Department of Psychiatry, SUNY Downstate Medical Center, Brooklyn, New York 11203-2098, USA.
J Nephrol. 2013 Mar-Apr;26(2):323-30. doi: 10.5301/jn.5000148. Epub 2012 Jun 7.
Uremia has long been associated with cognitive deficits. This study explored the importance of the time of measurement of neurocognitive functioning, by directly comparing changes in neurocognitive functioning from immediately after hemodialysis treatment to immediately before treatment.
Twenty-five hemodynamically stable hemodialysis patients and 6 peritoneal dialysis controls completed 2 computer-based assessment batteries (ANAM), one immediately before dialysis and the second upon completion of that dialysis session. Paired sample t-tests were used to compare postdialysis with predialysis neurocognitive functioning scores for both a composite measure of global functioning and the neurocognitive subtests.
There was significant improvement in global neuropsychological functioning from predialysis to postdialysis (t (24) = -7.5, p<0.001), showing an average of 18% improvement in the hemodialysis group, with no significant change in the peritoneal dialysis group.
This study suggests that computer-based testing can offer information on the cognitive fluctuations of medically complex populations and suggests that the end of the session may be a better time to discuss important and complex health messages with hemodialysis patients. It further implies that some of the neurocognitive impairment that is associated with end-stage renal disease is a consequence of uremia and is improved by hemodialysis.
尿毒症长期以来一直与认知功能缺陷有关。本研究通过直接比较血液透析治疗前后即刻的神经认知功能变化，探讨了测量神经认知功能的时间的重要性。
25 名血流动力学稳定的血液透析患者和 6 名腹膜透析对照组完成了 2 个基于计算机的评估测试（ANAM），一个在透析前，另一个在该透析疗程结束时。采用配对样本 t 检验比较透析后与透析前的神经认知功能评分，包括整体功能和神经认知子测试的综合衡量标准。
从透析前到透析后，整体神经心理功能有显著改善（t (24) = -7.5，p<0.001），血液透析组的平均改善率为 18%，而腹膜透析组则没有显著变化。
本研究表明，基于计算机的测试可以提供有关医学复杂人群认知波动的信息，并表明治疗结束时可能是与血液透析患者讨论重要和复杂健康信息的更好时机。它进一步表明，与终末期肾病相关的一些神经认知障碍是尿毒症的后果，可以通过血液透析得到改善。
