Cognitive impairment in hemodialysis patients: What can slow this decline?

With over 70% of hemodialysis (HD) patients, aged ≥55 years, having moderate to severe chronic cognitive impairment (CI), in an increasingly aging population, the need to stop this cognitive decline is paramount. CI amongst HD patients raises patient safety concerns, while limiting their ability to understand information such as medical advice and their decision-making ability. Unfortunately, the data available on assessment of cognition in HD patients and interventions utilized remain extremely limited. This paper discusses assessment of cognition, the theories of CI in HD patients, and current literature on cognitive interventions in chronic disease, with many not applicable to the HD population. An encouraging psychological intervention called cognitive stimulation therapy helps improve cognition as well as social skills in CI. This is the first review article discussing the possibility of cognition stimulation during HD which has not been investigated previously. With cognitive stimulation therapy showing improvements in cognition at 6-month follow-up, as well as being recommended by the National Institute for Health and Care Excellence for use in dementia, we suggest the need to study whether this therapy has any effect on cognition in HD patients both in short term, with respect to daily activities and decision making, and in long term, with respect to the possibility of reducing the risk of dementia.

在 55 歲或以上的血液透析 (HD) 病人間, 逾 70% 有中至重度的慢性認知障礙 (CI), 在目前老年化的人口中, 這是必須要解決的問題。在接受 HD 後, CI 可引發病人安全的隱憂, 同時亦限制患者接受資訊如醫囑、及決策的能力。然而, 至今關於 HD 病人認知功能與改善方案的數據仍非常有限。本文探討了認知功能的評估方法、及 CI 發生於 HD 的相關理論, 亦回顧了目前有關慢性病中認知功能改善方案的文獻, 雖然很多並不特定於 HD 病人群。我們注意到一種稱為認知刺激療法 (cognitive stimulation therapy, CST) 的心理治療方案, 可望改善 CI 患者的認知功能和社交技能。本文將首度就這種療法對 HD 病人的效應作出探討。事實上, CST 經證實可於 6 個月期間達到認知功能的改善, 亦是英國 NICE (National Institute for Health and Care Excellence) 建議的失智症療法, 我們認為有需要研究 CST 對 HD 病人認知功能的影響, 不論是在短期 (日常活動及決策能力)、或長期層面 (失智症的預防)。