Abstract
BackgroundThe prevalence of impaired cognitive functioning in older patients with end stage kidney disease (ESKD) is high. We aim to describe patterns of memory, executive function or psychomotor speed and to identify nephrologic, geriatric and neuroradiologic characteristics associated with cognitive impairment in older patients approaching ESKD who have not yet started with renal replacement therapy (RRT).MethodsThe COPE-study (Cognitive Decline in Older Patients with ESRD) is a prospective cohort study including 157 participants aged 65 years and older approaching ESKD (eGFR ≤20 ml/min/1.73 m2) prior to starting with RRT. In addition to routinely collected clinical parameters related to ESKD, such as vascular disease burden and parameters of metabolic disturbance, patients received a full geriatric assessment, including extensive neuropsychological testing. In a subgroup of patients (n = 93) a brain MRI was performed.ResultsThe median age was 75.3 years. Compared to the normative data of neuropsychological testing participants memory performance was in the 24th percentile, executive function in the 18th percentile and psychomotor speed in the 20th percentile. Independent associated characteristics of impairment in memory, executive and psychomotor speed were high age, low educational level and low functional status (all p-values < 0.003). A history of vascular disease (p = 0.007) and more white matter hyperintensities on brain MRI (p = 0.013) were associated with a lower psychomotor speed.ConclusionOlder patients approaching ESKD have a high prevalence of impaired memory, executive function and psychomotor speed. The patterns of cognitive impairment and brain changes on MRI are suggestive of vascular cognitive impairment. These findings could be of potentially added value in the decision-making process concerning patients with ESKD.
Highlights
The prevalence of impaired cognitive functioning in older patients with end stage kidney disease (ESKD) is high
In the COPE study [13] we aimed to describe patterns of memory, executive function or psychomotor speed and to identify nephrologic, geriatric and neuroradiologic characteristics associated with cognitive impairment in older patients approaching ESKD who have not yet started with renal replacement therapy RRT
We observed that associated characteristics of a worse cognitive function in the domains memory, executive and psychomotor speed were older age, lower education, lower functional status, frailty, higher burden of white matter hyperintensities on MRI and a history of vascular disease
Summary
The prevalence of impaired cognitive functioning in older patients with end stage kidney disease (ESKD) is high. Several pathophysiological mechanisms have been suggested as factor contributing to the high prevalence of impaired cognitive function in patients approaching ESKD such as vascular, neurodegenerative and metabolic processes [6, 7], [8]. Both the brain and kidney are low resistance end organs, exposed to high blood flow and vulnerable to vascular damage [9]. Information on the actual brain damage observed on brain MRI is scarce [12] This timepoint is of particular importance, as these cognitive impairments may influence treatment decisions and treatment outcome
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