Cognitive Impairment in End Stage Renal Disease

项目摘要 认知障碍影响大多数老年终末期肾病（ESRD）患者， 影响他们的生活质量、医疗保健成本和健康结果。我们的长期目标是制定战略 预防和治疗终末期肾病患者的认知障碍。我们的初步数据显示， 肾移植后，认知领域得到改善，大脑结构也相应改变。 这些数据表明，认知障碍和结构性脑变化的潜在可逆性， ESRD。在本提案中，我们将对肾移植前后的ESRD患者进行纵向研究。 移植通过比较ESRD患者和对照组的基线认知和脑MRI结果， 我们将更明确地定义ESRD中受影响的认知领域， 与ESRD相关的损伤对应于大脑的结构变化。通过比较认知 肾移植前后的功能和大脑变化，我们将确定可逆性的程度 在认知和伴随的大脑结构变化，可能在功能上调节 认知能力的提高。这项拟议中的研究将查明认知功能的可逆性领域， 脑结构的变化，并确定未来治疗的目标。这项研究的数据还将确定 终末期肾病患者移植前后的认知缺陷。这一信息将对以下方面产生影响： 终末期肾病患者的临床管理和患者教育方法。 该指导性患者导向职业发展奖（K23）将为PI提供 认知功能评估、脑成像和临床研究方面的必要培训和专业知识， 教学和实践课程，指导和应用经验。PI是一名移植肾病学家， 与杰弗里·伯恩斯医学博士合作，堪萨斯大学阿尔茨海默病中心的联合主任; 威廉布鲁克斯，博士，霍格伦德脑成像中心主任，大卫约翰逊，博士，主任 堪萨斯大学阿尔茨海默病中心的神经心理学和医学博士马克·萨纳克，一个 他是马萨诸塞州波士顿塔夫茨医学中心ESRD认知障碍领域的著名研究者。这种独特 专业知识的结合使我们的团队成为这项研究的理想选择。

PROJECT SUMMARY Cognitive impairment affects the majority of older adults with end stage renal disease (ESRD) and negatively impacts their quality of life, health care costs, and health outcomes. Our long-term goal is to develop strategies to prevent and treat cognitive impairment in patients with ESRD. Our preliminary data indicate that specific domains of cognition improve with kidney transplantation, with corresponding changes in brain structure. These data indicate potential reversibility in both cognitive impairment and structural brain changes associated with ESRD. In this proposal, we will longitudinally study patients with ESRD before and after kidney transplantation. By comparing baseline cognition and brain MRI findings between ESRD patients and controls, we will more firmly define the domains of cognition that are affected in ESRD, and whether cognitive impairment associated with ESRD corresponds to structural changes in the brain. By comparing cognitive function and brain changes before and after kidney transplantation, we will determine the extent of reversibility in cognition and in accompanying structural changes in the brain that may functionally regulate the improvements in cognition. The proposed research will pinpoint areas of reversibility in cognitive function and brain structural changes in ESRD and identify targets for future therapies. Data from this study will also identify cognitive deficits in both pre- and post- transplant patients with ESRD. This information will have implications in the clinical management of patients with ESRD and the methods used for patient education. This Mentored Patient-Oriented Career Development Award (K23) will provide the PI with the necessary training and expertise in cognitive function assessment, brain imaging, and clinical research through didactic and hands on courses, mentoring, and applied experiences. The PI is a transplant nephrologist who has collaborated with Jeffrey Burns, M.D., the Co-Director of University of Kansas Alzheimer's Disease Center; William Brooks, Ph.D, the Director of the Hoglund Brain Imaging Center, David Johnson, Ph.D, the Director of Neuropsychology at the University of Kansas Alzheimer's Disease Center and Mark Sarnak, M.D., an acclaimed investigator in cognitive impairment in ESRD at the Tufts Medical Center, Boston, MA. This unique combination of expertise makes our group ideal for this study.