Abstract
Introduction:Mild cognitive impairment (MCI) is a prevalent and underdiagnosed condition in chronic kidney disease (CKD), that shares common pathophysiological factors such as chronic inflammation.Objective:To evaluate the association of MCI in CKD stages 1-5 using inflammatory markers and changes by magnetic resonance imaging (MRI).Patients and Methods:Cross-sectional study in adult patients with pre-dialysis CKD. MCI was assessed by the Montreal Cognitive Assessment (MoCA) and the estimated glomerular filtration rate (eGFR) by the Chronic Kidney Disease Epidemiology Collaboration equation. Sociodemographic and clinical data were collected from medical records. The cytokines IL-4, IL-6, IL-17, TNF-α and hs-CRP were determined. Brain MRI was performed in a 1.5 Tesla device, without paramagnetic contrast. A descriptive analysis followed by a comparison of abnormal versus normal MoCA scores among all studied variables. A linear regression analysis was performed using MoCA as a dependent variable, adjusted for confounding factors.Results:Of 111 invited patients, eighty completed the neuropsychological assessment and 56 underwent MRI, and were included in the study. Mean age was 56.3 ± 8.3 years and 51.8% (n = 29) had altered MoCA. When compared to the group with normal MoCA, the group with altered MoCA had higher levels of IL-6 and IL-17. There was no correlation between altered MoCA with eGFR or with MRI abnormalities.Conclusão:MCI assessed by MoCA was prevalent in patients with pre-dialysis CKD, it was associated with inflammation and showed no correlation with MRI changes.
Highlights
Mild cognitive impairment (MCI) is a prevalent and underdiagnosed condition in chronic kidney disease (CKD), that shares common pathophysiological factors such as chronic inflammation
One of humanity’s achievements was the improvement in the diagnosis and treatment of maternal, child and infectious diseases, significantly reducing morbidity and mortality rates. This phenomenon led to the predominance of non-communicable chronic diseases (NCDs), highlighting systemic arterial hypertension (SAH) and diabetes mellitus (DM), a favorable scenario for the increased prevalence of cardiovascular diseases (CVD), chronic kidney disease (CKD) and dementia syndromes[1]
This study focuses on evaluating the MCI detected by Montreal Cognitive Assessment (MoCA), inflammatory markers and changes in brain magnetic resonance imaging (MRI), in patients with CKD under conservative treatment
Summary
Mild cognitive impairment (MCI) is a prevalent and underdiagnosed condition in chronic kidney disease (CKD), that shares common pathophysiological factors such as chronic inflammation. Conclusão: MCI assessed by MoCA was prevalent in patients with pre-dialysis CKD, it was associated with inflammation and showed no correlation with MRI changes. The most cited cognitive screening instruments are the Mini Mental State Examination (MMSE)[8] and the Montreal Cognitive Assessment (MoCA)[9], associated with the assessment of functional activities, usually performed using the functional activities questionnaire by Pfeffer et al.[10], in addition to laboratory tests for syphilis (VDRL), vitamin B12 dosing, thyroid hormones and human immunodeficiency virus (HIV) serology These are associated with running neuroimaging exams, represented by computerized tomography (CT) and/ or magnetic resonance (MR) of the brain, aiming to exclude reversible causes of CI11
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