Association Between Cerebral Blood Flow Variation and Cognitive Decline in Older Patients Undergoing Hemodialysis

Overview

Journal Front Aging Neurosci

Specialty Geriatrics

Date 2024 Oct 2

PMID 39355539

Authors

Yidan Guo

Wei Cui

Pengpeng Ye

Yang Luo

Affiliations

Soon will be listed here.

Abstract

Background: The mechanism of cognitive impairment in hemodialysis patients is multifactorial. The relationship between cerebral blood flow and the decline of cognitive function is poorly understood.

Objective: To investigate the association between cerebral blood flow variation and decline of cognitive function in older patients undergoing hemodialysis.

Methods: In this prospective observational cohort study of 121 older patients undergoing hemodialysis, we used transcranial Doppler ultrasound (TCD) to measure cerebral arterial mean flow velocity (MFV) throughout dialysis, assessed cognitive function at baseline and 12-month follow-up, and then analyzed associations between MFV and changes on cognitive scores.

Results: TCD recordings demonstrated a significant reduction in MFV throughout dialysis, which were significantly correlated with cumulative ultrafiltration volume (rho 0.356, < 0.001), ΔSBP (rho 0.251, = 0.005), and ΔMAP (rho 0.194, = 0.032). Compared with the baseline assessments, cognitive scores of participants at the 12-month follow-up were significantly worsened in global cognition (MOCA), some tests of memory (CFT-memory), executive function (TMT-B, SCWT-C, and SCWT-T), attention/processing speed (SDMT), and visuospatial function (CFT-copy) ( < 0.05). The worsening scores in global cognition (MOCA) ( = 0.066, 95% CI 0.018-0.113, = 0.007) and some tests of memory (AVLT5) ( = 0.050, 95% CI 0.004-0.097, = 0.035) and executive function (TMT-B, SCWT-C, SCWT-T) ( = 1.955, 95% CI 0.457-3.453, = 0.011; = 0.298, 95% CI 0.112-0.484, = 0.002 and = 1.371, 95% CI 0.429-2.303, = 0.004, respectively) were significantly associated with the reduction of MFV.

Conclusion: Hemodialysis may significantly reduce cerebral blood flow in older patients; Repetitive intradialytic decreases in CBF may be one of the mechanisms underlying the decline of cognitive function.

Clinical Trial Registration: https://register.clinicaltrials.gov/prs/app/action/SelectProtocol?sid=S000C5B5&selectaction=Edit&uid=U0003QEL&ts=4&cx=-djoi2.

References

Ghoshal S, Freedman B . Mechanisms of Stroke in Patients with Chronic Kidney Disease. Am J Nephrol. 2019; 50(4):229-239. DOI: 10.1159/000502446. View

Li G, Tang H, Chen J, Qi X, Chen S, Ma J . Executive and Visuospatial Dysfunction in Patients With Primary Restless Legs Syndrome/Willis-Ekbom Disease: Study of a Chinese Population. J Clin Sleep Med. 2018; 14(5):785-790. PMC: 5940429. DOI: 10.5664/jcsm.7106. View

Ma L, Zhao S . Risk factors for mortality in patients undergoing hemodialysis: A systematic review and meta-analysis. Int J Cardiol. 2017; 238:151-158. DOI: 10.1016/j.ijcard.2017.02.095. View

Angermann S, Schier J, Baumann M, Steubl D, Hauser C, Lorenz G . Cognitive Impairment is Associated with Mortality in Hemodialysis Patients. J Alzheimers Dis. 2018; 66(4):1529-1537. DOI: 10.3233/JAD-180767. View

Moist L, McIntyre C . Cerebral Ischemia and Cognitive Dysfunction in Patients on Dialysis. Clin J Am Soc Nephrol. 2019; 14(6):914-916. PMC: 6556724. DOI: 10.2215/CJN.00400119. View

Shaker A, Mohamed O, Mohamed M, El-Khashaba S . Impact of correction of anemia in end-stage renal disease patients on cerebral circulation and cognitive functions. Saudi J Kidney Dis Transpl. 2018; 29(6):1333-1341. DOI: 10.4103/1319-2442.248306. View

Tian R, Guo Y, Ye P, Zhang C, Luo Y . The validation of the Beijing version of the Montreal Cognitive Assessment in Chinese patients undergoing hemodialysis. PLoS One. 2020; 15(1):e0227073. PMC: 6952078. DOI: 10.1371/journal.pone.0227073. View

Kurella Tamura M, Yaffe K, Hsu C, Yang J, Sozio S, Fischer M . Cognitive Impairment and Progression of CKD. Am J Kidney Dis. 2016; 68(1):77-83. PMC: 4921255. DOI: 10.1053/j.ajkd.2016.01.026. View

Findlay M, Dawson J, Dickie D, Forbes K, McGlynn D, Quinn T . Investigating the Relationship between Cerebral Blood Flow and Cognitive Function in Hemodialysis Patients. J Am Soc Nephrol. 2018; 30(1):147-158. PMC: 6317612. DOI: 10.1681/ASN.2018050462. View

10.

Guo Y, Tian R, Ye P, Li X, Li G, Lu F . Cognitive Domain Impairment and All-Cause Mortality in Older Patients Undergoing Hemodialysis. Front Endocrinol (Lausanne). 2022; 13:828162. PMC: 8995766. DOI: 10.3389/fendo.2022.828162. View

11.

Dai X, Ryan J, Paolo A, Harrington R . Factor analysis of the mainland Chinese version of the Wechsler Adult Intelligence Scale (WAIS-RC) in a brain-damaged sample. Int J Neurosci. 1990; 55(2-4):107-11. DOI: 10.3109/00207459008985956. View

12.

Drew D, Weiner D, Tighiouart H, Scott T, Lou K, Kantor A . Cognitive function and all-cause mortality in maintenance hemodialysis patients. Am J Kidney Dis. 2014; 65(2):303-11. PMC: 4305473. DOI: 10.1053/j.ajkd.2014.07.009. View

13.

Polinder-Bos H, Garcia D, Kuipers J, Elting J, Aries M, Krijnen W . Hemodialysis Induces an Acute Decline in Cerebral Blood Flow in Elderly Patients. J Am Soc Nephrol. 2018; 29(4):1317-1325. PMC: 5875962. DOI: 10.1681/ASN.2017101088. View

14.

Ma J, Zhang Y, Guo Q . Comparison of vascular cognitive impairment--no dementia by multiple classification methods. Int J Neurosci. 2014; 125(11):823-30. DOI: 10.3109/00207454.2014.972504. View

15.

Igari R, Davy P, Sato H, Takahashi Y, Iseki C, Kato H . Cognitive impairment, brain ischemia and shorter telomeres are predictors of mortality in the Japanese elderly: A 13-year prospective community-based study. J Neurol Sci. 2019; 397:129-134. DOI: 10.1016/j.jns.2018.12.038. View

16.

Sachdev P, Kalaria R, OBrien J, Skoog I, Alladi S, Black S . Diagnostic criteria for vascular cognitive disorders: a VASCOG statement. Alzheimer Dis Assoc Disord. 2014; 28(3):206-18. PMC: 4139434. DOI: 10.1097/WAD.0000000000000034. View

17.

Huang C, Hwang A, Liu L, Lee W, Chen L, Peng L . Association of Dynapenia, Sarcopenia, and Cognitive Impairment Among Community-Dwelling Older Taiwanese. Rejuvenation Res. 2015; 19(1):71-8. DOI: 10.1089/rej.2015.1710. View

18.

Romero J, Beiser A, Seshadri S, Benjamin E, Polak J, Vasan R . Carotid artery atherosclerosis, MRI indices of brain ischemia, aging, and cognitive impairment: the Framingham study. Stroke. 2009; 40(5):1590-6. PMC: 2705324. DOI: 10.1161/STROKEAHA.108.535245. View

19.

Drew D, Sarnak M . Ischemic and hemorrhagic stroke: high incidence in hemodialysis and peritoneal dialysis patients. Am J Kidney Dis. 2014; 63(4):547-8. DOI: 10.1053/j.ajkd.2014.01.009. View

20.

Zhou A, Jia J . A screen for cognitive assessments for patients with vascular cognitive impairment no dementia. Int J Geriatr Psychiatry. 2009; 24(12):1352-7. DOI: 10.1002/gps.2265. View