Intradialytic Cognitive and Exercise Training May Preserve Cognitive Function

Abstract

IntroductionCognitive decline is common and increases mortality risk in hemodialysis patients. Intradialytic interventions like cognitive training (CT) and exercise training (ET) may preserve cognitive function.MethodsWe conducted a pilot randomized controlled trial of 20 hemodialysis patients to study the impact of 3 months of intradialytic CT (tablet-based brain games) (n = 7), ET (foot peddlers) (n = 6), or standard of care (SC) (n = 7) on cognitive function. Global cognitive function was measured by the Modified Mini Mental Status Exam (3MS), psychomotor speed was measured by Trail Making Tests A and B (TMTA and TMTB), and executive function was assessed by subtracting (TMTB − TMTA). Lower 3MS scores and slower TMTA and TMTB times reflected worse cognitive function. P values for differences were generated using analysis of variance, and 95% confidence intervals (CIs) and P values were generated from linear regression.ResultsPatients with SC experienced a decrease in psychomotor speed and executive function by 3 months (TMTA: 15 seconds; P = 0.055; TMTB: 47.4 seconds; P = 0.006; TMTB − TMTA; 31.7 seconds; P = 0.052); this decline was not seen among those with CT or ET (all P > 0.05). Compared with SC, the difference in the mean change in 3MS score was −3.29 points (95% CI: −11.70 to 5.12; P = 0.42) for CT and 4.48 points (95% CI: −4.27 to 13.22; P = 0.30) for ET. Compared with SC, the difference in mean change for TMTA was −15.13 seconds (95% CI: −37.64 to 7.39; P = 0.17) for CT and −17.48 seconds (95% CI: −41.18 to 6.22; P = 0.14) for ET, for TMTB, the difference was −46.72 seconds (95% CI: −91.12 to −2.31; P = 0.04) for CT and −56.21 seconds (95% CI: −105.86 to −6.56; P = 0.03) for ET, and for TMTB – TMTA, the difference was −30.88 seconds (95% CI: −76.05 to 14.28; P = 0.16) for CT and −34.93 seconds (95% CI: −85.43 to 15.56; P = 0.16) for ET.ConclusionPreliminary findings of our pilot study suggested that cognitive decline in psychomotor speed and executive function is possibly prevented by intradialytic CT and ET. These preliminary pilot findings should be replicated.

Breaking the cycle of functional decline in older dialysis patients

“…Dialysis patients have had improved function through engaging in physical therapy, exercise, resistance training, and gymnastics . The benefits from physical activity include increased mobility, preserved cognitive function, handgrip strength, motivation to exercise, and independence in household activities …”

“…42,43 The benefits from physical activity include increased mobility, preserved cognitive function, handgrip strength, motivation to exercise, and independence in household activities. 44 Because CGA in nondialysis populations has proven to minimize functional decline, there is a promise that CGA can be effective in the dialysis setting; however, we must first address important challenges to the implementation of CGA in this population. First, we must identify which patients are most likely to benefit from CGA.…”

Exercise and cognitive function in patients with end‐stage kidney disease

“…Most recently, two pilot studies assessed the impact of different types of intradialytic exercise on cognitive function . One pilot randomized controlled trail of 30 adult HD patients aged 18 years and older assessed the impact of 4 months of intradialytic cycling for aerobic exercise on cerebral blood flow and cognitive function.…”

“…Another pilot randomized controlled trial of 20 HD patients of all ages assessed the impact of 3 months of intradialytic CT (tablet‐based brain games) (N = 7), ET (foot peddlers) (N = 6), or standard of care (SC) (N = 7) on measured cognitive function using the 3MS and TMTA/B . Patients with SC experienced decline in psychomotor speed and executive function by 3 months of follow‐up; this decline was not seen among those with CT or ET.…”

Briefly Noted

“…9 A randomized, 3-month, controlled trial in 20 HD patients found that intradialytic use of tablet based brain games or exercise training with foot peddlers was associated with less cognitive decline in psychomotor speed and executive function than was seen in HD patients not so treated. 10…”