scholarly journals Cognitive Status and Risk Factors for Cognitive Impairment in Dialysis Patients

2020 ◽  
Vol 16 (4) ◽  
pp. 21-31
Author(s):  
A. Е. Khrulev ◽  
D. D. Tolbuzova ◽  
E. A. Plokhenko ◽  
P. A. Egorova ◽  
S. N. Sorokoumova ◽  
...  
Keyword(s):  
Risk Factors ◽  
Cognitive Impairment ◽  
Kidney Diseases ◽  
Neuropsychological Test ◽  
Cognitive Status ◽  
Control Group ◽  
Dialysis Patients ◽  
Mathematical Methods ◽  
Dialysis Adequacy ◽  
The Mean

The number of dialysis patients is increasing every year and is estimated to be more than 2 million, with an annual increase of 6–12% in dialysis programs. There is a high correlation between cognitive impairment and mortality in dialysis patients, which suggests the relevance of screening cognitive functions in dialysis patients using different neuropsychological scales.Aim of the study was to test the cognitive status and identify cognitive impairment in patients with terminal stage of chronic kidney disease treated using program hemodialysis, as well as to evaluate risk factors for cognitive impairment in this category of patients.Material and methods. 83 patients aged 28 to 78 years (mean age 56.7±13.7 years) were examined. The main group included 53 people who received program hemodialysis, of them 23 men and 30 women. The mean age of patients in this group was 58.3±13.3 years. The control group composed of 30 individuals without kidney diseases, including 13 men and 17 women. The mean age in the control group was 53.6±14.9 years. The MoCA and SLUMS scales were chosen for detecting cognitive impairment and assessment of neuropsychological status. We used mathematical methods of research data processing such as inductive statistics and correlation analysis.Results. Cognitive impairment was found to be significantly more frequent in dialysis patients (75.5–81.1% of cases, P=0.05) compared to those without kidney pathology. The SLUMS scale was shown to be more sensitive than MoCA (P=0.05, CI 95.0%). The risk factors of cognitive impairment in dialysis patients included increased dialysis duration, age (rs=–0.298) and low estimated urea dialysis adequacy index (Kt/V less than 1.2).Conclusion. A high risk of cognitive impairment is common in dialysis patients. For its timely detection,  the screening neuropsychological test are recommended to be used by clinicians. Cognitive impairment, diagnosed by the tests, is an indication for a specialist consultation.

scholarly journals Association of Posture, Gait, and Auditory Functioning with Cognitive Status in a Cohort of Community−Dwelling Older Adults

2021 ◽  
Vol 11 (21) ◽  
pp. 9970
Author(s):  
Emilija Kostic ◽  
Kiyoung Kwak ◽  
Dongwook Kim
Keyword(s):  
Risk Factors ◽  
Cognitive Impairment ◽  
Early Detection ◽  
Postural Stability ◽  
Predictive Ability ◽  
Cognitive Status ◽  
Community Dwelling ◽  
Home Healthcare ◽  
Control Group ◽  
Cognitively Impaired

Postural stability, hearing, and gait function deterioration are the risk factors associated with cognitive impairment. Although no method has been reported for treating severe cognitive impairment to date, developing an early detection model based on these risk factors could aid in slowing down or even reversing the deterioration process. In this study, the association between cognitive impairment and the combined predictive ability of sensory and gait features was assessed. Fifty−seven healthy community−dwelling men over the age of sixty−five participated in cognitive, postural stability, auditory, and level walking evaluations. They were divided into two groups: healthy control group (n = 39) and lower cognition group (n = 18), based on their Montreal cognitive assessment score. During gait, the center of mass of the cognitively impaired participants was confined to a smaller volume. Furthermore, the cognitively healthy participants were found to have better postural stability. Both groups possessed similar hearing ability; however, the cognitively impaired group made a significantly higher number of errors when repeating words or sentences. A logistic regression model utilizing each of these function quantifiers exhibited a high area under the receiver operating characteristic curve, suggesting excellent predictive ability. These models can be applied to smartphone or smart home healthcare technologies to detect the possibility of cognitive impairment, thus facilitating early detection.

scholarly journals Dialysis modalities as risk factors in the development of atherosclerosis

2003 ◽  
Vol 56 (1-2) ◽  
pp. 17-21 ◽  
Author(s):  
Tatjana Damjanovic ◽  
Nada Dimkovic
Keyword(s):  
Risk Factors ◽  
Blood Pressure ◽  
Peritoneal Dialysis ◽  
Carotid Arteries ◽  
Renal Diseases ◽  
Control Group ◽  
Atherosclerotic Cardiovascular Disease ◽  
Dialysis Patients ◽  
Cardiovascular Morbidity And Mortality ◽  
The Mean

Introduction Atherosclerosis is a major risk factor for increased cardiovascular morbidity and mortality in dialysis patients. First clinical symptoms are usually associated with initial atherosclerotic changes of blood vessels. The aim of this study was ultrasound evaluation of intimae media thickness (IMT) of carotid arteries in dialysis patients and its correlation with certain risk factors. Patients and methods IMT was measured in 45 dialysis patients with no signs of cardiovascular diseases:15 continuous ambulatory peritoneal dialysis (CAPD) patients, 30 haemodialysis (HD) patients and in 20 healthy controls. IMT was correlated with certain risk factors for atherosclerosis (general parameters - age, gender, duration of dialysis cause of renal diseases, parameters of nutrition, parameters of calcium and phosphorus metabolism, lipid parameters, blood pressure and smoking). Results The mean carotid artery IMT was significantly higher in dialysis patients than in the control group (p<0.05). In addition, the mean IMT was statistically significantly higher in PD than in HD patients (p<0.05). In CAPD patients there was a significant correlation between IMT and total and LDL cholesterol. In the second group (HD patients) IMT was significantly correlated with diastolic blood pressure, BMI and smoking. Conclusion Although atherosclerotic cardiovascular disease may not manifest in dialysis patients, IMT of carotid arteries significantly increases. Major risk factors affecting IMT are lipid disturbances in patients on peritoneal dialysis and hypertension, obesity and smoking in HD patients.

scholarly journals Association of Cognitive Function Screening Results with Adherence and Performance in a Pedometer-Based Intervention

2021 ◽  
pp. 1-9
Author(s):  
Anoop Sheshadri ◽  
Piyawan Kittiskulnam ◽  
Cynthia Delgado ◽  
Rebecca L. Sudore ◽  
Jennifer C. Lai ◽  
...  
Keyword(s):  
Cognitive Impairment ◽  
Cognitive Function ◽  
Physical Performance ◽  
Mixed Model ◽  
Linear Mixed Model ◽  
Controlled Trial ◽  
Cognitive Status ◽  
Dialysis Patients ◽  
Exercise Interventions ◽  
And Performance

<b><i>Introduction:</i></b> A randomized, controlled trial of a pedometer-based walking intervention with weekly activity goals led to increased walking among dialysis patients. We examined whether impairment per cognitive function screening is associated with adherence and performance in the intervention. <b><i>Methods:</i></b> Thirty dialysis patients were randomly assigned to a 3-month pedometer-based intervention with weekly goals. Participants were administered the Telephone Interview of Cognitive Status (TICS), a test of global mental status. We examined the association of levels of impairment on the TICS (≥33: unimpaired, 26–32: ambiguous impairment, 21–25: mild cognitive impairment [MCI]) with adherence, achieving weekly goals, and increasing steps, physical performance (Short Physical Performance Battery, SPPB), and self-reported physical function (PF) through multivariable linear mixed-model and logistic regression analyses adjusted for age, sex, BMI, dialysis modality, baseline steps, baseline SPPB, and stroke status. <b><i>Results:</i></b> One-third of participants were unimpaired, and 13% had MCI. Participants with worse results on cognitive function screening missed more calls and completed fewer weekly goals than participants with better results. During the intervention, a worse result on cognitive function screening was associated with smaller increases in steps compared to those without impairment: (ambiguous: −620 [95% CI −174, −1,415], MCI: −1,653 [95% CI −120, −3,187]); less improvement in SPPB (ambiguous: −0.22 points [95% CI −0.08, −0.44], MCI: −0.45 [95% CI −0.13, −0.77]); and less improvement in PF (ambiguous: −4.0 points [95% CI −12.2, 4.1], MCI: −14.0 [95% CI −24.9, −3.1]). During the postintervention period, a worse result on cognitive function screening was associated with smaller increases in SPPB (ambiguous: −0.54 [95% CI −1.27, 0.19], MCI: −0.97 [95% CI −0.37, −1.58]) and PF (ambiguous: −3.3 [95% CI −6.5, −0.04], MCI: −10.5 [95% CI −18.7, −2.3]). <b><i>Discussion/Conclusion:</i></b> Participants with worse results on cognitive function screening had worse adherence and derived less benefit from this pedometer-based intervention. Future exercise interventions should be developed incorporating methods to address cognitive impairment, for example, by including caregivers when planning such interventions.

The Ten Point Clock Test: A Quick Screen and Grading Method for Cognitive Impairment in Medical and Surgical Patients

1994 ◽  
Vol 24 (3) ◽  
pp. 229-244 ◽  
Author(s):  
Peter J. Manos ◽  
Rae Wu
Keyword(s):  
Cognitive Impairment ◽  
Cognitive Deficits ◽  
Neuropsychological Tests ◽  
Medical Center ◽  
Neuropsychological Test ◽  
Hospitalized Patients ◽  
Surgical Patients ◽  
Tertiary Referral Center ◽  
The Mean ◽  
State Examination

Objective: The objective of this study was to evaluate the clinical utility of the ten point clock test in screening for and grading cognitive deficits in medical and surgical patients. Method: The setting was the hospital and clinics of Virginia Mason Medical Center, a tertiary referral center. Consecutive samples of hospitalized patients, and clinic outpatients—with and without a dementia—were administered the ten point clock test as well as a number of other neuropsychological tests and measures of cognitive impairment. Results: Clock scores correlated with neuropsychological test scores and with the mini-mental state examination. They were stable from rater to rater, and from day to day in stable patients. The mean clock score of elderly outpatient controls was 8.5, significantly different from the mean of 5.5 scored by patients with a dementia. A cut off score of seven identified 76 percent of outpatients with dementia and 78 percent of elderly controls. Clock scores correlated well with nurses' ratings of their inpatients' cognitive deficits (Spearman's rs = −0.61). The test was easy to administer, even to hospitalized patients. Conclusions: The ten point clock test is reliable, valid, and useful as a quick screen and grading method for cognitive deficits in medical and surgical patients.

scholarly journals COGNITIVE IMPAIRMENT, THEIR DYNAMICS AND STRUCTURE IN THE ACUTE AND RECOVERY PERIODS OF STROKE, DEPENDING ON ARTERIAL HYPERTENSION SEVERITY AND DURATION

2018 ◽  
Vol 13 (3-4) ◽  
pp. 22-27
Author(s):  
T.M. Cherenko ◽  
Yu.L. Heletyuk
Keyword(s):  
Blood Pressure ◽  
Cognitive Impairment ◽  
Arterial Hypertension ◽  
Blood Pressure Monitoring ◽  
Cognitive Status ◽  
Neurological Deficits ◽  
Stroke Patients ◽  
Mean Values ◽  
Post Stroke ◽  
The Mean

Relevance. Cognitive impairment is common in the post-stroke period. Different characteristics of arterial hypertension (AH), namely its severity, duration and variability of blood pressure, can affect the development of cognitive impairment in stroke patients. Objective: to investigate cognitive impairment, their dynamics and structure in acute and recovering stroke periods, depending on the arterial hypertension severity and duration. Materials and methods. 150 patients with a primary ischemic stroke and history of hypertension: 74 (49,3 %) women and 76 (50,7 %) men, the mean age (67,4±0,7) years have been examined. Neurological deficits was evaluated by the NIHSS scale. The cognitive status was evaluated by the MMSE scale at the end of an acute period of 21 days and 1 year. Diagnosis of hypertension was based on the clinical and instrumental examination results and medical documents. Daily blood pressure monitoring was using on admission and every 4 hours during 6 days of acute stroke stage. Mean SBP, mean DBP, maximum SBP and DBP, standard deviation (SD) of SBP and DBP were studied. Results. By the mean score on the MMSE scale, there are differences in patients during acute post-stroke period, depending on the severity of hypertension: 27,2±0,6 points in the case of hypertension stage 1, 24,3±0,6 in the case of hypertension stage 2 and 20,7±0,8 in case of AH stage 3, (p=0.001). By this indicator, patients with different AH duration were different: 26,4±0,9 points; 25,1±0,5 points; 20,5±0,7 points, respectively. The significance of these differences by the mean values of MMSE score was obtained in patients with a duration of AH less than 5 years and more than 10 years, as well as when comparing the group of "6-10 years" and "over 10 years" (p=0,001). Significant differences in the structure of cognitive deficits severity, depending on the hypertension stage and its duration, were observed only in patients with moderate and severe stroke (p=0,006). Cognitive deterioration a year after a stroke was observed in 40 (31,5 %) patients. They have significantly higher mean values SD 1-3, SD 1-6, SBP on the first day after a stroke, and duration of hypertension. Conclusions. The relationship between the degree of intellectual decline and the duration of hypertension (r=0,592, p=0,001), severity of hypertension (r=0,459, p=0,001) was found. The severity of the neurological deficiency affects the structure of cognitive impairment at discharge in patients with different severity and duration of hypertension, and higher mean values of the variability of blood pressure from 1 to 6 days, SBP on the first day after stroke and higher duration of hypertension in the history is associated with a negative dynamics of cognitive impairment in stroke patients in a year after stroke.

scholarly journals Impact of rehabilitation measures on cognitive dysfunction in older patients after surgical treatment of nuclear cataract

2020 ◽  
Vol 22 (12) ◽  
pp. 89-92
Author(s):  
Evgenia V. Popova ◽  
◽  
Evgenia V. Popova ◽  
Evgenia V. Popova ◽  
◽  
...  
Keyword(s):  
Cognitive Impairment ◽  
Cognitive Abilities ◽  
Older Patients ◽  
Cognitive Status ◽  
Main Group ◽  
Control Group ◽  
Nuclear Cataract ◽  
Number Of Patients ◽  
Moderate Cognitive Impairment ◽  
Rehabilitation Measures

Background. The high prevalence of nuclear cataracts in older age groups is accompanied by a simultaneous decrease in cognitive abilities as a result of this ophthalmic disease, and other General somatic polymorbid pathology. Aim. To study the cognitive abilities of elderly and senile patients with nuclear cataracts during medical rehabilitation. Materials and methods. In clinical conditions, 68 elderly and senile patients with nuclear cataract underwent femtolaser-assisted cataract phacoemulsification with intraocular lens implantation, and in the postoperative period, medical and non-drug rehabilitation was performed (the main group). The control group con-sisted of 65 patients with nuclear cataract of the same age who also underwent the above-mentioned surgery without rehabilitation measures. The MMSE scale was used to assess cognitive impairment. Results. 9 months after surgical treatment, the cognitive status of patients in the main group improved from 17.4±0.2 to 20.7±0.3 points (p>0.05). Moderate initial cognitive dysfunction in patients of the main group changed to mild after 9 months, while in the control group it remained the same. At the same time, the proportion of patients with moderate cognitive impairment decreased significantly in the main group from 61.71±5.9% before rehabilitation to 13.2±4.1% after it was completed, and the number of patients with no cognitive deficit increased (p<0.001). In the control group, the number of patients with moderate cognitive impairment decreased from 60.0±6.0 to 46.2±6.2% (p>0.05). Conclusion. The implementation of rehabilitation measures in the postoperative period helps to improve the cognitive status of older patients with nuclear ca-taracts.

Risk Factors for Early Mortality in U.S. Peritoneal Dialysis Patients: Impact of Residual Renal Function

2002 ◽  
Vol 22 (3) ◽  
pp. 371-379 ◽  
Author(s):  
◽  
Michael V. Rocco ◽  
Diane L. Frankenfield ◽  
Barbara Prowant ◽  
Pamela Frederick ◽  
...  
Keyword(s):  
Risk Factors ◽  
Blood Pressure ◽  
Renal Function ◽  
Peritoneal Dialysis ◽  
Serum Albumin ◽  
Creatinine Clearance ◽  
Residual Renal Function ◽  
Chronic Peritoneal Dialysis ◽  
Dialysis Patients ◽  
The Mean

Background Potential risk factors for 1-year mortality, including the peritoneal component of dialysis dose, residual renal function, demographic data, hematocrit, serum albumin, dialysate-to-plasma creatinine ratio, and blood pressure, were examined in a national cohort of peritoneal dialysis patients randomly selected for the Centers for Medicare and Medicaid Services End-Stage Renal Disease (ESRD) Core Indicators Project. Methods The study involved retrospective analysis of a cohort of 1219 patients receiving chronic peritoneal dialysis who were alive on December 31, 1996. Results During the 1-year follow-up period, 275 patients were censored and 200 non censored patients died. Among the 763 patients who had at least one calculable adequacy measure, the mean [± standard deviation (SD)] weekly Kt/V urea was 2.16 ± 0.61 and the mean weekly creatinine clearance was 66.1 ± 24.4 L/1.73 m2. Excluding the 365 patients who were anuric, the mean (±SD) urinary weekly Kt/V urea was 0.64 ± 0.52 (median: 0.51) and the mean (±SD) urinary weekly creatinine clearance was 31.0 ± 23.3 L/1.73 m2 (median: 26.3 L/1.73 m2). By Cox proportional hazard modeling, lower quartiles of renal Kt/V urea were predictive of 1-year mortality; lower quartiles of renal creatinine clearance were of borderline significance for predicting 1-year mortality. The dialysate component of neither the weekly creatinine clearance nor the weekly Kt/V urea were predictive of 1-year mortality. Other predictors of 1-year mortality ( p < 0.01) included lower serum albumin level, older age, and the presence of diabetes mellitus as the cause of ESRD, and, for the creatinine clearance model only, lower diastolic blood pressure. Conclusion Residual renal function is an important predictor of 1-year mortality in chronic peritoneal dialysis patients.

scholarly journals Prevalence of Cognitive Impairment among Peritoneal Dialysis Patients, Impact on Peritonitis and Role of Assisted Dialysis

2016 ◽  
Vol 36 (3) ◽  
pp. 284-290 ◽  
Author(s):  
Yat Fung Shea ◽  
Man Fai Lam ◽  
Mi Suen Connie Lee ◽  
Ming Yee Maggie Mok ◽  
Sing-leung Lui ◽  
...  
Keyword(s):  
Risk Factors ◽  
Cognitive Impairment ◽  
Peritoneal Dialysis ◽  
Cognitive Assessment ◽  
Self Care ◽  
Blood Parameters ◽  
Montreal Cognitive Assessment ◽  
Dialysis Adequacy ◽  
Significant Independent Risk Factor

Background Chronic renal failure and aging are suggested as risk factors for cognitive impairment (CI). We studied the prevalence of CI among peritoneal dialysis (PD) patients using Montreal Cognitive Assessment (MoCA), its impact on PD-related peritonitis in the first year, and the potential role of assisted PD. Methods One hundred fourteen patients were newly started on PD between February 2011 and July 2013. Montreal Cognitive Assessment was performed in the absence of acute illness. Data on patient characteristics including demographics, comorbidities, blood parameters, dialysis adequacy, presence of helpers, medications, and the number PD-related infections were collected. Results The age of studied patients was 59±15.0 years, and 47% were female. The prevalence of CI was 28.9%. Patients older than 65 years old (odds ratio [OR] 4.88, confidence interval [CI] 1.79 – 13.28 p = 0.002) and with an education of primary level or below (OR 4.08, CI 1.30 – 12.81, p = 0.016) were independent risk factors for CI in multivariate analysis. Patients with PD-related peritonitis were significantly older ( p < 0.001) and more likely to have CI as defined by MoCA ( p = 0.035). After adjustment for age, however, CI was not a significant independent risk factor for PD-related peritonitis among self-care PD patients (OR 2.20, CI 0.65 – 7.44, p = 0.20). When we compared patients with MoCA-defined CI receiving self-care and assisted PD, there were no statistically significant differences between the 2 groups in terms of age, MoCA scores, or comorbidities. There were also no statistically significant differences in 1-year outcome of PD-related peritonitis rates or exit-site infections. Conclusion Cognitive impairment is common among local PD patients. Even with CI, peritonitis rate in self-care PD with adequate training is similar to CI patients on assisted PD.

scholarly journals Pulse-wave velocity is associated with cognitive impairment in haemodialysis patients

2017 ◽  
Vol 131 (13) ◽  
pp. 1495-1498 ◽  
Author(s):  
Eve Miller-Hodges ◽  
Neeraj Dhaun
Keyword(s):  
Risk Factors ◽  
Cognitive Impairment ◽  
Arterial Stiffness ◽  
Pulse Wave ◽  
The Elderly ◽  
Dialysis Patients ◽  
Maintenance Haemodialysis ◽  
Dementia Risk ◽  
Independent Association ◽  
Recent Demonstration

Chronic kidney disease (CKD) is common, its prevalence increasing with age. Cognitive impairment is common in the elderly, in CKD and in those on maintenance haemodialysis. As cognitive impairment is the precursor to dementia, the identification of reversible risk factors for cognitive decline is the key to reducing dementia risk. Arterial stiffness is one such potential risk factor. It is independently associated with cardiovascular outcome in dialysis patients. Importantly, the recent demonstration of an independent association between arterial stiffness and cognitive impairment in these patients suggests that vascular stiffness might be potentially causative in the development of cognitive impairment and also be an opportune target for interventions. Whether unstiffening of blood vessels in patients on maintenance haemodialysis can reduce the incidence of cognitive impairment or indeed slow its progression to dementia, remain unanswered questions. In this issue of the Clinical Science, Angermann and colleagues present thought-provoking data related to cognitive impairment in haemodialysis patients.

scholarly journals Correlation of Catecholamine Content and Clinical Influencing Factors in Depression among Psoriasis Patients: A Case-Control Study

2020 ◽  
Author(s):  
Hui-Ling Shu ◽  
Jing Fang ◽  
Deng-Mei Xia ◽  
Zheng-Qun Wang ◽  
Wen-Yao Mi ◽  
...  
Keyword(s):  
Risk Factors ◽  
Influencing Factors ◽  
Psoriasis Vulgaris ◽  
Depression Scale ◽  
Control Group ◽  
Hamilton Depression Scale ◽  
Dermatology Department ◽  
Dopamine Content ◽  
Significant Difference ◽  
The Mean

Abstract Backgroud: This study sought to investigate the clinical influencing factors of patients with psoriasis vulgaris complicated with depression, and to analyze whether the content of monoamine neurotransmitters in plasma was correlated with depression incidence among psoriasis patients. Methods Ninety patients aged 18-60 years with psoriasis vulgaris referred to the dermatology department and 40 healthy volunteers aged 18-60 years referred to the physical examination center of the Affiliated Hospital of Southwest Medical University were included. Questionnaires were administered in both groups to obtain basic patient information, Hamilton Depression Scale(HAMD), and Athens Insomnia Scale(AIS) scores. The questionnaire only for patients with psoriasis vulgaris included the course of disease, Psoriasis Area and Severity Index (PASI), and Dermatology Life Quality Index (DLQI). The catecholamine in plasma from the two groups was analyzed by radioimmunoassay. The data were analyzed by SPSS statistical software. Results: The mean HAMD (P=0.034) and mean AIS scores (P=0.001) of the psoriasis patients were higher than those of the control group, while the mean content of dopamine (P=0.004) and adrenaline in the plasma (P=0.007) of the psoriasis group were lower than those of the control group. Dopamine content in the plasma was lower (comparing psoriasis patients without depression and the control group: P<0.001), and was negatively correlated with HAMD, (P<0.05), AIS (P<0.05), and PASI scores (P<0.05) in the psoriasis patients with depression. There was no significant difference in the epinephrine and norepinephrine contents in all groups. PASI scores were positively correlated with HAMD scores in patients with psoriasis vulgaris, and the mean dopamine content in the patients with depression (P=0.001) was significantly lower than in those without depression. The low dopamine content and high PASI and DLQI scores were the risk factors for depression among the patient population. Conclusion: Psoriasis patients have a significantly higher risk of depression than healthy people, and higher PASI scores were linked to a higher incidence of depression. The dopamine levels of patients were influenced by both psoriasis and depression. The risk factors for depression in psoriasis patients are low dopamine levels in the plasma, severe skin lesions, and lower quality of life.

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