Background/Aims: The high risk and prevalence of dementia among patients with chronic kidney disease (CKD) and in those receiving hemodialysis (HD) may be preceded by mild cognitive impairment (MCI). We aimed to assess cognitive function in CKD and HD patients with no history of stroke or dementia, in order to identify and characterize early cognitive deficits. Methods: 24 CKD and 27 HD male outpatients without history of cerebrovascular or neurodegenerative disease underwent comprehensive neuropsychological testing in an observational cross-sectional study. Test results were used to categorize patients into MCI subtypes. Results: All subjects scored ≧28 on the Mini-Mental State Examination. The prevalence of executive function was at least 25% in both groups and memory impairment occurred in 13% of the HD patients and 15% of those with CKD. MCI occurred in 76% of the group and HD patients showed a higher prevalence of MCI compared to CKD patients (89 vs. 63%) with a preponderance (>70%) of cases across both groups classified as non-amnestic MCI. Conclusion: Predialysis CKD and HD patients have a high prevalence of MCI despite normal global cognitive function. MCI was more prevalent among the HD patients and deficits more frequently resulted in non-amnestic MCI.

Keywords:
Cognition, Mild cognitive impairment, Cerebrovascular disease, Chronic kidney disease, Hemodialysis
1.
Sehgal AR, Grey SF, DeOreo PB, Whitehouse PJ: Prevalence, recognition, and implications of mental impairment among hemodialysis patients. Am J Kidney Dis 1997;30:41–49.
2.
Murray AM, Tupper DE, Knopman DS, Gilbertson DT, Pederson SL, Li S, Smith GE, Hochhalter AK, Collins AJ, Kane RL: Cognitive impairment in hemodialysis patients is common. Neurology 2006;67:216–223.
3.
Kurella Tamura M, Wadley V, Yaffe K, McClure LA, Howard G, Go R, Allman RM, Warnock DG, McClellan W: Kidney function and cognitive impairment in us adults: the Reasons for Geographic and Racial Differences in Stroke (REGARDS) Study. Am J Kidney Dis 2008;52:227–234.
4.
Kurella M, Chertow GM, Luan J, Yaffe K: Cognitive impairment in chronic kidney disease. J Am Geriatr Soc 2004;52:1863–1869.
5.
Martinez-Vea A, Salvado E, Bardaji A, Gutierrez C, Ramos A, Garcia C, Compte T, Peralta C, Broch M, Pastor R, Angelet P, Marcas L, Sauri A, Oliver JA: Silent cerebral white matter lesions and their relationship with vascular risk factors in middle-aged predialysis patients with CKD. Am J Kidney Dis 2006;47:241–250.
6.
Fazekas G, Fazekas F, Schmidt R, Kapeller P, Offenbacher H, Krejs GJ: Brain MRI findings and cognitive impairment in patients undergoing chronic hemodialysis treatment. J Neurol Sci 1995;134:83–88.
7.
Ikram MA, Vernooij MW, Hofman A, Niessen WJ, van der Lugt A, Breteler MM: Kidney function is related to cerebral small vessel disease. Stroke 2008;39:55–61.
8.
Looi JC, Sachdev PS: Differentiation of vascular dementia from AD on neuropsychological tests. Neurology 1999;53:670–678.
9.
Roman GC, Royall DR: Executive control function: a rational basis for the diagnosis of vascular dementia. Alzheimer Dis Assoc Disord 1999;13(suppl 3):S69–S80.
10.
Petersen RC, Negash S: Mild cognitive impairment: an overview. CNS Spectr 2008;13:45–53.
11.
Lopez OL, Jagust WJ, DeKosky ST, Becker JT, Fitzpatrick A, Dulberg C, Breitner J, Lyketsos C, Jones B, Kawas C, Carlson M, Kuller LH: Prevalence and classification of mild cognitive impairment in the Cardiovascular Health Study Cognition Study: part 1. Arch Neurol 2003;60:1385–1389.
12.
Roberts RO, Geda YE, Knopman DS, Cha RH, Pankratz VS, Boeve BF, Ivnik RJ, Tangalos EG, Petersen RC, Rocca WA: The Mayo Clinic Study of Aging: design and sampling, participation, baseline measures and sample characteristics. Neuroepidemiology 2008;30:58–69.
13.
K/DOQI Clinical Practice Guidelines for Chronic Kidney Disease: Evaluation, classification, and stratification. Am J Kidney Dis 2002;39:S1–S266.
14.
Folstein MF FS, McHugh PR: Mini-Mental State: a practical method for grading the cognitive state of patients for the clinician. J Psychiatr Res 1975;12:189–198.
15.
Delis D, Kramer J, Kaplan E, Ober B: California Verbal Learning Test, ed 2 (CVLT-II). San Antonio, Psychological Corp, 2000.
16.
Benton AL, Hamsher KD: Multilingual Aphasia Examination, ed 3. Iowa City, AJA Associates, 1994.
17.
Wechsler D: Wechsler Memory Scale, ed 3. Administration and Scoring Manual. San Antonio, Psychological Corp, 1997.
18.
Smith A: Symbol Digit Modality Test (SDMT). Los Angeles, Western Psychological Services, 1991.
19.
Reitan RWD: The Halstead-Reitan Neuropsychological Test Battery. Tuscon, Neuropsychology Press, 1988.
20.
Golden JC: Stroop Color and Word Test. Chicago, Stoeling Corp, 1978.
21.
Wetzel L, Boll T: Short Category Test, Booklet Format. Los Angeles, Western Psychological Services, 1986.
22.
Lopez OL, Kuller LH, Fitzpatrick A, Ives D, Becker JT, Beauchamp N: Evaluation of dementia in the Cardiovascular Health Cognition Study. Neuroepidemiology 2003;22:1–12.
23.
Petersen RC: Mild cognitive impairment as a diagnostic entity. J Intern Med 2004;256:183–194.
24.
Pereira AA, Weiner DE, Scott T, Chandra P, Bluestein R, Griffith J, Sarnak MJ: Subcortical cognitive impairment in dialysis patients. Hemodial Int 2007;11:309–314.
25.
Yaffe K, Petersen RC, Lindquist K, Kramer J, Miller B: Subtype of mild cognitive impairment and progression to dementia and death. Dement Geriatr Cogn Disord 2006;22:312–319.
26.
Pugh KG, Lipsitz LA: The microvascular frontal-subcortical syndrome of aging. Neurobiol Aging 2002;23:421–431.
27.
De Groot JC, de Leeuw FE, Oudkerk M, van Gijn J, Hofman A, Jolles J, Breteler MM: Cerebral white matter lesions and cognitive function: The Rotterdam Scan Study. Ann Neurol 2000;47:145–151.
28.
Ylikoski R, Ylikoski A, Erkinjuntti T, Sulkava R, Raininko R, Tilvis R: White matter changes in healthy elderly persons correlate with attention and speed of mental processing. Arch Neurol 1993;50:818–824.
29.
Almkvist O, Wahlund LO, Andersson-Lundman G, Basun H, Backman L: White-matter hyperintensity and neuropsychological functions in dementia and healthy aging. Arch Neurol 1992;49:626–632.
30.
Boone KB, Miller BL, Lesser IM, Mehringer CM, Hill-Gutierrez E, Goldberg MA, Berman NG: Neuropsychological correlates of white-matter lesions in healthy elderly subjects. A threshold effect. Arch Neurol 1992;49:549–554.
31.
Meyer JS, Quach M, Thornby J, Chowdhury M, Huang J: MRI identifies MCI subtypes: vascular versus neurodegenerative. J Neurol Sci 2005;230:121–129.
32.
Weiner DE, Bartolomei K, Scott T, Price LL, Griffith JL, Rosenberg I, Levey AS, Folstein MF, Sarnak MJ: Albuminuria, cognitive functioning, and white matter hyperintensities in homebound elders. Am J Kidney Dis 2009;53:438–447.
33.
Fleck C, Janz A, Schweitzer F, Karge E, Schwertfeger M, Stein G: Serum concentrations of asymmetric (ADMA) and symmetric (SDMA) dimethylarginine in renal failure patients. Kidney Int Suppl 2001;78:S14–S18.
34.
Hoth KF, Tate DF, Poppas A, Forman DE, Gunstad J, Moser DJ, Paul RH, Jefferson AL, Haley AP, Cohen RA: Endothelial function and white matter hyperintensities in older adults with cardiovascular disease. Stroke 2007;38:308–312.
35.
Arici M, Walls J: End-stage renal disease, atherosclerosis, and cardiovascular mortality: is C-reactive protein the missing link? Kidney Int 2001;59:407–414.
36.
Weiss MF, Erhard P, Kader-Attia FA, Wu YC, Deoreo PB, Araki A, Glomb MA, Monnier VM: Mechanisms for the formation of glycoxidation products in end-stage renal disease. Kidney Int 2000;57:2571–2585.
37.
Raj DS, Choudhury D, Welbourne TC, Levi M: Advanced glycation end products: a nephrologist’s perspective. Am J Kidney Dis 2000;35:365–380.
38.
Himmelfarb J, Stenvinkel P, Ikizler TA, Hakim RM: The elephant in uremia: oxidant stress as a unifying concept of cardiovascular disease in uremia. Kidney Int 2002;62:1524–1538.
39.
Prohovnik I, Post J, Uribarri J, Lee H, Sandu O, Langhoff E: Cerebrovascular effects of hemodialysis in chronic kidney disease. J Cereb Blood Flow Metab 2007;27:1861–1869.
40.
Seliger SL, Longstreth WT Jr, Katz R, Manolio T, Fried LF, Shlipak M, Stehman-Breen CO, Newman A, Sarnak M, Gillen DL, Bleyer A, Siscovick DS: Cystatin C and subclinical brain infarction. J Am Soc Nephrol 2005;16:3721–3727.
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2010
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