Abstract
Background and Aims
Cognitive impairment (CI) are prevalent and devastating in dialysis patients, whereas the pathophysiology is not very clear. Brain atrophy may involve in the process of CI. To explore the correlation between brain atrophy and cognitive impairment, as well as the risk factors of brain atrophy, we used the voxel based morphometry (VBM) method to evaluate the changes of brain multi-component volume in maintenance dialysis patients, and analyzed it relationship with detailed cognitive function.
Method
From July 2013 to July 2014, 181 maintenance dialysis patients in our hospital were enrolled for 3.0T MRI examination and cognitive function evaluation. The statistical parameter map (SPM) 8 software package was used for VBM analysis, and the Monte Carlo simulation method (alphasim method) in the functional neural image analysis software package (AFNI) was used for multiple comparison correction at the cluster level to extract the volume of brain multi-component. Cognitive function was evaluated with MMSE, MoCA, Philadelphia word learning test, Boston Naming Test, semantic fluency test and trial making test. The risk factors for brain volume were explored, and the correlation between brain volume and CI was investigated by regression analysis.
Results
This study enrolled 181 dialysis patients, including 119 cases of maintenance hemodialysis and 62 cases of peritoneal dialysis. According to MMSE and MoCA, the incidence of cognitive impairment was 22.7% and 66.3% respectively. The mean values gray matter volume and white matter volume were 575.4mm3 and 457.8mm3, respectively. The volume of gray matter, white matter, amygdala, caudate nucleus and hippocampus were positively correlated with the scores of specific cognitive functions such as total, memory, language and execution. Among them, amygdala volume atrophy was significantly related to the decrease of cognitive function such as MMSE (β = 2.81, P = 0.005), MoCA (β = 6.26, P < 0.001). Serum albumin is the risk factor of gray matter volume (β = 5.0, 95% CI = 3.1 to 6.9, P < 0.001) and white matter volume (β = 3.6, 95% CI = 1.7 to 5.5, P < 0.001); Serum Hypersensitive C-reactive protein is the risk factor of gray matter volume (β = -0.9, 95% CI = -1.7 to - 0.1, P = 0.037).
Conclusion
Brain atrophy in maintenance dialysis patients is closely related to multiple cognitive impairment, and malnutrition - microinflammation may be a risk factor for multi-component brain atrophy.
Association of white matter hyperintensities and gray matter volume with cognition in older individuals without cognitive impairment
