Known unknowns: Examining the burden of neurocognitive impairment in the end-stage renal failure population.
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.
['Wilson|Scott|S|', 'Dhar|Arup|A|', 'Tregaskis|Peter|P|', 'Lambert|Gavin|G|', 'Barton|David|D|', 'Walker|Rowan|R|']
D000544:Alzheimer Disease D003071:Cognition D003072:Cognition Disorders D017281:Cost of Illness D015140:Dementia, Vascular D006304:Health Status D006801:Humans D007676:Kidney Failure, Chronic D000073216:Mental Status and Dementia Tests D009483:Neuropsychological Tests D011237:Predictive Value of Tests D015995:Prevalence D011379:Prognosis D011788:Quality of Life D006435:Renal Dialysis D012307:Risk Factors
dementia cognitive dysfunction renal dialysis