The effect of cognitive reserve on the risk of cognitive frailty in older patients receiving maintenance hemodialysis: a cross-sectional study.

BACKGROUND

Older patients undergoing hemodialysis may exhibit signs of cognitive frailty due to physiological degradation and the accumulation of toxins. This study aimed to explore the factors associated with both cognitive reserves and cognitive frailty in older patients receiving maintenance hemodialysis.

METHODS

Between February to December of 2023, older patients undergoing hemodialysis were selected from blood purification centers in Jiangsu Province, China, via convenience sampling. General data, dialysis data, biochemical indexes, GDS-5 scores, and cognitive reserve scores were collected. The patients were divided into two groups, namely, cognitively frail (74 patients) and non-cognitively frail (163 patients). Factors associated with cognitive frailty were analyzed via logistic regression, and ROC curve analysis was performed to evaluate the discriminative ability of cognitive reserve scores to identify cognitive frailty.

RESULTS

A total of 237 older patients receiving maintenance hemodialysis were included (61% male patients with a mean age of 70.8 ± 8.2 years), 31.2% of whom exhibited symptoms of cognitive frailty. Logistic regression showed that advanced age, longer dialysis durations, higher GDS-5 scores, lower cognitive reserve scores, and a history of inpatient admission within six months were independently associated with cognitive frailty. Each of these factors had a P value of < 0.05. The ROC curve analysis demonstrated that cognitive reserve scores had a strong discriminative ability to identify cognitive frailty, with an optimal cutoff value of 75.5 points, an AUC of 0.94, a sensitivity of 89.6%, and a specificity of 90.5%.

CONCLUSION

Cognitive frailty is prevalent in older patients undergoing maintenance hemodialysis and is associated with multiple factors. Lower cognitive reserve scores were independently associated with cognitive frailty and demonstrated ideal discriminative ability to identify affected individuals. Nevertheless, longitudinal studies can be carried out to investigate the relevant underlying causal relationships.