Department of Gerontology and Geriatrics C7-Q, Leiden University Medical Center, PO box 9600, 2300 RC, Leiden, The Netherlands.
Department of Nephrology, Leiden University Medical Center, Leiden, The Netherlands.
BMC Nephrol. 2020 Apr 9;21(1):126. doi: 10.1186/s12882-020-01764-2.
The prevalence of impaired cognitive functioning in older patients with end stage kidney disease (ESKD) is high. We aim to describe patterns of memory, executive function or psychomotor speed and to identify nephrologic, geriatric and neuroradiologic characteristics associated with cognitive impairment in older patients approaching ESKD who have not yet started with renal replacement therapy (RRT).
The COPE-study (Cognitive Decline in Older Patients with ESRD) is a prospective cohort study including 157 participants aged 65 years and older approaching ESKD (eGFR ≤20 ml/min/1.73 m) prior to starting with RRT. In addition to routinely collected clinical parameters related to ESKD, such as vascular disease burden and parameters of metabolic disturbance, patients received a full geriatric assessment, including extensive neuropsychological testing. In a subgroup of patients (n = 93) a brain MRI was performed.
The median age was 75.3 years. Compared to the normative data of neuropsychological testing participants memory performance was in the 24th percentile, executive function in the 18th percentile and psychomotor speed in the 20th percentile. Independent associated characteristics of impairment in memory, executive and psychomotor speed were high age, low educational level and low functional status (all p-values < 0.003). A history of vascular disease (p = 0.007) and more white matter hyperintensities on brain MRI (p = 0.013) were associated with a lower psychomotor speed.
Older patients approaching ESKD have a high prevalence of impaired memory, executive function and psychomotor speed. The patterns of cognitive impairment and brain changes on MRI are suggestive of vascular cognitive impairment. These findings could be of potentially added value in the decision-making process concerning patients with ESKD.
终末期肾病（ESKD）老年患者认知功能障碍的患病率较高。我们旨在描述记忆、执行功能或精神运动速度的模式，并确定与尚未开始肾脏替代治疗（RRT）的 ESKD 老年患者认知障碍相关的肾脏、老年和神经影像学特征。
COPE 研究（老年终末期肾病患者的认知下降）是一项前瞻性队列研究，纳入了 157 名年龄在 65 岁及以上、在开始 RRT 前 eGFR≤20ml/min/1.73m 的 ESKD 患者。除了与 ESKD 相关的常规临床参数（如血管疾病负担和代谢紊乱参数）外，患者还接受了全面的老年评估，包括广泛的神经心理测试。在一组患者（n=93）中进行了脑部 MRI。
中位年龄为 75.3 岁。与神经心理测试的正常数据相比，参与者的记忆表现处于第 24 百分位，执行功能处于第 18 百分位，精神运动速度处于第 20 百分位。记忆、执行和精神运动速度受损的独立相关特征为高龄、低教育程度和低功能状态（所有 p 值均<0.003）。血管疾病史（p=0.007）和脑部 MRI 上更多的脑白质高信号（p=0.013）与精神运动速度降低相关。
接近 ESKD 的老年患者记忆、执行功能和精神运动速度受损的患病率较高。认知障碍模式和 MRI 上的脑改变提示血管性认知障碍。这些发现可能对 ESKD 患者的决策过程具有潜在的附加价值。
