Cognitive Impairment among Egyptian Older Adults on Hemodialysis

Abstract

Background: Older patients are now the rule rather than the exception in hemodialysis (HD). Cognitive impairment is common among persons with end stage renal disease (ESRD) and is associated with poor outcomes. Aim: To assess the prevalence of cognitive impairment among older adults on HD and the association of different patients' demographics and characteristics with cognitive impairment. Materials and methods: A cross section study was conducted to assess the cognitive functions of elderly subjects on HD. 94 subjects, 60 years old and above, were included. All subjects were subjected to: 1-comprehensive geriatric assessment. 2-Laboratory investigations including: hemoglobin, serum creatinine, serum urea, serum potassium, serum sodium and serum albumin. Kt/V as a marker of dialysis adequacy was calculated. Results: The study revealed that 26 (27.7%) patients had normal cognitive function, 32 (43%) had mild cognitive impairment, 21 (23%) had mild dementia, 8 (8.5%) had moderate dementia and 7 (7.4%) had severe dementia. Older age, low education level and longer duration of dialysis history were found to have significant associations with cognitive impairment, [P: < 0.001, 0.002, and 0.012 respectively]. While hemoglobin, serum albumin, serum creatinine, serum urea, serum potassium and Kt/V showed no significant association with cognitive impairment, Serum sodium and dry weight dialysis showed significant difference between patients with normal cognitive function and patients with cognitive impairment, [P <0.001 both]. Conclusion: Cognitive impairment is prevalent in Egyptian older adults on HD and more prevalent and severe in those with older age, low education, lower level of serum sodium, longer duration of dialysis history and higher dry weight.

Cognitive abilities and physical activity in chronic kidney disease patients undergoing hemodialysis

“…Table 2 shows that the total average score (ACE-R) was lower than the cut-off points (78 points),15 , 16 confirming HD patients are at greater risk of developing dementia 5 , 7 - 13. Cognitive symptoms such as memory disorders, difficulty planning activities, impaired attention, decreased information processing speed, motor disability, and speech difficulty have been shown in mental health and CKD, revealing a negative influence of CKD on mental fitness 31…”

“…Furthermore, there is an increased odds ratio of 2.43 (95% CI, 1.38 to 4.29) for cognitive deficits in patients with an eGRF of <45 ml/min per 1.73 m2, even after adjusting for possible confounders 11 , 12. Another postulated theory for loss of cognitive functioning in CKD patients is that these patients often have underlying vascular disease such as diabetes mellitus and hypertension, which may contribute to cognitive impairment and, consequently, exert a negative influence on QOL 13…”

“…In contrast, non-pharmacological treatments such as physical activity may positively contribute to cognitive functioning in CKD patients 13. The physiological mechanisms underlying this improved cognition resulting from physical activity may include: 1) increased oxygen and nutrients supply for cerebral metabolism due to an increase in cerebral blood flow; 2) increased neurotransmitter expression capable of altering action potentials; and 3) modulation of several hormones (i.e.…”

“…The physiological mechanisms underlying this improved cognition resulting from physical activity may include: 1) increased oxygen and nutrients supply for cerebral metabolism due to an increase in cerebral blood flow; 2) increased neurotransmitter expression capable of altering action potentials; and 3) modulation of several hormones (i.e. β-endorphin, cortisol), which may affect the morphology of brain structures associated with cognitive functions 13…”

Cognitive Impairment and Associated Factors Among Chronic Kidney Disease Patients: A Comparative Cross-Sectional Study

“…11 The prevalence of cognitive impairment in CKD patients ranges from 17% to 87% depending on severity. [12][13][14][15][16] Its prevalence among CKD patients is 20% in the United Kingdom, 17 75.5% in China, 18 and 53.8% in India. 19 A comparative cross-sectional study in Nigeria showed that the prevalence of cognitive impairment CKD patients is 35.3% whereas for the control group it is 6%.…”