Known unknowns: Examining the burden of neurocognitive impairment in the end-stage renal failure population

Scott Wilson, Arup Dhar, Peter Tregaskis, Gavin Lambert, David Barton, Rowan Walker

Research output: Contribution to journalReview ArticleResearchpeer-review

Abstract

The burden of neurocognitive impairment (NCI) in patients receiving maintenance dialysis represents a spectrum of deficits across multiple cognitive domains that are associated with hospitalization, reduced quality-of-life, mortality and forced decision-making around dialysis withdrawal. Point prevalence data suggest that dialysis patients manifest NCI at rates 3- to 5-fold higher than the general population, with executive function the most commonly affected cognitive domain. The unique physiology of the renal failure state and maintenance dialysis appears to drive an excess of vascular dementia subtype compared to the general population where classical Alzheimer's disease predominates. Despite the absence of evidence-based cost-effective therapies for NCI, detecting it in this population creates opportunity to proactively personalize care through education, supported decision making and targeted communication strategies to cover specific areas of deficit and help define goals of care. This review discusses NCI in the dialysis setting, including developments in the definition of neurocognitive impairment, dialysis-specific epidemiology across modalities, screening strategies and opportunities for dialysis providers in this space.

Original languageEnglish
Pages (from-to)501-506
Number of pages6
JournalNephrology
Volume23
Issue number6
DOIs
Publication statusPublished - 1 Jun 2018

Keywords

  • cognitive dysfunction
  • dementia
  • renal dialysis

Cite this

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abstract = "The burden of neurocognitive impairment (NCI) in patients receiving maintenance dialysis represents a spectrum of deficits across multiple cognitive domains that are associated with hospitalization, reduced quality-of-life, mortality and forced decision-making around dialysis withdrawal. Point prevalence data suggest that dialysis patients manifest NCI at rates 3- to 5-fold higher than the general population, with executive function the most commonly affected cognitive domain. The unique physiology of the renal failure state and maintenance dialysis appears to drive an excess of vascular dementia subtype compared to the general population where classical Alzheimer's disease predominates. Despite the absence of evidence-based cost-effective therapies for NCI, detecting it in this population creates opportunity to proactively personalize care through education, supported decision making and targeted communication strategies to cover specific areas of deficit and help define goals of care. This review discusses NCI in the dialysis setting, including developments in the definition of neurocognitive impairment, dialysis-specific epidemiology across modalities, screening strategies and opportunities for dialysis providers in this space.",
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Known unknowns : Examining the burden of neurocognitive impairment in the end-stage renal failure population. / Wilson, Scott; Dhar, Arup; Tregaskis, Peter; Lambert, Gavin; Barton, David; Walker, Rowan.

In: Nephrology, Vol. 23, No. 6, 01.06.2018, p. 501-506.

Research output: Contribution to journalReview ArticleResearchpeer-review

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T2 - Examining the burden of neurocognitive impairment in the end-stage renal failure population

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AU - Dhar, Arup

AU - Tregaskis, Peter

AU - Lambert, Gavin

AU - Barton, David

AU - Walker, Rowan

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