|WINER, DANIEL - Tufts - New England Medical Center|
|SCOTT, TAMMY - Jean Mayer Human Nutrition Research Center On Aging At Tufts University|
|GIANG, LENA - Tufts - New England Medical Center|
|AGGANIS, BRIAN - Tufts - New England Medical Center|
|SORENSEN, ERIC - Tufts - New England Medical Center|
|TIGHIOUART, HOCINE - Tufts - New England Medical Center|
|SARNAK, MARK - Tufts - New England Medical Center|
Submitted to: American Journal of Kidney Diseases
Publication Type: Peer Reviewed Journal
Publication Acceptance Date: 11/1/2011
Publication Date: 11/1/2011
Citation: Winer, D.E., Scott, T.M., Giang, L.M., Agganis, B.T., Sorensen, E.P., Tighiouart, H., Sarnak, M. 2011. Cardiovascular disease and cognitive function in maintenance hemodialysis patients. American Journal of Kidney Diseases. 58(5):733-781.
Interpretive Summary: Cognitive impairment is common in dialysis patients, but it is unclear what factors put individuals at higher risk. The objective of this work is to evaluate whether the presence of cardiovascular disease is a risk factor for cognitive dysfunction in these patients. We found that those dialysis patients who also had cardiovascular disease performed worse on cognitive tests than did those dialysis patients without cardiovascular disease. The areas of cognitive function that appeared to be affected were information processing speed and executive function (the ability to plan, multi-task, and organize information). Identifying those dialysis patients who are at high risk of developing cognitive impairment will aid in planning patient care and the need for support systems.
Technical Abstract: Cardiovascular disease (CVD) and cognitive impairment are common in dialysis patients. Given the proposed role of microvascular disease on cognitive function, particularly cognitive domains that incorporate executive functions, we hypothesized that prevalent systemic CVD would be associated with worse cognitive performance in hemodialysis patients. Design was cross-sectional cohort of 200 maintenance hemodialysis patients without prior stroke from 5 Boston-area hemodialysis units. Predictor was CVD, defined as history of coronary disease or peripheral vascular disease. Outcome was performance on a detailed neurocognitive battery. Primary analyses quantified cognitive performance using principal components analysis to reduce cognitive tests to a processing speed/executive function domain and a memory domain. Multivariable linear regression models adjusted for age, sex, education, race, and other clinical and demographic characteristics. Mean (SD) age of participants was 62 (18) years and 75 (38%) had CVD. Individuals with CVD were older and more likely to be men, have diabetes, and be current or former smokers. In adjusted models, individuals with CVD performed 0.50 standard deviation worse (P < 0.001) on tests assessing processing speed/executive function, whereas there was no difference in performance on tests of memory. Similar results were seen assessing individual tests, with performance on the Block Design, Digit Symbol Coding, and Trail Making Tests A and B significantly associated with CVD in age-, sex-, education-, and race-adjusted analyses and approaching significance in fully adjusted models. Limitations were CVD ascertainment dependent on patient recall and dialysis unit documentation. No brain imaging. The presence of CVD is associated with worse cognitive performance on tests of processing speed and executive functioning in hemodialysis patients and identifies a high-risk population for greater difficulty with complex tasks.