Abstract
BackgroundCognitive impairment in hemodialysis patients has been acknowledged over the last years and has been reported in up to 80% of patients. Older age, high prevalence of cardiovascular risk factors, such as stroke and transient ischemic attack, uremia, and multiple metabolic disturbances represent the most common factors for cognitive impairment in hemodialysis patients.MethodsWe conducted a prospective cohort study on 408 patients from 10 hemodialysis centers in the regional government district of Middle Hesse (Germany). Patients underwent a neuropsychological test battery consisting of five tests, in addition to a phonemic fluency test, to assess cognitive profile. The patients were classified as no cognitive impairment or mildly-, moderately- or severely-impaired cognitive function, depending on the degree of impairment and number of domains where the deficit was determined. We analyzed the cognitive profile and the change in performance over time in hemodialysis patients based on their cognitive status at baseline vs. 1-year follow-up.ResultsOf 479 eligible patients, 408 completed all tests at baseline. Only 25% (n = 102) of the patients had no cognitive impairment. Fourteen per cent (n = 57), 36.5% (n = 149), and 24.5% (n = 100) of patients showed mild, moderate, and severe impairment, respectively. In patients with cognitive impairment, all cognitive domains were affected, and impairment was significantly associated with depression and education. The most impaired cognitive performance was immediate memory recall, and the best performance was found in naming ability. No significant change was observed after 1-year follow up in any domain. ConclusionOur study shows that the prevalence of cognitive impairment in hemodialysis patients is high and that it is affected by the presence of depression. Furthermore, education has an effect on cognitive test results. As depression has a significant influence on cognitive impairment, its early identification is essential in order to initiate treatment at an early stage, hoping to positively influence cognitive performance.
Highlights
The association of cognitive impairment with chronic kidney disease (CKD) has been reported over the last decade [1,2,3,4]
The goal of our study was to examine the extent of cognitive impairment, and to derive a distinct profile of cognitive function in hemodialysis patients using a standard tool for neuropsychological assessment, the Consortium to Establish a Registry for Alzheimer’s Disease (CERAD), in patients with mild cognitive impairment (MMSE Score ≥ 24)
We performed the analysis of variance (ANOVA) test with repeated-measures to analyze the cognitive profile and the change in performance over time in hemodialysis patients based on the cognitive status at baseline
Summary
The association of cognitive impairment with chronic kidney disease (CKD) has been reported over the last decade [1,2,3,4]. Hemodialysis patients are at increased risk of cognitive impairment because of their old age, high prevalence of cardiovascular risk factors, cerebrovascular involvement, including stroke and transient ischemic attack (TIA), and multiple metabolic disturbances [11,12,13]. High prevalence of cardiovascular risk factors, such as stroke and transient ischemic attack, uremia, and multiple metabolic disturbances represent the most common factors for cognitive impairment in hemodialysis patients. We analyzed the cognitive profile and the change in performance over time in hemodialysis patients based on their cognitive status at baseline vs 1-year follow-up. Conclusion Our study shows that the prevalence of cognitive impairment in hemodialysis patients is high and that it is affected by the presence of depression. As depression has a significant influence on cognitive impairment, its early identification is essential in order to initiate treatment at an early stage, hoping to positively influence cognitive performance
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