Department of Nephrology, Far Eastern Memorial Hospital, New Taipei, Taiwan; Graduate Program in Biomedical Informatics, Yuan Ze University, Taoyuan, Taiwan; Graduate Institute of Clinical Medicine, National Taiwan University, Taipei, Taiwan; Health Management Center, Far Eastern Memorial Hospital, New Taipei, Taiwan.
Division of Medical Imaging, Radiology, Far Eastern Memorial Hospital, New Taipei, Taiwan.
J Formos Med Assoc. 2019 May;118(5):867-875. doi: 10.1016/j.jfma.2019.01.011. Epub 2019 Feb 7.
Chronic kidney disease exhibits a prominent premature aging phenotype in many different organ systems, including the brain. Nevertheless, a comprehensive characterization of brain aging in non-demented patients with end-stage renal disease (ESRD) is lacking and it remains unclear if the collective changes of cognitive functions and brain structures in ESRD is compatible with aging.
We compared 56 non-demented, independently living dialysis patients (mean age 59.4 ± 11.0 years; mean dialysis vintage of 5.9 years) and 60 non-dialysis controls on a battery of neuropsychological tests, brain MRI T1 imaging and diffusion tensor imaging. Participants with diagnosis of dementia, Mini-Mental State Examination <24, medical history of stroke, or recent hospitalization within 1 month were excluded.
Dialysis patients showed significantly worse performance in attention/information processing speed and executive function adjusted for age, sex, education, diabetes and depression. Reduced total brain volume and subcortical volume including hippocampus were found in dialysis patients. Vertex-wise analysis showed cortical thinning in middle frontal, lateral occipital and precuneus region. Furthermore, decreased white matter integrity was found primarily in bilateral anterior thalamic tract, fronto-occipital fasciculus, forceps minor and uncinate tract after correction for multiple comparisons.
Overall, differences in cognitive functions, cortical volumes/thickness and white matter integrity associated with dialysis are also cognitive domains and brain structure changes associated with normal aging. In other words, non-demented, independently living dialysis patients present an accelerated brain aging phenotype even after taking into account effects of age, diabetes and depression.
慢性肾脏病在许多不同的器官系统中表现出明显的过早衰老表型，包括大脑。然而，对于终末期肾病（ESRD）非痴呆患者的大脑衰老还缺乏全面的描述，目前仍不清楚 ESRD 患者认知功能和大脑结构的整体变化是否与衰老相兼容。
我们比较了 56 名非痴呆、独立生活的透析患者（平均年龄 59.4±11.0 岁；平均透析年限 5.9 年）和 60 名非透析对照者的神经心理学测试、大脑 MRI T1 成像和弥散张量成像结果。排除痴呆诊断、简易精神状态检查 <24、有卒中病史或在 1 个月内最近住院的患者。
透析患者在注意力/信息处理速度和执行功能方面的表现明显差于年龄、性别、教育程度、糖尿病和抑郁调整后的对照组。透析患者的总脑体积和包括海马体在内的皮质下体积减少。在体素水平上的分析显示，中额、外侧枕叶和楔前叶区域的皮质变薄。此外，校正多重比较后，在双侧前丘脑束、额枕束、小钳和钩束中发现白质完整性降低。
总的来说，与透析相关的认知功能、皮质体积/厚度和白质完整性的差异也是与正常衰老相关的认知领域和大脑结构变化。换句话说，即使考虑到年龄、糖尿病和抑郁的影响，非痴呆、独立生活的透析患者也表现出加速的大脑衰老表型。
