Saele Kristin, Sønnesyn Hogne, Svarstad Einar, Aarsland Dag
Medisinsk avdeling, Haukeland universitetssykehus, 5058 Bergen.
Tidsskr Nor Laegeforen. 2009 Feb 12;129(4):296-9. doi: 10.4045/tidsskr.09.34396.
Renal failure occurs more frequently among the elderly and elderly patients comprise an increasing proportion of dialysis patients. The objective of this paper is to review the frequency of cognitive impairment among elderly people in dialysis, and discuss causes and consequences of cognitive impairment and dementia in patients with end-stage renal disease. Prevention and treatment of cognitive impairment are discussed.
The review is based on literature retrieved from a search of Medline and other web-sites, review papers and clinical experience.
Cognitive impairment occurs in 20-87% of patients in haemodialysis, and the frequency is significantly more increased than that for control groups. The etiology is multifactorial, including the primary renal disease, comorbidity, the effect of uraemia and treatment-related factors. Potentially reversible factors such as anaemia and treatment complications may contribute to cognitive impairment in these patients. Cognitive impairment has major clinical consequences for compliance, resource use and the prognosis for patients with renal failure, and is often not detected by the clinicians. The authors propose that cognitive assessment should be included in the routine evaluation of elderly patients with renal failure, with potential implications for the treatment and quality of treatment for these patients.
肾衰竭在老年人中更为常见，老年患者在透析患者中所占比例日益增加。本文的目的是回顾透析老年患者认知障碍的发生率，并探讨终末期肾病患者认知障碍和痴呆的原因及后果。还讨论了认知障碍的预防和治疗。
本综述基于从Medline及其他网站检索到的文献、综述文章以及临床经验。
血液透析患者中认知障碍的发生率为20%至87%，且该发生率显著高于对照组。病因是多因素的，包括原发性肾病、合并症、尿毒症的影响以及治疗相关因素。贫血和治疗并发症等潜在可逆因素可能导致这些患者出现认知障碍。认知障碍对肾衰竭患者的依从性、资源利用和预后具有重大临床影响，而临床医生往往未能察觉。作者建议，认知评估应纳入老年肾衰竭患者的常规评估中，这可能对这些患者的治疗及治疗质量产生影响。
