Prevalence of mild cognitive impairment and its association with handgrip strength in patients on hemodialysis

Sumi Hidaka,Takayasu Ohtake,Masahiro Hirata,Machiko Oka,Kunihiro Ishioka,Akinori Nishimiura,Kiyoshi Ozawa,Shuzo Kobayashi,Takehiko Kunieda,Masahiro Nishihara,Kiyotaka Imoto,Teiichi Tamura,Kazuhiko Shibata,Jin Oshikawa,Tadashi Kuji,Hidehisa Satta

doi:10.1038/s41598-022-07550-4

Abstract

Dementia is associated with a high risk of death and hospitalization among patients on hemodialysis (HD). We retrospectively evaluated the prevalence of mild cognitive impairment (MCI) in 421 patients on maintenance HD across nine facilities and investigated whether decreased handgrip strength was associated with decreased cognitive function. The Montreal Cognitive Assessment-Japan (MoCA-J) score and handgrip strength were measured. The mean age was 69.8 ± 11.2 years, and the median dialysis vintage 74.5 (IQR 30–150) months. The median MoCA-J score was 25 (IQR 21–27), and MCI was confirmed in 245 (58.2%) patients. Both the MoCA-J score and MoCA-J executive score were associated with age, history of cerebrovascular disease (CVA), and handgrip strength after adjustments. We found, among patients on HD aged under 70 years with a history of CVA, a handgrip strength < 90% (25.2 kg in males and 16.2 kg in females) correlated with significantly lower MoCA-J scores. A high prevalence of MCI and decreased handgrip strength were observed in patients on HD. Handgrip strength may be useful for the easy detection of MCI. A decrease in handgrip strength would allow for the early detection of MCI, especially among patients on HD aged under 70 years with a history of CVA.

Highlights

Dementia is associated with a high risk of death and hospitalization among patients on hemodialysis (HD)
We previously reported that hippocampal atrophy significantly correlated with hyperhomocysteinemia in patients on hemodialysis (HD)[5], and demonstrated that regional cerebral blood flow decreased in all these patients, irrespective of their clinical symptoms or Mini-Mental State Examination (MMSE) s cores[6]
We found that among patients on HD aged under 70 years with a history of cerebrovascular disease (CVA), a handgrip strength < 90% (25.2 kg for males and 16.2 kg for females) was associated with significantly lower Montreal Cognitive Assessment-Japan (MoCA-J) scores

Summary

Introduction

Dementia is associated with a high risk of death and hospitalization among patients on hemodialysis (HD). The median MoCA-J score was 25 (IQR 21–27), and MCI was confirmed in 245 (58.2%) patients Both the MoCA-J score and MoCA-J executive score were associated with age, history of cerebrovascular disease (CVA), and handgrip strength after adjustments. Among patients on HD aged under 70 years with a history of CVA, a handgrip strength < 90% (25.2 kg in males and 16.2 kg in females) correlated with significantly lower MoCA-J scores. A decrease in handgrip strength would allow for the early detection of MCI, especially among patients on HD aged under 70 years with a history of CVA. While silent brain infarcts and lacunar infarcts are well known to be associated with d ementia[2], we previously demonstrated that lacunar infarctions were more prevalent in patients with CKD, those with decreased renal function and a creatinine clearance of < 40 mL/min/1.73m23. The reliability and validity of the Japanese version of the MoCA (MoCA-J) have been proven, and it has been recommended for geriatric health screening in the Japanese c ommunity[12]; using a cut-off point of 25/26, the MoCA-J demonstrated a sensitivity of 93.0% and specificity of 87.0% for screening MCI

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