Abstract
The Dutch prospective multicenter cohort study COPE (Cognitive decline in Older Patients with End stage renal disease) aimed to investigate the association of cardiovascular structure and function with cerebrovascular changes and cognitive function in 85 older patients with chronic kidney disease stage 4 and 5, awaiting either dialysis or conservative care. MRI was performed measuring aortic stiffness (pulse wave velocity [PWV]) and cardiac systolic function (ejection fraction and cardiac index). Outcomes were MRI-derived cerebrovascular changes (microbleeds, lacunes and white matter hyperintensities) and cognitive function (memory, executive function and psychomotor speed). Mean age was 76 years and 66% were male. No statistically significant associations were observed between cardiovascular parameters and cerebrovascular changes. Cognitive function was worse in patients with high compared to low PWV in all three cognitive domains. Although there were clinically relevant associations of high PWV with poor cognition in all domains, after adjustment for age, sex and education only the Trail Making Test A remained statistically significant (p=0.030). In conclusion, this study suggests that a higher PWV might be associated with lower cognitive function, suggesting that arterial stiffness may be an underlying mechanism of development of cognitive impairment in older patients with ESRD. Larger studies should replicate and extend these findings.
Highlights
Cardiovascular diseases and cognitive impairment are frequent and increasingly prevalent, especially in older patients and patients with end-stage renal disease (ESRD) [1,2,3,4]
This study suggests that a higher pulse wave velocity (PWV) might be associated with lower cognitive function, suggesting that arterial stiffness may be an underlying mechanism of development of cognitive impairment in older patients with ESRD
Our findings that arterial stiffness may be an underlying mechanism of development of cognitive impairment is in line with known literature in both the general population, and in patients with ESRD
Summary
Cardiovascular diseases and cognitive impairment are frequent and increasingly prevalent, especially in older patients and patients with end-stage renal disease (ESRD) [1,2,3,4] Both chronic kidney disease, especially ESRD, and cardiovascular diseases have been identified as independent risk factors for the development of microvascular damage and cerebral small vessel disease, which can lead to structural cerebrovascular changes and cognitive impairment [5,6,7,8,9]. Especially ESRD, and cardiovascular diseases have been identified as independent risk factors for the development of microvascular damage and cerebral small vessel disease, which can lead to structural cerebrovascular changes and cognitive impairment [5,6,7,8,9] It is, unknown how cardiovascular structure and function associates with brain structure and function in older patients with ESRD. To what extent an altered cardiac structure and function play a role in cerebrovascular changes and cognitive impairment in older patients with ESRD remains unclear
Sign-in/Register to view highlights & summary Sign-in/Register to access full text options 
Talk to us
Join us for a 30 min session where you can share your feedback and ask us any queries you have
Schedule a callDisclaimer: All third-party content on this website/platform is and will remain the property of their respective owners and is provided on "as is" basis without any warranties, express or implied. Use of third-party content does not indicate any affiliation, sponsorship with or endorsement by them. Any references to third-party content is to identify the corresponding services and shall be considered fair use under The CopyrightLaw.
