الفهرس 
Dementia and cognitive impairmentOnly 14 pages are availabe for public view
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Abstract
SUMMARY AND CONCLUSIONS
Dementia, delirium and depression are all common conditions in patients with early stages of CKD and in those with ESRD treated with dialysis. Although dementia, delirium and depression are distinct disorders, depression can present with features of dementia, dementia can predispose to delirium, and delirium can be predictive of subsequent dementia. The full extent and scope of the neuropsychiatric complications of CKD have only recently become apparent.
Cognitive function, which is now recognized to start to deteriorate early in the course of renal disease, is impaired in almost 90% of dialysis-dependent patients. Impaired cognitive function is strongly associated with an increased risk of mortality. Haemodialysis treatment is far from a panacea; although it may temporarily address the toxic and metabolic imbalance in patients with CKD, it does so at the expense of cerebral perfusion, inducing recurrent cerebral edema and hypotension. Cognitive impairment in patients with CKD is likely to improve with renal transplantation. Additional measures for limiting delirium, detecting and minimizing the effect of dementia on day-to-day activities and aggressively treating depression are needed.
Neurological complications represent a major cause of disability and markedly impair quality of life in patients with CKD. Neurologists play a critical part in the diagnosis and therapeutic management of these complications.
Future studies could shed further light on the beneficial effects of strict potassium control on neuropathy in CKD, and on neuromuscular function more generally as the alteration in axonal membrane potential that develops in uremic neuropathy seems to be driven by chronic hyperkalemia.
Autonomic dysfunction, which is highly prevalent in CKD, is associated with vascular calcification, cardiac arrhythmia and sudden cardiac death. For CKD patients with myopathy, exercise programs, adequate nutritional intake, and treatment with erythropoietin to correct anemia remain the mainstays of therapy to improve exercise tolerance and neuromuscular function.
In haemodialysis patients, multiple neurological complications are commonly observed. They are an important cause of mortality and morbidity, but often underdiagnosed and undertreated. Haemodialysis patients need a close follow-up to manage and prevent neurological involvement. Adopting early and adequate treatments or preventative measures should partially resolve symptoms. Despite continuous therapeutic progress, most neurological complications of uremia fail to respond to dialysis treatments, some of them are even induced by haemodialysis itself. All of the available therapeutic measures should be considered, in particular improving and personalizing haemodialysis, and using pharmacological and psychological treatments.
Potentially neurotoxic drugs should be dosed accurately, and whenever necessary their serum levels should be monitored to prevent neurological toxicity. At a time of increasingly narrow medical specializations, we should not to forget to take a wider look at different clinical arenas.