Frequency of and risk factors for poor cognitive performance in hemodialysis patients
Frequency of and risk factors for poor cognitive performance in hemodialysis patients
复制标题
DOI：
10.1212/wnl.0b013e31827f0f7f
复制
发表时间：
2013-01-01
期刊：
影响因子：
9.9
通讯作者：
Weiner, Daniel E.
中科院分区：
文献类型：
--
作者：
Sarnak, Mark J.;Tighiouart, Hocine;Weiner, Daniel E.
目的：有关透析患者认知功能的详细资料较少。我们使用详细的神经认知测试来评估认知能力低下的频率和危险因素。方法：在这项横断面队列研究中，来自波士顿地区6个血液透析单元的314名血液透析患者接受了详细的认知评估。神经心理学组合评估了广泛的功能，并根据年龄、性别和教育程度确定了匹配的标准分数。使用主成分分析得出记忆和执行功能领域的综合得分。根据年龄、性别、种族和教育状况进行线性回归校正，对每个领域的风险因素进行评估。对MMSE评分为24分的患者进行重复分析。结果：与人群常模相比，透析患者的执行功能明显较差，但记忆表现不明显，这一发现在MMSE评分为24分的亚组中持续存在。在校正分析中，血管危险因素和血管疾病与执行功能低下相关(p<；0.01)。结论：血液透析患者认知功能低下的频率较高，主要影响执行功能。执行功能较差的风险因素包括血管风险因素和血管疾病。在MMSE上的正常表现并不排除认知功能受损，因为MMSE分数=24的个体也有很高的认知表现不佳的频率。神经病学(R)2013；80：471-480
Objective: There are few detailed data on cognition in patients undergoing dialysis. We evaluated the frequency of and risk factors for poor cognitive performance using detailed neurocognitive testing.Methods: In this cross-sectional cohort study, 314 hemodialysis patients from 6 Boston-area hemodialysis units underwent detailed cognitive assessment. The neuropsychological battery assessed a broad range of functions, with established age-, sex-, and education-matched normative scores. Principal component analysis was used to derive composite scores for memory and executive function domains. Risk factors for each domain were evaluated using linear regression adjusting for age, sex, race, and education status. Analyses were repeated in those with Mini-Mental State Examination (MMSE) score >= 24.Results: Compared with population norms, patients on dialysis had significantly poorer executive function but not memory performance, a finding that persisted in the subgroup with MMSE score >= 24. In adjusted analyses, vascular risk factors and vascular disease were associated with lower executive function (p < 0.01).Conclusions: There is a high frequency of poor cognitive performance in hemodialysis patients, primarily affecting executive function. Risk factors for worse executive function include vascular risk factors as well as vascular disease. Normal performance on the MMSE does not preclude impaired cognitive function, because individuals with MMSE score >= 24 also have a high frequency of poor cognitive performance. Neurology (R) 2013;80:471-480