Mara A McAdams-DeMarco1, Jingwen Tan2, Megan L Salter3, Alden Gross2, Lucy A Meoni4, Bernard G Jaar5, Wen-Hong Linda Kao2, Rulan S Parekh6, Dorry L Segev3, Stephen M Sozio7. 1. Departments of Epidemiology and Departments of Surgery and mara@jhu.edu. 2. Departments of Epidemiology and. 3. Departments of Epidemiology and Departments of Surgery and. 4. Biostatistics, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland; Medicine, Johns Hopkins University School of Medicine, Baltimore, Maryland; 5. Departments of Epidemiology and Medicine, Johns Hopkins University School of Medicine, Baltimore, Maryland; Nephrology Center of Maryland, Baltimore, Maryland; 6. Medicine, Johns Hopkins University School of Medicine, Baltimore, Maryland; Divisions of Nephrology, Hospital for Sick Children and University Health Network, Toronto, Canada; and Departments of Pediatrics and Medicine, University of Toronto, Toronto, Canada. 7. Medicine, Johns Hopkins University School of Medicine, Baltimore, Maryland;
Abstract
BACKGROUND AND OBJECTIVES: Patients of all ages undergoing hemodialysis (HD) have a high prevalence of cognitive impairment and worse cognitive function than healthy controls, and those with dementia are at high risk of death. Frailty has been associated with poor cognitive function in older adults without kidney disease. We hypothesized that frailty might also be associated with poor cognitive function in adults of all ages undergoing HD. DESIGN, SETTING, PARTICIPANTS, & MEASUREMENTS: At HD initiation, 324 adults enrolled (November 2008 to July 2012) in a longitudinal cohort study (Predictors of Arrhythmic and Cardiovascular Risk in ESRD) were classified into three groups (frail, intermediately frail, and nonfrail) based on the Fried frailty phenotype. Global cognitive function (3MS) and speed/attention (Trail Making Tests A and B [TMTA and TMTB, respectively]) were assessed at cohort entry and 1-year follow-up. Associations between frailty and cognitive function (at cohort entry and 1-year follow-up) were evaluated in adjusted (for sex, age, race, body mass index, education, depression and comorbidity at baseline) linear (3MS, TMTA) and Tobit (TMTB) regression models. RESULTS: At cohort entry, the mean age was 54.8 years (SD 13.3), 56.5% were men, and 72.8% were black. The prevalence of frailty and intermediate frailty were 34.0% and 37.7%, respectively. The mean 3MS was 89.8 (SD 7.6), TMTA was 55.4 (SD 29), and TMTB was 161 (SD 83). Frailty was independently associated with lower cognitive function at cohort entry for all three measures (3MS: -2.4 points; 95% confidence interval [95% CI], -4.2 to -0.5; P=0.01; TMTA: 12.1 seconds; 95% CI, 4.7 to 19.4; P<0.001; and TMTB: 33.2 seconds; 95% CI, 9.9 to 56.4; P=0.01; all tests for trend, P<0.001) and with worse 3MS at 1-year follow-up (-2.8 points; 95% CI, -5.4 to -0.2; P=0.03). CONCLUSIONS: In adult incident HD patients, frailty is associated with worse cognitive function, particularly global cognitive function (3MS).
BACKGROUND AND OBJECTIVES:Patients of all ages undergoing hemodialysis (HD) have a high prevalence of cognitive impairment and worse cognitive function than healthy controls, and those with dementia are at high risk of death. Frailty has been associated with poor cognitive function in older adults without kidney disease. We hypothesized that frailty might also be associated with poor cognitive function in adults of all ages undergoing HD. DESIGN, SETTING, PARTICIPANTS, & MEASUREMENTS: At HD initiation, 324 adults enrolled (November 2008 to July 2012) in a longitudinal cohort study (Predictors of Arrhythmic and Cardiovascular Risk in ESRD) were classified into three groups (frail, intermediately frail, and nonfrail) based on the Fried frailty phenotype. Global cognitive function (3MS) and speed/attention (Trail Making Tests A and B [TMTA and TMTB, respectively]) were assessed at cohort entry and 1-year follow-up. Associations between frailty and cognitive function (at cohort entry and 1-year follow-up) were evaluated in adjusted (for sex, age, race, body mass index, education, depression and comorbidity at baseline) linear (3MS, TMTA) and Tobit (TMTB) regression models. RESULTS: At cohort entry, the mean age was 54.8 years (SD 13.3), 56.5% were men, and 72.8% were black. The prevalence of frailty and intermediate frailty were 34.0% and 37.7%, respectively. The mean 3MS was 89.8 (SD 7.6), TMTA was 55.4 (SD 29), and TMTB was 161 (SD 83). Frailty was independently associated with lower cognitive function at cohort entry for all three measures (3MS: -2.4 points; 95% confidence interval [95% CI], -4.2 to -0.5; P=0.01; TMTA: 12.1 seconds; 95% CI, 4.7 to 19.4; P<0.001; and TMTB: 33.2 seconds; 95% CI, 9.9 to 56.4; P=0.01; all tests for trend, P<0.001) and with worse 3MS at 1-year follow-up (-2.8 points; 95% CI, -5.4 to -0.2; P=0.03). CONCLUSIONS: In adult incident HDpatients, frailty is associated with worse cognitive function, particularly global cognitive function (3MS).
Authors: Jeremy Walston; Mary Ann McBurnie; Anne Newman; Russell P Tracy; Willem J Kop; Calvin H Hirsch; John Gottdiener; Linda P Fried Journal: Arch Intern Med Date: 2002-11-11
Authors: Karen Bandeen-Roche; Qian-Li Xue; Luigi Ferrucci; Jeremy Walston; Jack M Guralnik; Paulo Chaves; Scott L Zeger; Linda P Fried Journal: J Gerontol A Biol Sci Med Sci Date: 2006-03 Impact factor: 6.053
Authors: Manjula Kurella Tamura; Virginia Wadley; Kristine Yaffe; Leslie A McClure; George Howard; Rodney Go; Richard M Allman; David G Warnock; William McClellan Journal: Am J Kidney Dis Date: 2008-06-30 Impact factor: 8.860
Authors: Joshua I Barzilay; Caroline Blaum; Tisha Moore; Qian Li Xue; Calvin H Hirsch; Jeremy D Walston; Linda P Fried Journal: Arch Intern Med Date: 2007-04-09
Authors: A J Nastasi; M A McAdams-DeMarco; J Schrack; H Ying; I Olorundare; F Warsame; A Mountford; C E Haugen; M González Fernández; S P Norman; D L Segev Journal: Am J Transplant Date: 2017-08-30 Impact factor: 8.086
Authors: María Pérez Fernández; Patricia Martínez Miguel; Hao Ying; Christine E Haugen; Nadia M Chu; Diego María Rodríguez Puyol; Leocadio Rodríguez-Mañas; Silas P Norman; Jeremy D Walston; Dorry L Segev; Mara A McAdams-DeMarco Journal: Am J Nephrol Date: 2019-01-09 Impact factor: 3.754
Authors: Jeremy Walston; Thomas N Robinson; Susan Zieman; Frances McFarland; Christopher R Carpenter; Keri N Althoff; Melissa K Andrew; Caroline S Blaum; Patrick J Brown; Brian Buta; E Wesley Ely; Luigi Ferrucci; Kevin P High; Stephen B Kritchevsky; Kenneth Rockwood; Kenneth E Schmader; Felipe Sierra; Kaycee M Sink; Ravi Varadhan; Arti Hurria Journal: J Am Geriatr Soc Date: 2017-04-19 Impact factor: 5.562
Authors: Nadia M Chu; Alden L Gross; Ashton A Shaffer; Christine E Haugen; Silas P Norman; Qian-Li Xue; A Richey Sharrett; Michelle C Carlson; Karen Bandeen-Roche; Dorry L Segev; Mara A McAdams-DeMarco Journal: J Am Soc Nephrol Date: 2019-01-24 Impact factor: 10.121
Authors: Christine E Haugen; Nadia M Chu; Hao Ying; Fatima Warsame; Courtenay M Holscher; Niraj M Desai; Miranda R Jones; Silas P Norman; Daniel C Brennan; Jacqueline Garonzik-Wang; Jeremy D Walston; Adam W Bingaman; Dorry L Segev; Mara McAdams-DeMarco Journal: Clin J Am Soc Nephrol Date: 2019-03-19 Impact factor: 8.237
Authors: Mara A McAdams-DeMarco; Matthew Daubresse; Sunjae Bae; Alden L Gross; Michelle C Carlson; Dorry L Segev Journal: Clin J Am Soc Nephrol Date: 2018-08-09 Impact factor: 8.237
Authors: Mara A McAdams-DeMarco; Sunjae Bae; Nadia Chu; Alden L Gross; Charles H Brown; Esther Oh; Paul Rosenberg; Karin J Neufeld; Ravi Varadhan; Marilyn Albert; Jeremy Walston; Dorry L Segev Journal: J Am Soc Nephrol Date: 2016-12-15 Impact factor: 10.121