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January 9, 2013

Frequency of and risk factors for poor cognitive performance in hemodialysis patients

Mark J. Sarnak, MD, MS, Hocine Tighiouart, MS, Tammy M. Scott, PhD, Kristina V. Lou, MS, MPH, Eric P. Sorensen, Lena M. Giang, David A. Drew, MD, Kamran Shaffi, MD, James A. Strom, MD, Ajay K. Singh, MD, and Daniel E. Weiner, MD, MSAuthors Info & Affiliations
January 29, 2013 issue
80 (5) 471-480
https://doi.org/10.1212/WNL.0b013e31827f0f7f
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Abstract

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.

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Supplementary Material

File (tables_e-1_-_e-3.pdf)

STUDY FUNDING

The study was funded by the NIDDK through grants R21 DK068310 (M.J.S.), R01 DK078204 (M.J.S.), and K23 DK71636 (D.E.W.).

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Information & Authors

Information

Published In

Neurology®
Volume 80 • Number 5 • January 29, 2013
Pages: 471-480
PubMed: 23303848

Copyright

© 2013 American Academy of Neurology.

Publication History

Received: May 29, 2012
Accepted: September 17, 2012
Published online: January 9, 2013
Published in print: January 29, 2013

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Disclosure

The authors report no disclosures relevant to the manuscript. Go to Neurology.org for full disclosures.

Authors

Affiliations & Disclosures

Mark J. Sarnak, MD, MS
From the Division of Nephrology (M.J.S., K.V.L., E.P.S., L.M.G., D.A.D., K.S., D.E.W.), Department of Medicine, Department of Psychiatry (T.M.S.), and Biostatistics Research Center (H.T.), Tufts Medical Center, Boston; Division of Nephrology (J.A.S.), St. Elizabeth's Medical Center, Brighton; and Division of Nephrology (A.K.S.), Brigham and Women's Hospital, Boston, MA.
Disclosure
Scientific Advisory Boards:
1.
NONE
Gifts:
1.
NONE
Funding for Travel or Speaker Honoraria:
1.
NONE
Editorial Boards:
1.
Editorial Board Annals of Internal Medicine 2010-2013
Patents:
1.
NONE
Publishing Royalties:
1.
NONE
Employment, Commercial Entity:
1.
NONE
Consultancies:
1.
NONE
Speakers' Bureaus:
1.
NONE
Other Activities:
1.
Data Safety monitoring board of trial of vitamin D in kidney disease
Clinical Procedures or Imaging Studies:
1.
NONE
Research Support, Commercial Entities:
1.
NONE
Research Support, Government Entities:
1.
NIH. K24, and 2 RO1 grant applications. Listed in Manuscript
Research Support, Academic Entities:
1.
NONE
Research Support, Foundations and Societies:
1.
NONE
Stock/stock Options/board of Directors Compensation:
1.
NONE
License Fee Payments, Technology or Inventions:
1.
NONE
Royalty Payments, Technology or Inventions:
1.
NONE
Stock/stock Options, Research Sponsor:
1.
NONE
Stock/stock Options, Medical Equipment & Materials:
1.
NONE
Legal Proceedings:
1.
NONE
View all articles by this author
Hocine Tighiouart, MS
From the Division of Nephrology (M.J.S., K.V.L., E.P.S., L.M.G., D.A.D., K.S., D.E.W.), Department of Medicine, Department of Psychiatry (T.M.S.), and Biostatistics Research Center (H.T.), Tufts Medical Center, Boston; Division of Nephrology (J.A.S.), St. Elizabeth's Medical Center, Brighton; and Division of Nephrology (A.K.S.), Brigham and Women's Hospital, Boston, MA.
Disclosure
Scientific Advisory Boards:
1.
NONE
Gifts:
1.
NONE
Funding for Travel or Speaker Honoraria:
1.
NONE
Editorial Boards:
1.
American Journal of Kidney Diseases, Statistical Editor, 5 years
Patents:
1.
NONE
Publishing Royalties:
1.
NONE
Employment, Commercial Entity:
1.
NONE
Consultancies:
1.
NONE
Speakers' Bureaus:
1.
NONE
Other Activities:
1.
NONE
Clinical Procedures or Imaging Studies:
1.
NONE
Research Support, Commercial Entities:
1.
NONE
Research Support, Government Entities:
1.
NONE
Research Support, Academic Entities:
1.
NONE
Research Support, Foundations and Societies:
1.
NONE
Stock/stock Options/board of Directors Compensation:
1.
NONE
License Fee Payments, Technology or Inventions:
1.
NONE
Royalty Payments, Technology or Inventions:
1.
NONE
Stock/stock Options, Research Sponsor:
1.
NONE
Stock/stock Options, Medical Equipment & Materials:
1.
NONE
Legal Proceedings:
1.
NONE
View all articles by this author
Tammy M. Scott, PhD
From the Division of Nephrology (M.J.S., K.V.L., E.P.S., L.M.G., D.A.D., K.S., D.E.W.), Department of Medicine, Department of Psychiatry (T.M.S.), and Biostatistics Research Center (H.T.), Tufts Medical Center, Boston; Division of Nephrology (J.A.S.), St. Elizabeth's Medical Center, Brighton; and Division of Nephrology (A.K.S.), Brigham and Women's Hospital, Boston, MA.
Disclosure
Scientific Advisory Boards:
1.
NONE
Gifts:
1.
NONE
Funding for Travel or Speaker Honoraria:
1.
NONE
Editorial Boards:
1.
NONE
Patents:
1.
NONE
Publishing Royalties:
1.
NONE
Employment, Commercial Entity:
1.
NONE
Consultancies:
1.
NONE
Speakers' Bureaus:
1.
NONE
Other Activities:
1.
NONE
Clinical Procedures or Imaging Studies:
1.
NONE
Research Support, Commercial Entities:
1.
NONE
Research Support, Government Entities:
1.
NIH/NCRR, UL1 RR025752, Role: Research methodologist, Research Design and Conduct center NIH, 1 R01 DK065114-01, Role: Co-Investigator NIH, NGA-5U01-AG020480-06, Role: Co-Investigator NIH, 1R21DK070249-01, Role: Co-Investigator
Research Support, Academic Entities:
1.
NONE
Research Support, Foundations and Societies:
1.
NONE
Stock/stock Options/board of Directors Compensation:
1.
NONE
License Fee Payments, Technology or Inventions:
1.
NONE
Royalty Payments, Technology or Inventions:
1.
NONE
Stock/stock Options, Research Sponsor:
1.
NONE
Stock/stock Options, Medical Equipment & Materials:
1.
NONE
Legal Proceedings:
1.
NONE
View all articles by this author
Kristina V. Lou, MS, MPH
From the Division of Nephrology (M.J.S., K.V.L., E.P.S., L.M.G., D.A.D., K.S., D.E.W.), Department of Medicine, Department of Psychiatry (T.M.S.), and Biostatistics Research Center (H.T.), Tufts Medical Center, Boston; Division of Nephrology (J.A.S.), St. Elizabeth's Medical Center, Brighton; and Division of Nephrology (A.K.S.), Brigham and Women's Hospital, Boston, MA.
Disclosure
Scientific Advisory Boards:
1.
NONE
Gifts:
1.
NONE
Funding for Travel or Speaker Honoraria:
1.
NONE
Editorial Boards:
1.
NONE
Patents:
1.
NONE
Publishing Royalties:
1.
NONE
Employment, Commercial Entity:
1.
NONE
Consultancies:
1.
NONE
Speakers' Bureaus:
1.
NONE
Other Activities:
1.
NONE
Clinical Procedures or Imaging Studies:
1.
NONE
Research Support, Commercial Entities:
1.
NONE
Research Support, Government Entities:
1.
NONE
Research Support, Academic Entities:
1.
NONE
Research Support, Foundations and Societies:
1.
NONE
Stock/stock Options/board of Directors Compensation:
1.
NONE
License Fee Payments, Technology or Inventions:
1.
NONE
Royalty Payments, Technology or Inventions:
1.
NONE
Stock/stock Options, Research Sponsor:
1.
NONE
Stock/stock Options, Medical Equipment & Materials:
1.
NONE
Legal Proceedings:
1.
NONE
View all articles by this author
Eric P. Sorensen
From the Division of Nephrology (M.J.S., K.V.L., E.P.S., L.M.G., D.A.D., K.S., D.E.W.), Department of Medicine, Department of Psychiatry (T.M.S.), and Biostatistics Research Center (H.T.), Tufts Medical Center, Boston; Division of Nephrology (J.A.S.), St. Elizabeth's Medical Center, Brighton; and Division of Nephrology (A.K.S.), Brigham and Women's Hospital, Boston, MA.
Disclosure
Scientific Advisory Boards:
1.
NONE
Gifts:
1.
NONE
Funding for Travel or Speaker Honoraria:
1.
NONE
Editorial Boards:
1.
NONE
Patents:
1.
NONE
Publishing Royalties:
1.
NONE
Employment, Commercial Entity:
1.
NONE
Consultancies:
1.
NONE
Speakers' Bureaus:
1.
NONE
Other Activities:
1.
NONE
Clinical Procedures or Imaging Studies:
1.
NONE
Research Support, Commercial Entities:
1.
NONE
Research Support, Government Entities:
1.
NONE
Research Support, Academic Entities:
1.
NONE
Research Support, Foundations and Societies:
1.
NONE
Stock/stock Options/board of Directors Compensation:
1.
NONE
License Fee Payments, Technology or Inventions:
1.
NONE
Royalty Payments, Technology or Inventions:
1.
NONE
Stock/stock Options, Research Sponsor:
1.
NONE
Stock/stock Options, Medical Equipment & Materials:
1.
NONE
Legal Proceedings:
1.
NONE
View all articles by this author
Lena M. Giang
From the Division of Nephrology (M.J.S., K.V.L., E.P.S., L.M.G., D.A.D., K.S., D.E.W.), Department of Medicine, Department of Psychiatry (T.M.S.), and Biostatistics Research Center (H.T.), Tufts Medical Center, Boston; Division of Nephrology (J.A.S.), St. Elizabeth's Medical Center, Brighton; and Division of Nephrology (A.K.S.), Brigham and Women's Hospital, Boston, MA.
Disclosure
Scientific Advisory Boards:
1.
NONE
Gifts:
1.
NONE
Funding for Travel or Speaker Honoraria:
1.
NONE
Editorial Boards:
1.
NONE
Patents:
1.
NONE
Publishing Royalties:
1.
NONE
Employment, Commercial Entity:
1.
NONE
Consultancies:
1.
NONE
Speakers' Bureaus:
1.
NONE
Other Activities:
1.
NONE
Clinical Procedures or Imaging Studies:
1.
NONE
Research Support, Commercial Entities:
1.
NONE
Research Support, Government Entities:
1.
NONE
Research Support, Academic Entities:
1.
NONE
Research Support, Foundations and Societies:
1.
NONE
Stock/stock Options/board of Directors Compensation:
1.
NONE
License Fee Payments, Technology or Inventions:
1.
NONE
Royalty Payments, Technology or Inventions:
1.
NONE
Stock/stock Options, Research Sponsor:
1.
NONE
Stock/stock Options, Medical Equipment & Materials:
1.
NONE
Legal Proceedings:
1.
NONE
View all articles by this author
David A. Drew, MD
From the Division of Nephrology (M.J.S., K.V.L., E.P.S., L.M.G., D.A.D., K.S., D.E.W.), Department of Medicine, Department of Psychiatry (T.M.S.), and Biostatistics Research Center (H.T.), Tufts Medical Center, Boston; Division of Nephrology (J.A.S.), St. Elizabeth's Medical Center, Brighton; and Division of Nephrology (A.K.S.), Brigham and Women's Hospital, Boston, MA.
Disclosure
Scientific Advisory Boards:
1.
NONE
Gifts:
1.
NONE
Funding for Travel or Speaker Honoraria:
1.
NONE
Editorial Boards:
1.
NONE
Patents:
1.
NONE
Publishing Royalties:
1.
NONE
Employment, Commercial Entity:
1.
NONE
Consultancies:
1.
NONE
Speakers' Bureaus:
1.
NONE
Other Activities:
1.
NONE
Clinical Procedures or Imaging Studies:
1.
NONE
Research Support, Commercial Entities:
1.
NONE
Research Support, Government Entities:
1.
NONE
Research Support, Academic Entities:
1.
NONE
Research Support, Foundations and Societies:
1.
American Society of Nephrology
Stock/stock Options/board of Directors Compensation:
1.
NONE
License Fee Payments, Technology or Inventions:
1.
NONE
Royalty Payments, Technology or Inventions:
1.
NONE
Stock/stock Options, Research Sponsor:
1.
NONE
Stock/stock Options, Medical Equipment & Materials:
1.
NONE
Legal Proceedings:
1.
NONE
View all articles by this author
Kamran Shaffi, MD
From the Division of Nephrology (M.J.S., K.V.L., E.P.S., L.M.G., D.A.D., K.S., D.E.W.), Department of Medicine, Department of Psychiatry (T.M.S.), and Biostatistics Research Center (H.T.), Tufts Medical Center, Boston; Division of Nephrology (J.A.S.), St. Elizabeth's Medical Center, Brighton; and Division of Nephrology (A.K.S.), Brigham and Women's Hospital, Boston, MA.
Disclosure
Scientific Advisory Boards:
1.
NONE
Gifts:
1.
NONE
Funding for Travel or Speaker Honoraria:
1.
NONE
Editorial Boards:
1.
NONE
Patents:
1.
NONE
Publishing Royalties:
1.
NONE
Employment, Commercial Entity:
1.
NONE
Consultancies:
1.
NONE
Speakers' Bureaus:
1.
NONE
Other Activities:
1.
NONE
Clinical Procedures or Imaging Studies:
1.
NONE
Research Support, Commercial Entities:
1.
NONE
Research Support, Government Entities:
1.
NONE
Research Support, Academic Entities:
1.
NONE
Research Support, Foundations and Societies:
1.
NONE
Stock/stock Options/board of Directors Compensation:
1.
NONE
License Fee Payments, Technology or Inventions:
1.
NONE
Royalty Payments, Technology or Inventions:
1.
NONE
Stock/stock Options, Research Sponsor:
1.
NONE
Stock/stock Options, Medical Equipment & Materials:
1.
NONE
Legal Proceedings:
1.
NONE
View all articles by this author
James A. Strom, MD
From the Division of Nephrology (M.J.S., K.V.L., E.P.S., L.M.G., D.A.D., K.S., D.E.W.), Department of Medicine, Department of Psychiatry (T.M.S.), and Biostatistics Research Center (H.T.), Tufts Medical Center, Boston; Division of Nephrology (J.A.S.), St. Elizabeth's Medical Center, Brighton; and Division of Nephrology (A.K.S.), Brigham and Women's Hospital, Boston, MA.
Disclosure
Scientific Advisory Boards:
1.
NONE
Gifts:
1.
NONE
Funding for Travel or Speaker Honoraria:
1.
NONE
Editorial Boards:
1.
NONE
Patents:
1.
NONE
Publishing Royalties:
1.
NONE
Employment, Commercial Entity:
1.
NONE
Consultancies:
1.
NONE
Speakers' Bureaus:
1.
NONE
Other Activities:
1.
NONE
Clinical Procedures or Imaging Studies:
1.
NONE
Research Support, Commercial Entities:
1.
NONE
Research Support, Government Entities:
1.
NONE
Research Support, Academic Entities:
1.
NONE
Research Support, Foundations and Societies:
1.
NONE
Stock/stock Options/board of Directors Compensation:
1.
NONE
License Fee Payments, Technology or Inventions:
1.
NONE
Royalty Payments, Technology or Inventions:
1.
NONE
Stock/stock Options, Research Sponsor:
1.
NONE
Stock/stock Options, Medical Equipment & Materials:
1.
NONE
Legal Proceedings:
1.
NONE
View all articles by this author
Ajay K. Singh, MD
From the Division of Nephrology (M.J.S., K.V.L., E.P.S., L.M.G., D.A.D., K.S., D.E.W.), Department of Medicine, Department of Psychiatry (T.M.S.), and Biostatistics Research Center (H.T.), Tufts Medical Center, Boston; Division of Nephrology (J.A.S.), St. Elizabeth's Medical Center, Brighton; and Division of Nephrology (A.K.S.), Brigham and Women's Hospital, Boston, MA.
Disclosure
Scientific Advisory Boards:
1.
US Department of the Army, Member of DSMB
Gifts:
1.
NONE
Funding for Travel or Speaker Honoraria:
1.
NONE
Editorial Boards:
1.
Editor, Biosimilars
Patents:
1.
NONE
Publishing Royalties:
1.
Springer, Core Concepts Renal Transplantation 2011
Employment, Commercial Entity:
1.
NONE
Consultancies:
1.
Sandoz, Member of Steering Committee Rockwell, PI of study
Speakers' Bureaus:
1.
NONE
Other Activities:
1.
NONE
Clinical Procedures or Imaging Studies:
1.
NONE
Research Support, Commercial Entities:
1.
Janssen Cilag, GRID Study
Research Support, Government Entities:
1.
NONE
Research Support, Academic Entities:
1.
NONE
Research Support, Foundations and Societies:
1.
NONE
Stock/stock Options/board of Directors Compensation:
1.
NONE
License Fee Payments, Technology or Inventions:
1.
NONE
Royalty Payments, Technology or Inventions:
1.
NONE
Stock/stock Options, Research Sponsor:
1.
NONE
Stock/stock Options, Medical Equipment & Materials:
1.
NONE
Legal Proceedings:
1.
Expert witness, 2011, US Attorney's Office, acting for the defense
View all articles by this author
Daniel E. Weiner, MD, MS
From the Division of Nephrology (M.J.S., K.V.L., E.P.S., L.M.G., D.A.D., K.S., D.E.W.), Department of Medicine, Department of Psychiatry (T.M.S.), and Biostatistics Research Center (H.T.), Tufts Medical Center, Boston; Division of Nephrology (J.A.S.), St. Elizabeth's Medical Center, Brighton; and Division of Nephrology (A.K.S.), Brigham and Women's Hospital, Boston, MA.
Disclosure
Scientific Advisory Boards:
1.
Served on a scientific advisory board in March 2011 for Takeda Biopharmaceuticals.
Gifts:
1.
NONE
Funding for Travel or Speaker Honoraria:
1.
NONE
Editorial Boards:
1.
Deputy Editor, American Journal of Kidney Diseases
Patents:
1.
NONE
Publishing Royalties:
1.
Editor of the Primer on Kidney Diseases, 6th Edition. Potential to receive royalties.
Employment, Commercial Entity:
1.
NONE
Consultancies:
1.
NONE
Speakers' Bureaus:
1.
NONE
Other Activities:
1.
NONE
Clinical Procedures or Imaging Studies:
1.
NONE
Research Support, Commercial Entities:
1.
Research funding, Keryx (Site PI) Research funding, Dialysis Clinic, Inc. (Investigator Initiated) Research funding, Covidien (Co-Investigator, Boston Site)
Research Support, Government Entities:
1.
NIDDK R01 DK090401(Co-PI), 09/20/2011-08/31/2015; Exercise Training and Cognitive and Physical Function in CKD NIH 268200900047C-0-0-1 (Role: Site PI); 11/01/2009-10/30/2018; The Systolic Blood Pressure Intervention Trial (SPRINT) NIK/NHLBI R01 HL107241 (Role: Site PI) 09/01/2011-06/30/2012; Pulse Wave Velocity and Central Aortic Pressure Outcomes in SPRINT NIH/NIDDK K23 DK071636 Role: PI; 09/30/2005-06/30/2011; Kidney Disease, Stroke and Cognitive Impairment
Research Support, Academic Entities:
1.
NONE
Research Support, Foundations and Societies:
1.
Carl W Gottschalk Research Scholar Grant; (PI: Weiner); 10/01/2010-09/30/2012; American Society of Nephrology; Medical, Economic and Ecologic Effects of Dialyzer Reprocessing Paul Teschan Research & Development Fund (Role: PI); 12/01/2009-11/30/2011; Administered by Dialysis Clinic, Inc; Transglutaminase 2 and Vascular Calcification in Chronic Kidney Disease: A Pilot Study
Stock/stock Options/board of Directors Compensation:
1.
NONE
License Fee Payments, Technology or Inventions:
1.
NONE
Royalty Payments, Technology or Inventions:
1.
NONE
Stock/stock Options, Research Sponsor:
1.
NONE
Stock/stock Options, Medical Equipment & Materials:
1.
NONE
Legal Proceedings:
1.
NONE
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Notes

Correspondence to Dr. Sarnak: [email protected]
Go to Neurology.org for full disclosures. Funding information and disclosures deemed relevant by the authors, if any, are provided at the end of the article.
The results presented in this article have not been published previously in whole or part, except in abstract format. An abstract based on the content of this manuscript was accepted as a poster at the American Society of Nephrology Annual Meeting in Philadelphia in 2011.

Author Contributions

Mark Sarnak: drafting/revising the manuscript, study concept or design, analysis or interpretation of data, acquisition of data, study supervision, obtaining funding. Hocine Tighiouart: drafting/revising the manuscript, analysis or interpretation of data, statistical analysis. Tammy Scott: drafting/revising the manuscript, study concept or design, analysis or interpretation of data. Kristina Lou, Eric Sorensen, and Lena Giang: drafting/revising the manuscript, acquisition of data, study supervision. David Drew: drafting/revising the manuscript. Kamran Shaffi: drafting/revising the manuscript, study supervision. James Strom: drafting/revising the manuscript, analysis or interpretation of data, study supervision. Ajay Singh: drafting/revising the manuscript, contribution of vital reagents/tools/patients, study supervision. Daniel Weiner: drafting/revising the manuscript, study concept or design, analysis or interpretation of data, acquisition of data, statistical analysis, study supervision.

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