Assessment of Cognitive Functions and Neuroimaging in Chronic Renal Failure Patients Before and After Renal Transplantation.

Abstract

Background:Cognitive impairment is common in patients with chronic renal disease and ESRD. Kidney transplantationis considered the treatment of choice in the terminal stage of the disease, but their influence on brain structure and cognitive profile of transplant patients in not well known. Objectives: To evaluate prospectively cognitive function and brain MRI characteristics in patients with ESRD at transplant and after one year of successful transplantation. Material and Methods: We prospectively included 17 patients, evaluated within7 days peri-transplant with brain MRI and cognitive test (MiniMentalTest, Addenbrooke's Cognitive Examination, Scale Wechsler Logical Memory(WMS), Auditory Learning king, Trail Making A and B (TMA and TMB), digit Span, phonological and semantic verbal fluencies, Rey complex figure and Beck Depression Inventory. Both assessment procedures were repeated year after transplantation, each patient being its own control. Results: At the time of transplantation, 81.25% had abnormal MRI images in the first observed no changes on MRI control. The first cognitive assessment showed mild cognitive impairment(MCI) in 64.70% non-amnestic, amnestic MCI at 17.64% and normal cognitive status at 17.64%. Year after transplantation23% had cognitive state average,also evidencing improvement in testsTMB (150.02 ±16.33vs123.54, P = 0.02) and phonological verbal fluency(10.92±1.10vs14.14±1.48, p = 0.02). Conclusions: Although abnormalities in brain MRI persisted one year after successful renal transplantation, some functions such as attention, executive functions and language evolved favorably after the procedure. The data suggest that successful renal transplantation could be considered as a process that would improve certain cognitive domains in individuals with chronic kidney disease.