Cardiovascular disease and cognitive function in maintenance hemodialysis patients.
Cardiovascular disease and cognitive function in maintenance hemodialysis patients.
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DOI：
10.1053/j.ajkd.2011.03.034
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发表时间：
2011-11
期刊：
影响因子：
--
通讯作者：
Sarnak MJ
中科院分区：
文献类型：
--
作者：
Weiner DE;Scott TM;Giang LM;Agganis BT;Sorensen EP;Tighiouart H;Sarnak MJ
心血管疾病（CVD）和认知障碍在透析患者中很常见。考虑到微血管疾病对认知功能的作用，特别是包含执行功能的认知领域，我们假设血液透析患者中普遍存在的全身性CVD与认知能力较差相关。来自波士顿地区5个血液透析中心CVD的200例既往无卒中的维持性血液透析患者的横断面队列，根据冠状动脉疾病或外周血管疾病史定义。主要分析量化的认知性能，使用主成分分析，以减少认知测试的处理速度/执行功能域和记忆域。根据年龄、性别、教育、种族和其他临床和人口统计学特征调整的多变量线性回归模型。参与者的平均（SD）年龄为62（18）岁，75（38%）例患有CVD。患有CVD的个体年龄较大，更可能是男性，糖尿病患者以及当前或以前的吸烟者。在调整后的模型中，CVD患者在评估处理速度/执行功能的测试中表现差0.50个标准差（p<0.001），而在记忆测试中表现没有差异。当评估个体测试时，观察到类似的结果，在年龄、性别、教育和种族调整的分析中，区组设计、数字符号编码和连线测试A和B的表现与CVD显著相关，并且在完全调整的模型中接近显著性。CVD确定取决于患者召回和透析单位记录。没有脑成像。CVD的存在与血液透析患者在处理速度和执行功能测试中的认知表现较差相关，并确定了复杂任务难度更大的高风险人群。
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. Cross-sectional cohort 200 maintenance hemodialysis patients without prior stroke from 5 Boston-area hemodialysis units CVD, defined by history of coronary disease or peripheral vascular disease 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, more likely to be men, diabetic, and current or former smokers. In adjusted models, individuals with CVD performed 0.50 standard deviations worse (p<0.001) on tests assessing processing speed/executive function, while there was no difference in performance on tests of memory. Similar results were seen when 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 toward significance in fully adjusted models. 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.
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