Cognitive Dysfunction and Gait Abnormalities in CKD

Abstract

Background and objectivesCognitive impairment is a major cause of morbidity in CKD. We hypothesized that gait abnormalities share a common pathogenesis with cognitive dysfunction in CKD, and therefore would be associated with impaired cognitive function in older adults with CKD, and focused on a recently defined gait phenotype linked with CKD.Design, setting, participants, & measurementsGait assessments and neuropsychological testing were performed in 312 nondisabled, community-dwelling older adults (aged ≥65 years). A subset (n=115) underwent magnetic resonance imaging. The primary cognitive outcome was the Repeatable Battery for the Assessment of Neuropsychological Status (RBANS) total scale score. Associations with cognitive function were tested using multivariable linear regression and nearest-neighbor matching. The risk of developing mild cognitive impairment syndrome was assessed using Cox proportional hazards models.ResultsLower eGFR was associated with lower RBANS score only among participants with the gait phenotype (P for interaction =0.04). Compared with participants with neither CKD nor the gait phenotype, adjusted RBANS scores were 5.4 points (95% confidence interval, 1.8 to 9.1) lower among participants with both, who demonstrated poorer immediate memory, visuospatial ability, delayed memory, and executive function. In a matched analysis limited to participants with CKD, the gait phenotype was similarly associated with lower RBANS scores (−6.9; 95% confidence interval, −12.2 to −1.5). Neuroimaging identified a pattern of gray matter atrophy common to both CKD and the gait phenotype involving brain regions linked with cognition. The gait phenotype was associated with higher risk of mild cognitive impairment (hazard ratio, 3.91; 95% confidence interval, 1.46 to 10.44) independent of eGFR.ConclusionsThe gait phenotype was associated with poorer function in a number of cognitive domains among older adults with CKD, and was associated with incident mild cognitive impairment independent of eGFR. CKD and the gait phenotype were associated with a shared pattern of gray matter atrophy.

How to Overcome Anabolic Resistance in Dialysis-Treated Patients?

“…The progressive aging-associated muscle atrophy, which frequently presents with muscle weakness and slow motion, is the most common type of muscle atrophy observed in humans ( 39 ). With aging, the risk of both CKD and declining capacities such as reduced strength and cognition increases ( 40 ); this risk is maximized in subjects developing “accelerated biological aging” ( 41 ). Sensory–motor functioning is very common in frail individuals who are at highly vulnerable for loss of independence in activities of day living, fall and mortality ( 42 ).…”

Step length and fall risk in adults with chronic kidney disease: a pilot study

“…Gait speed, for example, is simple to measure, takes less than 1 min to complete, and is associated with both functional and cognitive outcomes [ 3 , 9 ]. In addition, our work and that of others have identified other abnormalities of gait among adults with CKD [ 10 , 11 ]; these are present even among individuals with preserved gait speed and are associated with elevated risk of falls and development of cognitive impairment, the latter of which can further exacerbate fall risk [ 10 , 12 , 13 ].…”

Signatures of Gait Movement Variability in CKD Patients Scheduled for Hemodialysis Indicate Pathological Performance Before and After Hemodialysis: A Prospective, Observational Study

“…Our findings are in line with a recent publication demonstrating gray matter atrophy in brain regions in control of gait and cognition in CKD patients. This study, furthermore, identified a gait phenotype specific to CKD patients that was distinct from established neurological gaits ( 80 ).…”

“…It seems that renal disease patients have much worse gait variability in the temporal domain measures, e.g., ST, but similar characteristics in the spatial measures (SL), compared to the healthy elderly ( 61 ), to middle aged patients on HD ( 47 ), and to neurological patients ( 26 ). Different regions of the brain are associated with different spatio-temporal gait parameters ( 79 ), and in CKD mainly the pre-frontal, frontal, and temporal cortexes are affected by gray matter atrophy ( 80 ), which may explain these differences. At first sight it seems not to be logical to compare our renal disease patient data with optimal thresholds derived from healthy and neurological patients.…”