Anita van Zwieten1,2, Germaine Wong1,2,3, Marinella Ruospo4,5, Suetonia C Palmer6, Maria Rosaria Barulli7, Annalisa Iurillo7, Valeria Saglimbene1,4, Patrizia Natale4, Letizia Gargano4, Marco Murgo4, Clement T Loy1,8, Rosanna Tortelli7, Jonathan C Craig1,2,9, David W Johnson10,11, Marcello Tonelli12, Jörgen Hegbrant4, Charlotta Wollheim4, Giancarlo Logroscino7,13, Giovanni F M Strippoli1,4,14. 1. Sydney School of Public Health, University of Sydney, Sydney, New South Wales, Australia. 2. Centre for Kidney Research, Children's Hospital at Westmead, Westmead, New South Wales, Australia. 3. Department of Renal Medicine, Westmead Hospital, Westmead, New South Wales, Australia. 4. Diaverum Medical-Scientific Office, Lund, Sweden. 5. Division of Nephrology and Transplantation, Amedeo Avogadro University of Eastern Piedmont, Novara, Italy. 6. Department of Medicine, University of Otago Christchurch, Christchurch, New Zealand. 7. Neurodegenerative Diseases Unit, Department of Clinical Research in Neurology, University of Bari 'A. Moro', 'Pia Fondazione Cardinale G. Panico', Tricase, Lecce, Italy. 8. Huntington Disease Service, Westmead Hospital, Westmead, New South Wales, Australia. 9. Department of Nephrology, Children's Hospital at Westmead, Westmead, New South Wales, Australia. 10. Department of Nephrology, Princess Alexandra Hospital, Woolloongabba, Queensland, Australia. 11. Translational Research Institute, University of Queensland, Woolloongabba, Queensland, Australia. 12. Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada. 13. Department of Basic Medical Sciences, Neurosciences and Sense Organs, University of Bari 'A. Moro', Bari, Italy. 14. Department of Emergency and Organ Transplantation, University of Bari, Piazza Giulio Cesare, Bari, Italy.
Abstract
Background: Mounting evidence indicates an increased risk of cognitive impairment in adults with end-stage kidney disease on dialysis, but the extent and pattern of deficits across the spectrum of cognitive domains are uncertain. Methods: We conducted a cross-sectional study of 676 adult hemodialysis patients from 20 centers in Italy, aiming to evaluate the prevalence and patterns of cognitive impairment across five domains of learning and memory, complex attention, executive function, language and perceptual-motor function. We assessed cognitive function using a neuropsychological battery of 10 tests and calculated test and domain z-scores using population norms (age or age/education). We defined cognitive impairment as a z-score ≤ -1.5. Results: Participants' median age was 70.9 years (range 21.6-94.1) and 262 (38.8%) were women. Proportions of impairment on each domain were as follows: perceptual-motor function 31.5% (150/476), language 41.2% (273/662), executive function 41.7% (281/674), learning and memory 42.2% (269/638), complex attention 48.8% (329/674). Among 474 participants with data for all domains, only 28.9% (n = 137) were not impaired on any domain, with 25.9% impaired on a single domain (n = 123), 17.3% on two (n = 82), 13.9% on three (n = 66), 9.1% on four (n = 43) and 4.9% (n = 23) on all five. Across patients, patterns of impairment combinations were diverse. Conclusions: In conclusion, cognitive impairment is extremely common in hemodialysis patients, across numerous domains, and patients often experience multiple deficits simultaneously. Clinical care should be tailored to meet the needs of patients with different types of cognitive impairment and future research should focus on identifying risk factors for cognitive decline.
Background: Mounting evidence indicates an increased risk of cognitive impairment in adults with end-stage kidney disease on dialysis, but the extent and pattern of deficits across the spectrum of cognitive domains are uncertain. Methods: We conducted a cross-sectional study of 676 adult hemodialysis patients from 20 centers in Italy, aiming to evaluate the prevalence and patterns of cognitive impairment across five domains of learning and memory, complex attention, executive function, language and perceptual-motor function. We assessed cognitive function using a neuropsychological battery of 10 tests and calculated test and domain z-scores using population norms (age or age/education). We defined cognitive impairment as a z-score ≤ -1.5. Results:Participants' median age was 70.9 years (range 21.6-94.1) and 262 (38.8%) were women. Proportions of impairment on each domain were as follows: perceptual-motor function 31.5% (150/476), language 41.2% (273/662), executive function 41.7% (281/674), learning and memory 42.2% (269/638), complex attention 48.8% (329/674). Among 474 participants with data for all domains, only 28.9% (n = 137) were not impaired on any domain, with 25.9% impaired on a single domain (n = 123), 17.3% on two (n = 82), 13.9% on three (n = 66), 9.1% on four (n = 43) and 4.9% (n = 23) on all five. Across patients, patterns of impairment combinations were diverse. Conclusions: In conclusion, cognitive impairment is extremely common in hemodialysis patients, across numerous domains, and patients often experience multiple deficits simultaneously. Clinical care should be tailored to meet the needs of patients with different types of cognitive impairment and future research should focus on identifying risk factors for cognitive decline.
Authors: Nadia M Chu; Zhan Shi; Christine E Haugen; Silas P Norman; Alden L Gross; Daniel C Brennan; Michelle C Carlson; Dorry L Segev; Mara A McAdams-DeMarco Journal: Am J Kidney Dis Date: 2020-02-03 Impact factor: 8.860
Authors: Santiago Cedeño; Manuel Desco; Yasser Aleman; Nicolás Macías; Alberto Fernández-Pena; Almudena Vega; Soraya Abad; Juan Manuel López-Gómez Journal: Clin Kidney J Date: 2020-12-05
Authors: Aminu K Bello; Ikechi G Okpechi; Mohamed A Osman; Yeoungjee Cho; Htay Htay; Vivekanand Jha; Marina Wainstein; David W Johnson Journal: Nat Rev Nephrol Date: 2022-02-22 Impact factor: 42.439
Authors: Janine F Farragher; Katherine E Stewart; Tyrone G Harrison; Lisa Engel; Samantha E Seaton; Brenda R Hemmelgarn Journal: Syst Rev Date: 2020-03-17