Cognitive impairment of patients with chronic renal disease on hemodialysis and its relationship with sociodemographic and clinical characteristics.

Gabriela Dutra Gesualdo,Karina Gramani Say,Sofia Cristina Iost Pavarini,Juliana Gomes Duarte,Luciana Kusumota,Fabiana De Souza Orlandi,Marisa Silvana Zazzetta

doi:10.1590/1980-57642016dn11-030003

Abstract

ABSTRACTCognitive impairment and dementia commonly occur in individuals with chronic kidney disease, especially in advanced stages, but are still poorly diagnosed.OBJECTIVE:To evaluate the cognitive ability of patients with chronic kidney disease on hemodialysis and its relationship with sociodemographic and clinical characteristics.METHODS:A cross-sectional study was carried out in a Renal Replacement Therapy Unit in the interior of the State of São Paulo involving 99 patients. The data were collected through an individual interview, using the Sociodemographic and Clinical Characterization questionnaires and the Addenbrooke's Cognitive Examination – Revised (ACE-R) questionnaire.RESULTS:Participants were predominantly male, with a mean age of 54.68 years. The mean ACE-R score was 64.26 points, and 76.76% of patients had lower-than-expected scores, suggesting the presence of cognitive impairment. A moderate, negative correlation was found between total score on the ACE-R and age (r= –0.38, p≤0.001), a moderate positive correlation with years of education (r=0.52, p≤0.001), and a weak positive correlation of total score with hemodialysis time (r=0.26, p≤0.001).CONCLUSION:A relationship was found between cognitive ability and age, years of education and hemodialysis time, suggesting that individuals who were older, had less education and longer hemodialysis time presented greater cognitive impairment.

Highlights

Cognitive impairment and dementia commonly occur in individuals with chronic kidney disease (CKD), especially in advanced stages, but are still poorly diagnosed.[1]
The profile of the patients studied was similar to those found in similar studies involving participants with CKD on hemodialysis in Brazil and other countries.[22,23]
In a study of 1315 hemodialysis patients in the city of Singapore, decreasing estimated GFR and the presence of CKD in patients over 55 years of age were associated with greater overall cognitive decline at four years of follow-up.[25]

Summary

Introduction

Cognitive impairment and dementia commonly occur in individuals with chronic kidney disease (CKD), especially in advanced stages, but are still poorly diagnosed.[1] Dementia is a state of persistent and progressive cognitive dysfunction characterized by impairment in memory and in at least one other aspect, or domain, of cognitive function, such as language, orientation, reasoning, attention, or executive functioning - the cognitive skill necessary for planning and sequencing tasks.[2] The term cognitive impairment is used to describe a deficit beyond that associated with normal aging, but not characterized as dementia. Individuals at any stage of the disease are susceptible to cognitive dysfunction, associated with increased risk of death, poor adherence to recommended treatments, increased progression of cerebrovascular disease and longer hospitalizations.[3,4,5] CKD maybe strongly associated with the incidence of dementia, especially Vascular Dementia,[6,7] relative to the general population. Mild cognitive impairment differs from the dementia syndrome and, unlike dementia, has no impact on individual daily activities

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