Prevalence and Correlates of Cognitive Impairment in Hemodialysis Patients

Tamura, Manjula Kurella; Larive, Brett; Unruh, Mark; Stokes, John B.; Nissenson, Allen R.; Mehta, Ravindra L.; Chertow, Glenn M.

doi:10.2215/cjn.01090210

Cited by 179 publications

(178 citation statements)

References 30 publications

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“…These include a potential for survival bias that may have resulted in an underestimation of the burden of disability, inability to generalize across all populations, and a lack of longitudinal outcome data. Several studies have noted that patients on dialysis (both HD and PD) have a high burden of cognitive impairment (34,37,38). Through our choice chair without the use of their arms or an aid, while 51% were unable to perform the TUG mobility test within the normal range of 0-10 s.…”

Section: Study Populationmentioning

confidence: 94%

Functional Disability in Older Adults Maintained on Peritoneal Dialysis Therapy

et al. 2016

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♦ Background: Older in-center hemodialysis patients have a high burden of functional disability. However, little is known about patients on home chronic peritoneal dialysis (PD). As patients opting for home dialysis are expected to play a greater role in their own dialysis care, we hypothesized that a relatively low number of PD patients would require help with basic self-care tasks (ADL) and instrumental activities of daily living (IADL). ♦ Methods: We used a cross-sectional study design to measure the proportion of patients aged 65 years and older undergoing outpatient PD who needed help with day-to-day activities. Patients living in nursing homes were excluded from the study. Functional dependence in ADL and IADL tasks were measured by the Barthel and Lawton Scales. Physical performance measures used included the timed up-and-go (TUG) test, chair stands and Folstein mini-mental score (MMSE).♦ Results: A total of 74 of 76 (97%) eligible PD patients participated. Patients had a mean age of 76.2 ± 7.5 years. Thirty-six percent had impaired MMSE scores, 69% were unable to stand from a chair without the use of their arms and 51% had abnormal TUG scores. Only 8 patients (11%) were fully independent for both ADL and IADL activities. Dependence in one or more ADL activity was reported by 64% of participants, while 89% reported dependence in one or more IADL. ♦ Conclusions: Impaired physical and functional performance is common in older patients maintained on PD. Collaborative geriatric-renal programs may be beneficial within the dialysis community.

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Section: Study Populationmentioning

confidence: 94%

Functional Disability in Older Adults Maintained on Peritoneal Dialysis Therapy

et al. 2016

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“…Our results confirm prior studies that have demonstrated a high prevalence of cognitive impairment in this population. 3,[20][21][22] In one study, the MMSE was administered to 336 dialysis patients: 22% of subjects had mild impairment (MMSE scores 18-23) and 8% had moderate-severe impairment (MMSE scores 0-17). 3 In another study evaluating 338 hemodialysis patients, 14% were classified with mild impairment, 36% with moderate impairment, 37% with severe impairment, and 13% with normal cognition.…”

mentioning

confidence: 99%

“…22 In the Frequent Hemodialysis Network, impaired executive function, defined by failure to complete the Trail Making B task within 5 minutes, was common among hemodialysis patients but was not strongly associated with patient or dialysis-associated factors. 21 Our study substantially adds to these by performing detailed cognitive testing, focusing on both memory and executive function, evaluating a wide range of risk factors for each form of cognitive impairment, and comparing the results to validated normative data. We also demonstrate that, even among those with MMSE score $24, there is a high frequency of more subtle degrees of cognitive impairment.…”

mentioning

confidence: 99%

Frequency of and risk factors for poor cognitive performance in hemodialysis patients

Sarnak¹,

Tighiouart²,

Scott³

et al. 2013

Neurology

210

186

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Objective: There are few detailed data on cognition in patients undergoing dialysis. We evaluated the frequency of and risk factors for poor cognitive performance using detailed neurocognitive testing.Methods: In this cross-sectional cohort study, 314 hemodialysis patients from 6 Boston-area hemodialysis units underwent detailed cognitive assessment. The neuropsychological battery assessed a broad range of functions, with established age-, sex-, and education-matched normative scores. Principal component analysis was used to derive composite scores for memory and executive function domains. Risk factors for each domain were evaluated using linear regression adjusting for age, sex, race, and education status. Analyses were repeated in those with Mini-Mental State Examination (MMSE) score $24.Results: Compared with population norms, patients on dialysis had significantly poorer executive function but not memory performance, a finding that persisted in the subgroup with MMSE score $24. In adjusted analyses, vascular risk factors and vascular disease were associated with lower executive function (p , 0.01).Conclusions: There is a high frequency of poor cognitive performance in hemodialysis patients, primar- Cognitive impairment in dialysis is an increasingly important public health problem given the aging end-stage renal disease (ESRD) population and the increasing prevalence of diabetes and vascular disease. In older studies in hemodialysis patients, cognitive impairment, defined by poor performance on the Mini-Mental State Examination (MMSE), was present in 40% to 60%. 1-3 Despite the fact that the MMSE remains the most frequently used screening tool for cognitive impairment, it focuses on memory and largely neglects other cognitive domains such as executive function; accordingly, the MMSE may not be sufficient to detect more subtle degrees of cognitive impairment.The major causes of dementia in the general population are Alzheimer disease, which initially manifests with memory loss with later involvement of other cognitive domains, and vascular dementia, which primarily manifests with impairment in executive function. [4][5][6][7] Although it is likely that patients undergoing dialysis have similar causes for cognitive impairment as the general population, there are few studies that have attempted to distinguish the prevalence of and risk factors for each type of cognitive impairment in this population.The goals of this study were therefore to evaluate the frequency of and risk factors for poor cognitive performance in hemodialysis patients using detailed measures of multiple cognitive domains, From the Division of Nephrology (M.J.S., K

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“…An association between renal failure and cognitive impairment has been reported (14)(15)(16). The point prevalence of cognitive impairment and dementia was two-fold higher in patients with ESRD than in those without ESRD (17).…”

Section: Cognitive Impairmentmentioning

confidence: 96%

Renal Replacement Therapy in the Elderly Population

Berger¹,

Hedayati

2012

Clinical Journal of the American Society of Nephrology

101

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Summary ESRD has become an important problem for elderly patients. The segment of the ESRD population age 65 years or older has grown considerably, and this growth is expected to accelerate in coming years. Nephrologists caring for the elderly with advanced kidney disease will encounter patients with comorbid conditions common in younger patients, as well as physical, psychological, and social challenges that occur with increased frequency in the aging population. These challenging factors must be addressed to help inform decisions regarding the option to initiate dialysis, the choice of dialysis modality, whether to pursue kidney transplantation, and end-of-life care. This article will highlight some common problems encountered by elderly patients with ESRD and review data on the clinical outcomes of elderly patients treated with different modalities of dialysis, outcomes of kidney transplantation in the elderly, and nondialytic management of CKD stage 5.

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Prevalence and Correlates of Cognitive Impairment in Hemodialysis Patients

Cited by 179 publications

References 30 publications

Functional Disability in Older Adults Maintained on Peritoneal Dialysis Therapy

Functional Disability in Older Adults Maintained on Peritoneal Dialysis Therapy

Frequency of and risk factors for poor cognitive performance in hemodialysis patients

Renal Replacement Therapy in the Elderly Population

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