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Abstract
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, primarily affecting executive function. Risk factors for worse executive function include vascular risk factors as well as vascular disease. Normal performance on the MMSE does not preclude impaired cognitive function, because individuals with MMSE score ≥24 also have a high frequency of poor cognitive performance.
GLOSSARY
- CESD=
- Center for Epidemiological Studies Depression Scale;
- COWAT=
- Controlled Oral Word Association Test;
- DCI=
- Dialysis Clinic Inc.;
- ESRD=
- end-stage renal disease;
- MMSE=
- Mini-Mental State Examination;
- PCA=
- principal component analysis;
- WBC=
- white blood cell
Footnotes
Go to Neurology.org for full disclosures. Funding information and disclosures deemed relevant by the authors, if any, are provided at the end of the article.
The results presented in this article have not been published previously in whole or part, except in abstract format. An abstract based on the content of this manuscript was accepted as a poster at the American Society of Nephrology Annual Meeting in Philadelphia in 2011.
Supplemental data at www.neurology.org
- Received May 29, 2012.
- Accepted September 17, 2012.
- © 2013 American Academy of Neurology
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