Jayanti A, Foden P, Brenchley P, Wearden A, Mitra S
Renal Research Division, Central Manchester University Hospitals NHS Trust, Manchester, UK.
Department of Biostatistics, University of Manchester, Manchester, UK.
Kidney Int Rep. 2016 Aug 10;1(4):240-249. doi: 10.1016/j.ekir.2016.07.010. eCollection 2016 Nov.
Kidney disease is associated with significant cognitive dysfunction. Subjective reports of cognitive ability have not been studied extensively in chronic kidney disease. We investigated the association between objective and subjective cognitive functions in predialysis patients and their association with self-care dialysis modality choice.
Cross-sectional data from the Barriers to Successful Implementation of Care in Home Haemodialysis study were used for the study of cognition in 220 predialysis patients. The data were used to ascertain the demographics, clinical, laboratory, and neuropsychometric variables. The latter includes Trail Making Tests (TMT) parts A and B, Modified Mini Mental State Examination, and metacognition questionnaire for subjective assessment of one's cognitive ability. The outcome variable was fully assisted and self-care dialysis modality choice.
Within the study cohort, 90 patients chose fully assisted hemodialysis and 114 patients chose self-care dialysis. The median Modified Mini Mental State Examination, TMT part A, and TMT part B scores were greater for the assisted versus the self-care group. Metamemory was not significantly different between groups, but the metaconcentration score was significantly worse in the group choosing assisted dialysis. Higher (i.e., better) metaconcentration scores were significantly associated with the self-care modality choice in the univariate and hierarchical regression analyses. Adjusted and unadjusted analyses showed a significant association between perceived concentration and TMT part B scores ( < 0.01). With every 1.6-minute increase in TMT part B score, there was a 1-unit reduction in metaconcentration score, and the latter was associated with 20% lower odds of choosing self-care dialysis over a fully assisted dialysis modality.
Patients' self-perception of cognitive ability is a significant predictor of self-care dialysis modality choice. Subjective report of "metaconcentration" is also strongly associated with poorer outcome on the TMT part B.
肾脏疾病与显著的认知功能障碍相关。慢性肾脏病患者认知能力的主观报告尚未得到广泛研究。我们调查了透析前患者客观和主观认知功能之间的关联及其与自我护理透析方式选择的关系。
来自家庭血液透析护理成功实施障碍研究的横断面数据用于研究220例透析前患者的认知情况。这些数据用于确定人口统计学、临床、实验室和神经心理测量变量。后者包括连线测验（TMT）A部分和B部分、改良简易精神状态检查表以及用于主观评估个人认知能力的元认知问卷。结局变量是完全辅助和自我护理透析方式的选择。
在研究队列中，90例患者选择完全辅助血液透析，114例患者选择自我护理透析。辅助组的改良简易精神状态检查表、TMT A部分和TMT B部分的中位数得分高于自我护理组。两组间元记忆无显著差异，但选择辅助透析组的元注意力得分明显更差。在单因素和分层回归分析中，较高（即较好）的元注意力得分与自我护理方式选择显著相关。调整和未调整分析均显示，感知注意力与TMT B部分得分之间存在显著关联（<0.01）。TMT B部分得分每增加1.6分钟，元注意力得分就降低1个单位，后者与选择自我护理透析而非完全辅助透析方式的几率低20%相关。
患者对认知能力的自我认知是自我护理透析方式选择的重要预测因素。“元注意力”的主观报告也与TMT B部分较差的结果密切相关。
