老年血液透析患者脑血流变化与认知功能减退之间的关联
Association between cerebral blood flow variation and cognitive decline in older patients undergoing hemodialysis.
作者信息
Guo Yidan, Cui Wei, Ye Pengpeng, Luo Yang
机构信息
Department of Nephrology, Beijing Shijitan Hospital, Capital Medical University, Beijing, China.
Department of Neurology, Beijing Shijitan Hospital, Capital Medical University, Beijing, China.
出版信息
Front Aging Neurosci. 2024 Sep 17;16:1457675. doi: 10.3389/fnagi.2024.1457675. eCollection 2024.
BACKGROUND
The mechanism of cognitive impairment in hemodialysis patients is multifactorial. The relationship between cerebral blood flow and the decline of cognitive function is poorly understood.
OBJECTIVE
To investigate the association between cerebral blood flow variation and decline of cognitive function in older patients undergoing hemodialysis.
METHODS
In this prospective observational cohort study of 121 older patients undergoing hemodialysis, we used transcranial Doppler ultrasound (TCD) to measure cerebral arterial mean flow velocity (MFV) throughout dialysis, assessed cognitive function at baseline and 12-month follow-up, and then analyzed associations between MFV and changes on cognitive scores.
RESULTS
TCD recordings demonstrated a significant reduction in MFV throughout dialysis, which were significantly correlated with cumulative ultrafiltration volume (rho 0.356, < 0.001), ΔSBP (rho 0.251, = 0.005), and ΔMAP (rho 0.194, = 0.032). Compared with the baseline assessments, cognitive scores of participants at the 12-month follow-up were significantly worsened in global cognition (MOCA), some tests of memory (CFT-memory), executive function (TMT-B, SCWT-C, and SCWT-T), attention/processing speed (SDMT), and visuospatial function (CFT-copy) ( < 0.05). The worsening scores in global cognition (MOCA) ( = 0.066, 95% CI 0.018-0.113, = 0.007) and some tests of memory (AVLT5) ( = 0.050, 95% CI 0.004-0.097, = 0.035) and executive function (TMT-B, SCWT-C, SCWT-T) ( = 1.955, 95% CI 0.457-3.453, = 0.011; = 0.298, 95% CI 0.112-0.484, = 0.002 and = 1.371, 95% CI 0.429-2.303, = 0.004, respectively) were significantly associated with the reduction of MFV.
CONCLUSION
Hemodialysis may significantly reduce cerebral blood flow in older patients; Repetitive intradialytic decreases in CBF may be one of the mechanisms underlying the decline of cognitive function.
CLINICAL TRIAL REGISTRATION
背景
血液透析患者认知功能障碍的机制是多因素的。脑血流量与认知功能下降之间的关系尚不清楚。
目的
探讨老年血液透析患者脑血流量变化与认知功能下降之间的关联。
方法
在这项对121例老年血液透析患者进行的前瞻性观察队列研究中，我们使用经颅多普勒超声（TCD）在整个透析过程中测量脑动脉平均血流速度（MFV），在基线和12个月随访时评估认知功能，然后分析MFV与认知评分变化之间的关联。
结果
TCD记录显示整个透析过程中MFV显著降低，这与累积超滤量（rho 0.356，P＜0.001）、收缩压变化量（rho 0.251，P = 0.005）和平均动脉压变化量（rho 0.194，P = 0.032）显著相关。与基线评估相比，参与者在12个月随访时的认知评分在整体认知（蒙特利尔认知评估量表）、一些记忆测试（连续视觉记忆测试-记忆）、执行功能（连线测验B、符号数字模式测验-完成、符号数字模式测验-总分）、注意力/处理速度（数字符号替换测验）和视觉空间功能（连续视觉记忆测试-复制）方面显著恶化（P＜0.05）。整体认知（蒙特利尔认知评估量表）（P = 0.066，95%可信区间0.018 - 0.113，P = 0.007）、一些记忆测试（听觉词语学习测验第5次试验）（P = 0.050，95%可信区间0.004 - 0.097，P = 0.035）和执行功能（连线测验B、符号数字模式测验-完成、符号数字模式测验-总分）（分别为P = 1.955，95%可信区间0.457 - 3.453，P = 0.011；P = 0.298，95%可信区间0.112 - 0.484，P = 0.002和P = 1.371，95%可信区间0.429 - 2.303，P = 0.004）的恶化评分与MFV降低显著相关。
结论
血液透析可能显著降低老年患者的脑血流量；透析过程中脑血流量的反复减少可能是认知功能下降的潜在机制之一。
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