Department of Medicine, National Taiwan University Hospital Bei-Hu branch, Taipei, Taiwan.
Department of Medicine, National Taiwan University Hospital Jin-Shan branch, New Taipei City, Taiwan.
BMC Geriatr. 2017 Dec 2;17(1):277. doi: 10.1186/s12877-017-0673-3.
Frailty is prevalent among patients with end-stage renal disease (ESRD) and is associated with an increased risk of cognitive impairment. However, apart from its influence on cognition, it is currently unknown whether frailty affects subtler cerebral function in patients with ESRD.
Patients with ESRD were prospectively enrolled, with clinical features and laboratory data recorded. The severity of frailty among these patients with ESRD was ascertained using the previously validated simple FRAIL scale, and was categorized as none-to-mild and moderate-to-severe frailty. All participants underwent quantitative electroencephalography (EEG), with band powers documented following the generation of the delta to alpha ratio (DAR) and delta/theta to alpha/beta ratio (DTABR). EEG results were then compared between groups of different levels of frailty.
In this cohort, (mean age: 68.9 ± 10.4 years, 37% male, 3.4 ± 3 years of dialysis), 20, 60, 40, 17, and 6% patients exhibited positivity in the fatigue, resistance, ambulation, illness, and loss-of-body-weight domains, respectively, with 45.7% being none to mildly frail and 54.3% being moderately to severely frail. Those with mild frailty had a significantly higher delta power compared to those with more severe frailty, involving all topographic sites. Patients with ESRD and severe frailty had significantly lower global, left frontal, left temporo-occipital, and right temporo-occipital DAR and DTABR, except in the right frontal area, and tended to have central accentuation of alpha, beta, and theta power, and more homogeneous DTABR and DAR distribution compared to the findings in those with mild frailty.
Frailty in patients with ESRD can have subtler neurophysiological influences, presenting as altered EEG findings, which warrant our attention.
虚弱是终末期肾病（ESRD）患者中普遍存在的问题，并且与认知障碍风险增加有关。然而，除了对认知的影响外，目前尚不清楚虚弱是否会影响 ESRD 患者更微妙的大脑功能。
前瞻性招募 ESRD 患者，记录其临床特征和实验室数据。使用先前验证的简单 FRAIL 量表确定这些 ESRD 患者的虚弱严重程度，并分为无到轻度和中度到重度虚弱。所有参与者都接受了定量脑电图（EEG）检查，并记录了生成 delta 到 alpha 比（DAR）和 delta/theta 到 alpha/beta 比（DTABR）后的频段功率。然后比较了不同虚弱程度组之间的 EEG 结果。
在该队列中（平均年龄：68.9±10.4 岁，37%为男性，透析时间为 3.4±3 年），分别有 20%、60%、40%、17%和 6%的患者在疲劳、抵抗力、活动能力、疾病和体重减轻等领域呈阳性，分别有 45.7%为无到轻度虚弱，54.3%为中度到重度虚弱。轻度虚弱的患者 delta 功率明显高于重度虚弱的患者，涉及所有的拓扑区域。ESRD 且虚弱严重的患者的全局、左额、左颞枕和右颞枕 DAR 和 DTABR 明显较低，除了右额区，并且倾向于具有 alpha、beta 和 theta 功率的中央强调，以及更均匀的 DTABR 和 DAR 分布，与轻度虚弱患者的发现相比。
ESRD 患者的虚弱可能会产生更微妙的神经生理影响，表现为脑电图异常，这值得我们关注。
