Neuropsychological Assessment of Cognitive Impairment in Kidney Transplantation (NAsKiT) and its related risk factors: a study protocol

Abstract

Background Association of cognitive impairment with chronic kidney disease has been reported over the last decade. Individuals show better cognitive performance after kidney transplantation than individuals on dialysis but are more likely to be affected by cognitive impairment than age-matched comparison groups. Better knowledge of the prevalence as well as course and profile of cognitive impairment is important for the design of future studies assessing the clinical impact of cognitive impairment and developing management strategies. The goal of our study is to examine the extent of cognitive impairment before and after transplantation and to derive a distinct profile of cognitive function using standard neurocognitive tests. Furthermore, we aim to assess whether transplantation per se leads to an improvement in cognitive performance. Methods We are conducting a prospective single-center cohort study involving 100 kidney transplant individuals. Individuals who are wait-listed to receive a kidney transplantation or have already received one will be included in this study. Individuals will undergo a battery of detailed neurocognitive tests at baseline (in part before surgery), and then 3 and 12 months afterwards. Furthermore, the enrolled patients will complete a validated German version of the Cognitive Failure Questionnaire for self-assessment (s-CFQ) as well as the Hospital Anxiety and Depression Scale -Deutsche (HADS-D), a self-report screening instrument with two scales that capture anxiety and depression. In addition, a hair sample will be taken at each measurement time point for the determination of hair cortisol levels as a parameter for the cumulative hypothalamic-pituitary-adrenocortical axis activity over the previous three months. The primary outcome measure will be (a) the effect of kidney transplantation on the cognitive performance up to 12 months after transplantation and (b) the course of cognitive performance following kidney transplantation over time. Discussion The results of our study have potentially important implications for the prevention and treatment of cognitive impairment in kidney transplant individuals. By increasing our knowledge of the neurocognitive profile and assigning the corresponding deficits, it might be possible to create an individualized training program to positively impact cognitive deficits in kidney transplant patients.

Cognitive Impairment and Anxiety Are Prevalent in Kidney Transplant Recipients

“…Improvements in fatigue and depression were also reported [28]. Unfortunately, the studies published so far are difficult to compare due to methodological hurdles such as the use of different screening tests covering different cognitive domains, various assessment times, lack of determination of cutoff scores, and lack of matched healthy control group [29‒32]. There are some limitations in our study.…”

Neuropsychological and biopsychosocial evolution, therapeutic adherence and unmet care needs during paediatric transplantation: study protocol of a mixed-methods design (observational cohort study and focus groups) – the TransplantKIDS mental health project

“…Also, the results and conclusions derived from this project will be directly transferred to routine clinical practice and real-world patients. As mentioned above, the use of standardized measures (neuropsychological tests and biopsychosocial questionnaires) by the Mental Health team during the entire transplantation process will allow the early detection of potential neuro−/psychosocial problems, as well as the implementation or prescription of the adequate specific intervention (therapeutic or preventive) that may be required at an early stage ( Karakizlis et al, 2022 ). For example, family disfunctions can be identified during any stage of the transplantation process so that an early intervention can be applied by Mental Health professionals ( Cushman et al, 2019 ; Liu et al, 2020 ; Tadros et al, 2020 ).…”

“…Moreover, as mentioned previously, other functional and clinical indicators of the paediatric population in the process of transplantation or in those already transplanted should also be systematically incorporated into hospitals' protocols for these patients, such as neuropsychological evaluations. In this regard, scientific literature confirms that this clinical population presents outstanding needs both at the level of global intellectual functioning and specific neurocognitive domains, both in transplant recipients of different solid organs (Alonso and Sorensen, 2009;Urschel et al, 2018;Gold et al, 2020;Karakizlis et al, 2022;Østensen et al, 2022) and of hematopoietic progenitors (Fahnehjelm et al, 2018;Wu et al, 2022).…”

“…This assessment, together with the evaluation of other biopsychosocial domains, will allow for the early detection of high-risk clinical conditions at the mental health level as well as the identification of peri-surgical neurocognitive disorders ( Kaustov et al, 2021 ). Similarly, early identification of these deficits is essential to be able to activate potential educational adaptations or cognitive rehabilitative interventions, which will be optimally effective if implemented in the critical periods of child neurodevelopment ( Karakizlis et al, 2022 ).…”

Neuropsychiatric Adverse Events Following Antiretroviral Therapy in People Living with HIV: A Real-World Study of Dynamic Trends and Risk Factors in Hangzhou, China

“… 33 , 34 Each item is scored on a 4-point Likert scale (0–3) and total scores range from 0–21. 35 For HADS-A and HADS-D, the following score reflects the severity of anxiety or depression: 0–7, none; 8–10, mild; 11–14, moderate; and 15–21, severe. 36 The Cronbach’s alpha coefficient for this scale among PLWH in China was 0.904, with 0.869 for the anxiety subscale and 0.807 for the depression subscale.…”