Hypoalbuminemia and Not Hyperhomocysteinemia as a Risk Factor for Dementia in Hemodialysis Patients

Huang, Ying‐Chih; Kuo, Ya-Wen; Lee, Tsong‐Hai; Lee, Meng; Hsiao, Ming-Chang; Wang, Chia-Lian; Lee, Jiann-Der

doi:10.1053/j.jrn.2007.12.003

Cited by 7 publications

(5 citation statements)

References 37 publications

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“…Although this paper represents a synopsis of our current understanding between HHcy and hypovitaminosis B12 and MCI or dementia, some investigations and reviews reveal contrary results or recommendations 27,41,62,188,340,398,401,506–508. Possible errors from this review and its conclusions are that Medline was the primary database, searches may not have captured all relevant studies and case reports, and it is presumed that there are unpublished vitamin B12 treatment responses.…”

Section: Discussionmentioning

confidence: 95%

Cobalamin deficiency, hyperhomocysteinemia, and dementia

Werder¹

2010

NDT

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IntroductionAlthough consensus guidelines recommend checking serum B12 in patients with dementia, clinicians are often faced with various questions: (1) Which patients should be tested? (2) What test should be ordered? (3) How are inferences made from such testing? (4) In addition to serum B12, should other tests be ordered? (5) Is B12 deficiency compatible with dementia of the Alzheimer’s type? (6) What is to be expected from treatment? (7) How is B12 deficiency treated?MethodsOn January 31st, 2009, a Medline search was performed revealing 1,627 citations related to cobalamin deficiency, hyperhomocysteinemia, and dementia. After limiting the search terms, all abstracts and/or articles and other references were categorized into six major groups (general, biochemistry, manifestations, associations and risks, evaluation, and treatment) and then reviewed in answering the above questions.ResultsThe six major groups above are described in detail. Seventy-five key studies, series, and clinical trials were identified. Evidence-based suggestions for patient management were developed.DiscussionEvidence is convincing that hyperhomocysteinemia, with or without hypovitaminosis B12, is a risk factor for dementia. In the absence of hyperhomocysteinemia, evidence is less convincing that hypovitaminosis B12 is a risk factor for dementia. B12 deficiency manifestations are variable and include abnormal psychiatric, neurological, gastrointestinal, and hematological findings. Radiological images of individuals with hyperhomocysteinemia frequently demonstrate leukoaraiosis. Assessing serum B12 and treatment of B12 deficiency is crucial for those cases in which pernicious anemia is suspected and may be useful for mild cognitive impairment and mild to moderate dementia. The serum B12 level is the standard initial test: 200 picograms per milliliter or less is low, and 201 to 350 picograms per milliliter is borderline low. Other tests may be indicated, including plasma homocysteine, serum methylmalonic acid, antiparietal cell and anti-intrinsic factor antibodies, and serum gastrin level. In B12 deficiency dementia with versus without pernicious anemia, there appear to be different manifestations, need for further workup, and responses to treatment. Dementia of the Alzheimer’s type is a compatible diagnosis when B12 deficiency is found, unless it is caused by pernicious anemia. Patients with pernicious anemia generally respond favorably to supplemental B12 treatment, especially if pernicious anemia is diagnosed early in the course of the disease. Some patients without pernicious anemia, but with B12 deficiency and either mild cognitive impairment or mild to moderate dementia, might show some degree of cognitive improvement with supplemental B12 treatment. Evidence that supplemental B12 treatment is beneficial for patients without pernicious anemia, but with B12 deficiency and moderately-severe to severe dementia is scarce. Oral cyanocobalamin is generally favored over intramuscular cyanocobalamin.

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Section: Discussionmentioning

confidence: 95%

Cobalamin deficiency, hyperhomocysteinemia, and dementia

Werder¹

2010

NDT

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“…On the other hand, nonessential element aluminum (Al), a known neurotoxin, can alter the neuronal homeostasis of some essential elements in Alzheimer's disease [14] and cause extensive damage to the nervous system [15]. Among dialysis patients, insufficient dose of dialysis, Al exposure, and malnutrition have also been implicated as risk factors for dementia [16,17]; yet, these findings have not been confirmed.…”

Section: Introductionmentioning

confidence: 99%

Alterations in Trace Elements and Oxidative Stress in Uremic Patients with Dementia

Guo¹,

Ko²,

Chen³

et al. 2009

Biol Trace Elem Res

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The present study was conducted to compare the trace elements and oxidative status between uremic patients with and without dementia. Chronic hemodialysis patients with dementia (n = 20) and without dementia (n = 25), and age-matched healthy volunteers (n = 20) were enrolled. The nutritional status, blood levels of trace elements aluminum (Al), zinc (Zn), copper (Cu), magnesium (Mg) and iron (Fe), malondialdehyde (MDA), and protein carbonyl production, antioxidant enzymes glutathione peroxidase (GPx), and glutathione reductase (GR) activities were measured. No significant difference in nutritional status or clinical characteristics was observed between nondementia and dementia patients. However, uremic patients with dementia have significantly higher Al, Cu, and Mg and lower Zn concentrations, as well as increased Cu/Zn ratio in comparison to nondementia patients. There were statistically significant increased MDA and carbonyl production and decreased GPx and GR activities in dementia patients. Furthermore, the significant associations of Al, Mg, and Cu/Zn ratio with oxidative status in patients with dementia were noted. The dementia may initially worsen with abnormal metabolism of trace elements and oxidative stress occurrence. Our results suggest that abnormalities in trace element levels are associated with oxidative stress and may be a major risk factor in the dementia development of uremic patients.

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“…There were 46 studies meeting the inclusion criteria for final analysis [10,11,12,13,14,15,16,17,18,19,20,21,22,23,24,25,26,27,28,29,30,31,32,33,34,35,36,37,38,39,40,41,42,43,44,45,46,47,48,49,50,51,52,53,54,55]. An overview of the reviewed articles is presented in Table 2.…”

Section: Resultsmentioning

confidence: 99%

Screening of Cognitive Impairment in the Dialysis Population: A Scoping Review

San

Hiremagalur

Muircroft

et al. 2017

Dement Geriatr Cogn Disord

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Background: Cognitive impairment in end-stage kidney disease patients on dialysis is increasingly common. This study aimed to review the practice of screening and to evaluate the evidence on cognitive impairment prevalence in this population. Methods: This scoping review of studies summarises the evidence on cognitive impairment in dialysis populations. The search included the Medline, CINAHL, Embase, PsycINFO, PubMed, and Cochrane Library databases for English-language articles published between 2000 and 2015. A total of 46 articles were reviewed. Results: The studies were of prospective observational design, with the majority conducted in the haemodialysis population. The reported prevalence of cognitive impairment ranged from 6.6 to 51%. Three screening tools were consistently used. Conclusion: While cognitive impairment is recognised in the dialysis population, there is paucity of screening data. The design of prospective comparisons ideally includes established screening instruments, particularly the Montreal Cognitive Assessment, to determine the optimal results for this population. Translation of established screening tools to increase the inclusion of people from other cultural and language groups is required. Regular screening can enhance the timing to introduce home-based care support and advance care planning discussions.

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Hypoalbuminemia and Not Hyperhomocysteinemia as a Risk Factor for Dementia in Hemodialysis Patients

Cited by 7 publications

References 37 publications

Cobalamin deficiency, hyperhomocysteinemia, and dementia

Cobalamin deficiency, hyperhomocysteinemia, and dementia

Alterations in Trace Elements and Oxidative Stress in Uremic Patients with Dementia

Screening of Cognitive Impairment in the Dialysis Population: A Scoping Review

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