Patterns and characteristics of cognitive functioning in older patients approaching end stage kidney disease, the COPE-study

Abstract

Background: The prevalence of impaired cognitive functioning in older patients with end stage kidney disease (ESKD) is high. We aim to describe patterns of memory, executive function or psychomotor speed and to identify nephrologic, geriatric and neuroradiologic characteristics associated with cognitive impairment in older patients approaching ESKD who have not yet started with renal replacement therapy (RRT). Methods: The COPE-study (Cognitive Decline in Older Patients with ESRD) is a prospective cohort study including 157 participants aged 65 years and older approaching ESKD (eGFR ≤20 ml/min/1.73 m 2 ) prior to starting with RRT. In addition to routinely collected clinical parameters related to ESKD, such as vascular disease burden and parameters of metabolic disturbance, patients received a full geriatric assessment, including extensive neuropsychological testing. In a subgroup of patients (n = 93) a brain MRI was performed. Results: The median age was 75.3 years. Compared to the normative data of neuropsychological testing participants memory performance was in the 24th percentile, executive function in the 18th percentile and psychomotor speed in the 20th percentile. Independent associated characteristics of impairment in memory, executive and psychomotor speed were high age, low educational level and low functional status (all p-values < 0.003). A history of vascular disease (p = 0.007) and more white matter hyperintensities on brain MRI (p = 0.013) were associated with a lower psychomotor speed. Conclusion: Older patients approaching ESKD have a high prevalence of impaired memory, executive function and psychomotor speed. The patterns of cognitive impairment and brain changes on MRI are suggestive of vascular cognitive impairment. These findings could be of potentially added value in the decision-making process concerning patients with ESKD. Age, median (IQR) 75.3 (70.8-80.8) Male gender, n (%) 103 (65.6) Caucasian origin, n (%) 138 (89.0) Married/living together, n (%) 94 (61.4) Higher Educational level, n (%) 48 (30.6) Current smoking 23 (15.0) Alcohol consumption 77 (50.3) Disease specific eGFR at study enrolment, mean (SD) 16.2 (4.4) Δ eGFR (ml/min), mean (SD) a 9.1 (8.0) Primairy kidney disease Non-vascular cause, n (%) 56 (35.7) Vascular cause, n (%) 99 (63.1) Diabetes mellitus, n (%) 63 (40.1) (history of) malignancy, n (%) 47 (29.9) History of vascular disease, (n%) 74 (47.4) Ankle-brachial index (right), mean (SD) 0.96 (0.23) Medication use Polypharmacy (the use of ≥5 medications), n (%) 139 (89.7) Glucose lowering medication, n (%) 54 (34.4) Antihypertensive medication, n (%) 145 (92.4) Diuretics, n (%) 94 (60.3) Cholesterol lowering drugs, n (%) 112 (71.3) Vitamin D supplement, n (%) 131 (83.4) Nutrition status Normal Subjective Global Assessment (SGA) score 42 (49.4) SNAQ score Malnourished 8 (10.7) Risk for malnutrition 9 (12.0) BMI, median (IQR) 27.4 (24.6-30.9) Special diet, n (%) 127 (83.0) Geriatric assessment Frail according to FFI, n (%) 37 (24.5) Functional dependence by GARS-score, mea...

Circulating angiopoietin-2 and angiogenic microRNAs associate with cerebral small vessel disease and cognitive decline in older patients reaching end-stage renal disease

“…The full design, methods and baseline characteristics of the Cognitive decline in Older Patients with End-stage renal disease (COPE) study have been published previously [10,21]. The patients selected for this study were those patients for which a cardiac MRI was available.…”

“…Diseases affecting small arteries and arterioles in the brain, also known as cerebral small vessel disease (SVD), play an important role in the development of cerebrovascular disease and cognitive impairment [7,8]. A history of vascular disease is a determinant of cognitive impairment in patients reaching ESRD (before receiving renal replacement therapy) [9,10] and SVD has been associated with impaired cognition [11]. Being exposed to high-volume blood flow, the brain and kidney share a high vulnerability for endothelial dysfunction and vascular…”

Design of a consensus-based geriatric assessment tailored for older chronic kidney disease patients: results of a pragmatic approach

“…The MoCA [29] is developed to measure cognitive decline in multiple cognitive domains, such as executive function, orientation, recall, and visuospatial ability. The LDST [30] is used in CKD G4-G5 patients [14] to measure the speed of processing general information. The 6-CIT [31] is a screening instrument for dementia, assessing only six items on orientation, attention, and memory.…”

“…Nephrology-specific geriatric assessment could be meaningful, first because the geriatric phenotype is often severely impacted by vascular problems, such as vascular cognitive impairment [14], which necessitates the use of instruments that are sensitive to these impairments. Second, due to the chronic nature of kidney diseases, nephrologists perceive to have a full geriatric picture of their patients' status, but without objective measurements, impairments may still be overlooked [6].…”

Cognitive impairment in patients with chronic kidney disease—Next of kin's experiences

“…CI is more common in those undertaking haemodialysis and peritoneal dialysis, but a substantial number of predialysis and kidney‐transplanted patients still demonstrate a decline in cognitive functions (Lambert et al, 2017). For persons with CKD, the effects of CI can have consequences for their mental health and social skills, as it can affect vital functions such as memory, understanding, their ability to acquire knowledge, concentration and decision‐making capacity (van Deudekom et al, 2020; Koushik et al, 2010; Madero et al, 2008; Mcquillan & Jassal, 2010; Viggiano et al, 2020) (Box 1).…”