Background

The prevalence of impaired cognitive functioning in older patients with end stage kidney disease (ESKD) is high. We aim to describe patterns of memory, executive function or psychomotor speed and to identify nephrologic, geriatric and neuroradiologic characteristics associated with cognitive impairment in older patients approaching ESKD who have not yet started with renal replacement therapy (RRT).

Methods

The COPE-study (Cognitive Decline in Older Patients with ESRD) is a prospective cohort study including 157 participants aged 65 years and older approaching ESKD (eGFR ≤20 ml/min/1.73 m2) prior to starting with RRT. In addition to routinely collected clinical parameters related to ESKD, such as vascular disease burden and parameters of metabolic disturbance, patients received a full geriatric assessment, including extensive neuropsychological testing. In a subgroup of patients (n = 93) a brain MRI was performed.

Results

The median age was 75.3 years. Compared to the normative data of neuropsychological testing participants memory performance was in the 24th percentile, executive function in the 18th percentile and psychomotor speed in the 20th percentile. Independent associated characteristics of impairment in memory, executive and psychomotor speed were high age, low educational level and low functional status (all p-values < 0.003). A history of vascular disease (p = 0.007) and more white matter hyperintensities on brain MRI (p = 0.013) were associated with a lower psychomotor speed.

Conclusion

Older patients approaching ESKD have a high prevalence of impaired memory, executive function and psychomotor speed. The patterns of cognitive impairment and brain changes on MRI are suggestive of vascular cognitive impairment. These findings could be of potentially added value in the decision-making process concerning patients with ESKD.

Overview publication

TitlePatterns and characteristics of cognitive functioning in older patients approaching end stage kidney disease, the COPE-study.
DateApril 9th, 2020
Issue nameBMC nephrology
Issue numberv21.1:126
DOI10.1186/s12882-020-01764-2
PubMed32272897
Authorsvan Deudekom FJ, Kallenberg MH, Berkhout-Byrne NC, Blauw GJ, Boom H, de Bresser J, van Buchem MA, Gaasbeek A, Hammer S, Lagro J, van Osch MJP, Witjes-Ané MN, Rabelink TJ, van Buren M & Mooijaart SP
KeywordsCognitive function, End stage renal disease, Geriatric assessment, Geriatrics, Older patients
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