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United States Department of Agriculture

Agricultural Research Service

Research Project: NUTRITIONAL MODULATION OF GAIT AND COGNITION IN AGING Title: Cognitive dysfunction and depression in adult kidney transplant recipients: baseline findings from the FAVORIT Ancillary Cognitive Trial (FACT)

Authors
item Troen, Aron -
item Scott, Tammy -
item D'Anci, Kristen E. -
item Moorthy, Denish -
item Dobson, Beverly -
item Rogers, Gail -
item Weiner, Daniel E. -
item Levey, Andrew S. -
item Dallal, Gerard E. -
item Jacques, Paul F. -
item Selhub, Jacob -
item Rosenberg, Irwin -

Submitted to: Journal of Renal Nutrition
Publication Type: Peer Reviewed Journal
Publication Acceptance Date: December 6, 2011
Publication Date: March 1, 2012
Citation: Troen, A., Scott, T., D'Anci, K., Moorthyk, D., Dobson, B., Rogers, G., Weiner, D., Levey, A., Dallal, G., Jacques, P., Selhub, J., Rosenberg, I. 2012. Cognitive dysfunction and depression in adult kidney transplant recipients: baseline findings from the FAVORIT Ancillary Cognitive Trial (FACT). Journal of Renal Nutrition. 22(2):268-276.e1-3.

Interpretive Summary: Hyperhomocysteinemia (high blood homocysteine), cognitive impairment and depression all are common in individuals with kidney disease, including kidney transplant recipients. Accordingly, we assessed the prevalence of cognitive impairment and depressive symptoms in transplant recipients and their association with kidney function, plasma total homocysteine (tHcy) and B-vitamin concentrations. Baseline data from the FAVORIT Ancillary Cognitive Trial included 183 participants in FAVORIT who underwent detailed neuropsychological assessment prior to the study intervention. The mean and standard deviation (SD) of age was 54.0 +/- 9.5 yrs (range 7-386 months). Men comprised 55.2% of the cohort and the mean time between the current transplant and cognitive testing was 7.0 +/- 5.8 yrs. Twenty four percent of participants reported neurological or psychiatric complaints and 30% exhibited symptoms of mild to severe depression. Testing revealed evidence of significant and selective deficits in this population: 33% performed more than 1 SD below normed means on a memory test, 58% fell lower than 1 SD below the norms on a test of attention and mental processing speed, and 33-42% fell lower than 1 SD below the norms on several tests of executive function. Lower kidney function and lower folate were associated with poorer performance on tests of memory and executive function. Correction of folate status could benefit cognitive function in these patients.

Technical Abstract: Hyperhomocysteinemia and B-vitamin deficiency may be treatable risk factors for cognitive impairment and decline. Hyperhomocysteinemia, cognitive impairment and depression all are common in individuals with kidney disease, including kidney transplant recipient. Accordingly, we assessed the prevalence of cognitive impairment and depressive symptoms in transplant recipients and their association with kidney function, plasma total homocysteine (tHcy) and B-vitamin concentrations. Cross sectional analysis of baseline data from the FAVORIT Ancillary Cognitive Trial, which included 183 participants in FAVORIT who underwent detailed neuropsychological assessment prior to the study intervention. The mean age was 54.0 +/- 9.5 yrs (range 7-386 months). Men comprised 55.2% of the cohort and the mean time between the current transplant and cognitive testing was 7.0 +/- 5.8 yrs. 24% of participants reported neurological or psychiatric complaints and 30% exhibited symptoms of mild to severe depression. Testing revealed evidence of significant and selective deficits in this population: 33% performed more than 1 SD below normed means on a memory test, 58% fell lower than 1 SD below the norms on a test of attention and mental processing speed, and 33-42% fell lower than 1 SD below the norms on several tests of executive function. Lower estimated glomerular filtration rate and lower folate were associated with poorer performance on tests of memory and executive function. These observations confirm previous reports of mood and cognitive impairments in adult kidney transplant recipients. Further research is needed to determine the benefit of B-vitamin supplementation and other interventions in this patient population.

Last Modified: 11/23/2014
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