#5742 MID-ARM CIRCUMFERENCE AS A CORRELATE TO DIFFERENT: ASPECT NEUROCOGNITIVE IMPAIRMENT IN HEMODIALYSIS PATIENTS

Abstract

Abstract Background and Aims Malnutrition is associated with poor cognitive function (CI) in Hemodialysis (HD) patients. Both have multiple ways of assessment scaled from simple bedside screening tests to more sophisticated time- and cost-consuming measures. This work aims to define the best nutritive assessment measure that correlates to the degree of CI. Method A cross-sectional study was carried out on 116 patients in 4 different HD units from Delta Nile, Egypt. The nutritional status was examined after the dialysis session in euvolemic patients using (1) anthropometric measurements, including body mass index (BMI), mid-arm circumference (MAC), skin fold thickness (SFT), and mid-arm muscle circumference (MAMC); (2) bioelectrical impedance analysis for assessment of skeletal muscle mass (SMM), skeletal muscle index (SMI), free fat mass (FFM), body fat mass (BFM), and total body water (TBW); (3) Hand grip strength was used to assess muscle power. The assessment of cognition was made using (1) a mini-mental state examination (MMSE) for orientation, registration, attention, recall, language, and copying; (2) Saint Louis University Mental Status Exam (SLUMS) for early CI and executive functioning; (3) Arabic version of Penn Web-Based Computerized Neurocognitive Battery (WebCNP) for those who scored no CI in the previous two tests. Results The results of MMSE and SLUMS tests showed that 34.5% of our cohort (n = 40) had no CI, 34.5% (n = 40) had mild to moderate degrees of CI, and 31% (n = 36) had a severe form of CI. Comparing the nutritional assessment parameters between the categories of cognitive scores revealed that there were no significant differences except in significantly lower median values of MAC (P 0.01), SMI in bioelectrical impedance analysis (P0.01), and hand grip strength (P 0.002) in severe CI group than the normal to patients without CI. In correlation statistics, MAC and hand grip strength were negatively correlated to the degree of CI (r = -0.3, P 0.006 and r = -0.26, P 0.009, respectively). MAC was the only parameter correlated with attention, emotional recognition, and differentiation functioning in the forty patients with no CI who underwent computerized neurocognitive assessment. The highest reported positive correlations reported were between the MAC and response time of both emotion recognition (r = 0.57, P <0.001) and differentiation (r = 0.55, P <0.001). Conclusion Of the different parameters of nutritional state assessment, MAC, the simple bedside measurement, was the best correlate with the degree of cognitive impairment in HD patients, even in its mild primitive forms.