Psychotic Symptoms Associated with Poor Renal Function in Mild Cognitive Impairment and Dementias

Kunschmann, Ralf; Busse, Stefan; Frodl, Thomas; Busse, Mandy

doi:10.3233/jad-161306

Cited by 7 publications

(4 citation statements)

References 43 publications

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“…Also, the reduced renal function can worsen clinical symptoms in patients with cognitive impairment. For instance, it has been reported that psychotic symptoms are associated with poorer renal function in people with mild cognitive impairment and Alzheimer’s disease (Kunschmann et al, 2017).…”

Section: Cognitive Impairment In Ckdmentioning

confidence: 99%

Neuropsychiatric Disorders in Chronic Kidney Disease

Silva

Miranda²,

Rocha

et al. 2019

Front. Pharmacol.

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Neuropsychiatric conditions including depression, anxiety disorders, and cognitive impairment are prevalent in patients with chronic kidney disease (CKD). These conditions often make worse the quality of life and also lead to longer hospitalizations and higher mortality. Over the past decades, some hypotheses have tried to explain the connection between CKD and neuropsychiatric disorders. The most common hypothesis is based on the occurrence of cerebrovascular disease and accumulated uremic toxins in adult patients with CKD. However, the lack of a direct association between known vascular risk factors (e.g., diabetes and hypertension) with CKD-related cognitive deficits suggests that other mechanisms may also play a role in the pathophysiology shared by renal and neuropsychiatric diseases. This hypothesis is corroborated by the occurrence of neuropsychiatric comorbidities in pediatric patients with CKD preceding vascular damage, and the inconsistent findings on neuroprotective effects of antihypertensives. The aim of this narrative review was to summarize clinical evidence and potential mechanisms that links CKD and brain disorders, specifically in regard to cognitive impairment, anxiety, and depression.

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Section: Cognitive Impairment In Ckdmentioning

confidence: 99%

Neuropsychiatric Disorders in Chronic Kidney Disease

Silva

Miranda²,

Rocha

et al. 2019

Front. Pharmacol.

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“…Consistent with previous research, this present study demonstrated a 70% increased likelihood of cognitive impairment among participants with renal dysfunction compared to their counterparts with preserved renal functions. Despite of its poorly understood pathophysiology, the relationship between cognitive impairment and renal dysfunction appears to be complex and bidirectional [154][155][156]. Nevertheless, direct neuronal injury from uremic toxins and the high prevalence of both subclinical and symptomatic ischemic cerebrovascular lesions are conceivable underlying mechanisms [157].…”

Section: Discussionmentioning

confidence: 99%

Burden and correlates of cognitive impairment among hypertensive patients in Tanzania: a cross-sectional study

Pallangyo¹,

Mkojera²,

Komba³

et al. 2021

BMC Neurol

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Background The evolution of cognitive impairment of vascular origin is increasingly becoming a prominent health threat particularly in this era where hypertension is the leading contributor of global disease burden and overall health loss. Hypertension is associated with the alteration of the cerebral microcirculation coupled by unfavorable vascular remodeling with consequential slowing of mental processing speed, reduced abstract reasoning, loss of linguistic abilities, and attention and memory deficits. Owing to the rapidly rising burden of hypertension in Tanzania, we sought to assess the prevalence and correlates of cognitive impairment among hypertensive patients attending a tertiary cardiovascular hospital in Tanzania. Methodology A hospital-based cross-sectional study was conducted at Jakaya Kikwete Cardiac Institute, a tertiary care public teaching hospital in Dar es Salaam, Tanzania between March 2020 and February 2021. A consecutive sampling method was utilized to recruit consented hypertensive outpatients during their scheduled clinic visit. General Practitioner Assessment of Cognition (GPCOG) Score was utilized in the assessment of cognitive functions. All statistical analyses utilized STATA v11.0 software. Pearson Chi square and Student’s T-test were used to compare categorical and continuous variables respectively. Logistic regression analyses were used to assess for factors associated with cognitive impairment. Odd ratios with 95% confidence intervals and p-values are reported. All tests were 2-sided and p < 0.05 was used to denote a statistical significance. Results A total of 1201 hypertensive patients were enrolled in this study. The mean age was 58.1 years and females constituted nearly two-thirds of the study population. About three quarters had excess body weight, 16.6% had diabetes, 7.7% had history of stroke, 5.7% had heart failure, 16.7% had renal dysfunction, 53.7% had anemia, 27.7% had hypertriglyceridemia, 38.5% had elevated LDL, and 2.4% were HIV-infected. Nearly two-thirds of participants had uncontrolled blood pressure and 8.7% had orthostatic hypotension. Overall, 524 (43.6%) of participants had cognitive impairment. During bivariate analysis in a logistic regression model of 16 characteristics, 14 parameters showed association with cognitive functions. However, after controlling for confounders, multivariate analysis revealed ≤primary education (OR 3.5, 95%CI 2.4–5.2, p < 0.001), unemployed state (OR 1.7, 95%CI 1.2–2.6, p < 0.01), rural habitation (OR 1.8, 95%CI 1.1–2.9, p = 0.01) and renal dysfunction (OR 1.7, 95%CI 1.0–2.7, p = 0.04) to have independent association with cognitive impairment. Conclusion This present study underscore that cognitive decline is considerably prevalent among individuals with systemic hypertension. In view of this, it is pivotal to incorporate cognitive assessment in routine evaluation of hypertensive patients.

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“…Despite of its poorly understood pathophysiology, the relationship between cognitive impairment and renal dysfunction appears to be complex and bidirectional. [156][157][158] Nevertheless, direct neuronal injury from uremic toxins and the high prevalence of both subclinical and symptomatic ischemic cerebrovascular lesions are conceivable underlying mechanisms. 159 It is postulated that, for every decrease of 15 ml/min/1.73 m 2 in glomerular ltration rate, there is a decline in cognitive function similar to that of a 3-year aging.…”

Section: Discussionmentioning

confidence: 99%

Burden and correlates of cognitive impairment among hypertensive patients in Tanzania: A cross-sectional study

Pallangyo¹,

Mkojera²,

Komba³

et al. 2021

Preprint

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Background: The evolution of cognitive impairment of vascular origin is increasingly becoming a prominent health threat particularly in this era where hypertension is the leading contributor of global disease burden and overall health loss. Hypertension is associated with the alteration of the cerebral microcirculation coupled by unfavorable vascular remodeling with consequential slowing of mental processing speed, reduced abstract reasoning, loss of linguistic abilities, and attention and memory deficits. Owing to the rapidly rising burden of hypertension in Tanzania, we sought to assess the prevalence and correlates of cognitive impairment among hypertensive patients attending a tertiary cardiovascular hospital in Tanzania.Methodology: A hospital-based cross-sectional study was conducted at Jakaya Kikwete Cardiac Institute, a tertiary care public teaching hospital in Dar es Salaam, Tanzania between March 2020 and February 2021. A consecutive sampling method was utilized to recruit consented hypertensive outpatients during their scheduled clinic visit. General Practitioner Assessment of Cognition (GPCOG) Score was utilized in the assessment of cognitive functions. All statistical analyses utilized STATA v11.0 software. Pearson Chi square and Student’s T-test were used to compare categorical and continuous variables respectively. Logistic regression analyses were used to assess for factors associated with cognitive impairment. Odd ratios with 95% confidence intervals and p-values are reported. All tests were 2-sided and p<0.05 was used to denote a statistical significance. Results: A total of 1201 hypertensive patients were enrolled in this study. The mean age was 58.1 years and females constituted nearly two-thirds of the study population. About three quarters had excess body weight, 16.6% had diabetes, 7.7% had history of stroke, 5.7% had heart failure, 16.7% had renal dysfunction, 53.7% had anemia, 27.7% had hypertriglyceridemia, 38.5% had elevated LDL, and 2.4% were HIV-infected. Nearly two-thirds of participants had uncontrolled blood pressure and 8.7% had orthostatic hypotension. Overall, 524 (43.6%) of participants had cognitive impairment. During bivariate analysis in a logistic regression model of 16 characteristics, 14 parameters showed association with cognitive functions. However, after controlling for confounders, multivariate analysis revealed ≤primary education (OR 3.5, 95%CI 2.4-5.2, p<0.001), unemployed state (OR 1.7, 95%CI 1.2-2.6, p<0.01), rural habitation (OR 1.8, 95%CI 1.1-2.9, p=0.01) and renal dysfunction (OR 1.7, 95%CI 1.0-2.7, p= 0.04) to have independent association with cognitive impairment. Conclusion: This present study underscore that cognitive decline is highly prevalent among individuals with systemic hypertension. Moreover, our observation suggests that low education, rural life, unemployment status and renal dysfunction interactions with elevated blood pressure has the potential to predict cognitive performance over time. As the effective disease-modifying treatments for cognitive impairment are lacking, these findings imply that several modifiable risk factors including hypertension represents a potentially vital mechanism for prevention or delay of cognitive impairment.

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Psychotic Symptoms Associated with Poor Renal Function in Mild Cognitive Impairment and Dementias

Cited by 7 publications

References 43 publications

Neuropsychiatric Disorders in Chronic Kidney Disease

Neuropsychiatric Disorders in Chronic Kidney Disease

Burden and correlates of cognitive impairment among hypertensive patients in Tanzania: a cross-sectional study

Burden and correlates of cognitive impairment among hypertensive patients in Tanzania: A cross-sectional study

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