Neurology:血液透析可导致认知障碍
2013-01-28 Neurology Dxy geniusgodyu
关于血透患者认知功能的详细报道很少。为此,美国波士顿塔斯夫医学中心神经科的Mark J. Sarnak博士等人进行了一项研究,研究结果在线发表在2013年1月9日的Neurology杂志上。研究结果发现:血透患者中认知功能差的发生率很高,主要影响的是执行功能。执行功能差的危险因素包含了血管危险因素和血管病。MMSE正常不能排除认知功能受损。 该研究为横断面队列研究。研究人员对314位血透
关于血透患者认知功能的详细报道很少。为此,美国波士顿塔斯夫医学中心神经科的Mark J. Sarnak博士等人进行了一项研究,研究结果在线发表在2013年1月9日的Neurology杂志上。研究结果发现:血透患者中认知功能差的发生率很高,主要影响的是执行功能。执行功能差的危险因素包含了血管危险因素和血管病。MMSE正常不能排除认知功能受损。
该研究为横断面队列研究。研究人员对314位血透患者(来自6个波士顿地区的血透中心)进行了详细的认知评估。该神经精神系列评分评估了多种功能情况,有确定的年龄、性别和教育匹配的正常人得分。主要的成分分析用于获取记忆和执行功能域的成分得分。使用线性回归校正年龄、性别、种族和教育状态,评估每个域的危险因素。对迷你精神状态测试(MMSE)得分≥24者进行重复分析。
研究结果显示:相较人群正常人,血透患者执行功能显著较差,但记忆功能差不多。这个结果在MMSE得分≥24的亚组中依然存在。在校正分析中,血管危险因素和血管病与较差的执行功能相关(p < 0.01)。
该研究发现:血透患者中认知功能差的发生率很高,主要影响的是执行功能。执行功能差的危险因素包含了血管危险因素和血管病。MMSE正常不能排除认知功能受损,因为在MMSE得分≥24的患者中,认知功能差的发生率也很高。
Frequency of and risk factors for poor cognitive performance in hemodialysis patients
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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#Neurol#
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#血液透析#
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