Cognitive Impairment Early After Initiating Maintenance Hemodialysis: A Cross Sectional Study

Abstract

BackgroundAbnormalities in cognitive function are almost universal in patients receiving hemodialysis (HD) and are associated with worse quality of life, impaired decision making, increased healthcare utilization and mortality. While cognitive impairment in the HD population is increasingly recognized, it is unclear how quickly it develops after starting HD.MethodsThis was a cross-sectional study of a cohort of low dialysis vintage HD patients (<12 months). We used the validated Cambridge Brain Science (CBS) battery of web-based tests to evaluate cognition compared to age- and sex matched controls across three cognitive domains: verbal processing, reasoning and short-term memory.ResultsForty-nine HD patients were included in this study; 43 completed the full battery of tests. The average scores for HD patients were consistently below the age and sex-matched controls. Fifty-five percent of HD patients had cognitive impairment in verbal skills, 43% in reasoning and 18% in short-term memory.ConclusionsThere is a high prevalence of CI evident early after starting HD, with the largest deficits seen in reasoning and verbal processing. These deficits may be attributable to the HD treatment itself. Further studies are needed to characterize the natural history of CI in this patient population and to test interventions aimed at preventing or slowing its progression.

Altered Brain Functional Connectivity of resting-state networks in Neurologically Asymptomatic Patients with End-Stage Renal Disease Undergoing Maintenance Hemodialysis

“…conventional treatment, HD and peritoneal dialysis) or the severity of the disease. Melissa et al [39] found that patients undergoing HD are more vulnerable to damage to their visual-spatial processing, deductive reasoning, executing, and verbal skills than their short-term memory, and these ndings support our speculation; however, a study with a larger sample size will be required to validate our ndings. Nevertheless, our discovery of FC regions in the right MFG may provide additional brain imaging markers for cognitive impairment in patients with ESHD.…”

Patterns of Cognitive Impairment in Hemodialysis Patients and Related Factors including Depression and Anxiety

“…Consequently, HD patients are more likely than the general population to have white matter hyperintensities on magnetic resonance imaging (MRI), a marker for small-vessel ischemic disease, and are therefore at higher risk for future stroke or cognitive decline [4,5]. It is known that HD patients are at increased risk of developing cognitive problems such as mild cognitive impairment (MCI), i.e., mild, noticeable deterioration of cognitive functions, and dementia [6][7][8]. Up to 80% of HD patients aged 55 and older have been shown to have moderate to severe chronic cognitive impairment (CI) [6,7].…”