接受血液透析的老年患者脑血流量变化与认知能力下降之间的关系

IF 4.1 2区医学 Q2 GERIATRICS & GERONTOLOGY

Frontiers in Aging Neuroscience Pub Date : 2024-09-18 DOI:10.3389/fnagi.2024.1457675

Yidan Guo, Wei Cui, Pengpeng Ye, Yang Luo

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The relationship between cerebral blood flow and the decline of cognitive function is poorly understood.ObjectiveTo investigate the association between cerebral blood flow variation and decline of cognitive function in older patients undergoing hemodialysis.MethodsIn 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.ResultsTCD recordings demonstrated a significant reduction in MFV throughout dialysis, which were significantly correlated with cumulative ultrafiltration volume (rho 0.356, p &lt; 0.001), ΔSBP (rho 0.251, p = 0.005), and ΔMAP (rho 0.194, p = 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) (p &lt; 0.05). The worsening scores in global cognition (MOCA) (β = 0.066, 95% CI 0.018–0.113, p = 0.007) and some tests of memory (AVLT5) (β = 0.050, 95% CI 0.004–0.097, p = 0.035) and executive function (TMT-B, SCWT-C, SCWT-T) (β = 1.955, 95% CI 0.457–3.453, p = 0.011; β = 0.298, 95% CI 0.112–0.484, p = 0.002 and β = 1.371, 95% CI 0.429–2.303, p = 0.004, respectively) were significantly associated with the reduction of MFV.ConclusionHemodialysis 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 registrationhttps://register.clinicaltrials.gov/prs/app/action/SelectProtocol?sid=S000C5B5&amp;selectaction=Edit&amp;uid=U0003QEL&amp;ts=4&amp;cx=-djoi2","PeriodicalId":12450,"journal":{"name":"Frontiers in Aging Neuroscience","volume":"28 1","pages":""},"PeriodicalIF":4.1000,"publicationDate":"2024-09-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":"0","resultStr":"{\"title\":\"Association between cerebral blood flow variation and cognitive decline in older patients undergoing hemodialysis\",\"authors\":\"Yidan Guo, Wei Cui, Pengpeng Ye, Yang Luo\",\"doi\":\"10.3389/fnagi.2024.1457675\",\"DOIUrl\":null,\"url\":null,\"abstract\":\"BackgroundThe mechanism of cognitive impairment in hemodialysis patients is multifactorial. The relationship between cerebral blood flow and the decline of cognitive function is poorly understood.ObjectiveTo investigate the association between cerebral blood flow variation and decline of cognitive function in older patients undergoing hemodialysis.MethodsIn 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.ResultsTCD recordings demonstrated a significant reduction in MFV throughout dialysis, which were significantly correlated with cumulative ultrafiltration volume (rho 0.356, p &lt; 0.001), ΔSBP (rho 0.251, p = 0.005), and ΔMAP (rho 0.194, p = 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) (p &lt; 0.05). 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引用次数: 0

摘要

背景血液透析患者认知功能受损的机制是多因素的。目的研究接受血液透析的老年患者脑血流变化与认知功能下降之间的关系。方法在这项前瞻性观察性队列研究中，我们使用经颅多普勒超声（TCD）测量了整个透析过程中的脑动脉平均血流速度（MFV），评估了基线和随访 12 个月时的认知功能，然后分析了 MFV 与认知评分变化之间的关联。结果TCD记录显示，在整个透析过程中，MFV明显下降，这与累积超滤量（rho 0.356，p < 0.001）、ΔSBP（rho 0.251，p = 0.005）和ΔMAP（rho 0.194，p = 0.032）显著相关。与基线评估相比，参加者在 12 个月随访期间的认知评分在总体认知（MOCA）、部分记忆测试（CFT-记忆）、执行功能（TMT-B、SCWT-C 和 SCWT-T）、注意力/处理速度（SDMT）和视觉空间功能（CFT-复制）方面明显恶化（p < 0.05）。总体认知（MOCA）（β = 0.066，95% CI 0.018-0.113，p = 0.007）和一些记忆测试（AVLT5）（β = 0.050，95% CI 0.004-0.097，p = 0.035）以及执行功能（TMT-B、SCWT-C、SCWT-T）的评分恶化（β = 1.955，95% CI 0.457-3.453，p = 0.011；β = 0.298，95% CI 0.112-0.484，p = 0.002 和 β = 1.371，95% CI 0.429-2.303，p = 0.004）与 MFV 的降低显著相关。结论血液透析可能会显著降低老年患者的脑血流量；透析内CBF的反复降低可能是认知功能下降的机制之一。临床试验注册https://register.clinicaltrials.gov/prs/app/action/SelectProtocol?sid=S000C5B5&selectaction=Edit&uid=U0003QEL&ts=4&cx=-djoi2

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Association between cerebral blood flow variation and cognitive decline in older patients undergoing hemodialysis

BackgroundThe mechanism of cognitive impairment in hemodialysis patients is multifactorial. The relationship between cerebral blood flow and the decline of cognitive function is poorly understood.ObjectiveTo investigate the association between cerebral blood flow variation and decline of cognitive function in older patients undergoing hemodialysis.MethodsIn 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.ResultsTCD recordings demonstrated a significant reduction in MFV throughout dialysis, which were significantly correlated with cumulative ultrafiltration volume (rho 0.356, p < 0.001), ΔSBP (rho 0.251, p = 0.005), and ΔMAP (rho 0.194, p = 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) (p < 0.05). The worsening scores in global cognition (MOCA) (β = 0.066, 95% CI 0.018–0.113, p = 0.007) and some tests of memory (AVLT5) (β = 0.050, 95% CI 0.004–0.097, p = 0.035) and executive function (TMT-B, SCWT-C, SCWT-T) (β = 1.955, 95% CI 0.457–3.453, p = 0.011; β = 0.298, 95% CI 0.112–0.484, p = 0.002 and β = 1.371, 95% CI 0.429–2.303, p = 0.004, respectively) were significantly associated with the reduction of MFV.ConclusionHemodialysis 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 registrationhttps://register.clinicaltrials.gov/prs/app/action/SelectProtocol?sid=S000C5B5&selectaction=Edit&uid=U0003QEL&ts=4&cx=-djoi2

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来源期刊

Frontiers in Aging Neuroscience GERIATRICS & GERONTOLOGY-NEUROSCIENCES

CiteScore

6.30

自引率

8.30%

发文量

1426

期刊介绍： Frontiers in Aging Neuroscience is a leading journal in its field, publishing rigorously peer-reviewed research that advances our understanding of the mechanisms of Central Nervous System aging and age-related neural diseases. Specialty Chief Editor Thomas Wisniewski at the New York University School of Medicine is supported by an outstanding Editorial Board of international researchers. This multidisciplinary open-access journal is at the forefront of disseminating and communicating scientific knowledge and impactful discoveries to researchers, academics, clinicians and the public worldwide.