21][22][23][24][25] Executive Function in CKD There is a growing literature documenting a wide range of cognitive impairments associated with CKD, with the functions of attention, memory, verbal memory and language, processing speed, and executive function all having been identified as problematic in CKD in children [14][15][16][17]23 and adults, [18][19][20][21][22]24,25 especially with worsening disease severity. Furthermore, these impairments have been reported in patients who have received renal replacement therapy, such as a successful transplant [23][24][25][26] or dialysis, 18,19,21,…”

“…[14][15][16][17][18][19][20][21][22][23][24][25] Executive Function in CKD There is a growing literature documenting a wide range of cognitive impairments associated with CKD, with the functions of attention, memory, verbal memory and language, processing speed, and executive function all having been identified as problematic in CKD in children [14][15][16][17]23 and adults, [18][19][20][21][22]24,25 especially with worsening disease severity. Furthermore, these impairments have been reported in patients who have received renal replacement therapy, such as a successful transplant [23][24][25][26] or dialysis, 18,19,21,22 and also in patients who have not yet required such treatments. 17,20,24 Although it remains unknown what mechanism(s) causes these cognitive impairments, perhaps including its directionality, there is recent focus on the underlying brain structure and function for the cognitive functions, particularly white matter infarcts and related abnormalities in the frontal regions.…”

Screening of Cognitive Impairment in the Dialysis Population: A Scoping Review

“…There were 46 studies meeting the inclusion criteria for final analysis [10,11,12,13,14,15,16,17,18,19,20,21,22,23,24,25,26,27,28,29,30,31,32,33,34,35,36,37,38,39,40,41,42,43,44,45,46,47,48,49,50,51,52,53,54,55]. An overview of the reviewed articles is presented in Table 2.…”