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العنوان
Effect of Atherosclerosis on Cognitive Function in Hemodialysis Patients/
المؤلف
Nassar, Noura Mohamed Wafaa Ibrahim.
هيئة الاعداد
مشرف / Noura Mohamed Wafaa Ibrahim Nassar
مشرف / Mohamed Aly Ibrahim
مشرف / Maha Abd El Moneim Behairy
مشرف / Ahmed Mohamed Osman Bakry
تاريخ النشر
2015.
عدد الصفحات
220 p. ;
اللغة
الإنجليزية
الدرجة
ماجستير
التخصص
الطب الباطني
تاريخ الإجازة
1/1/2015
مكان الإجازة
جامعة عين شمس - كلية الطب - أمراض الباطنة العامة
الفهرس
Only 14 pages are availabe for public view

from 220

from 220

Abstract

Cognitive impairment, including dementia, is a common but poorly recognized problem among patients with end-stage renal disease (ESRD), affecting 16–38% of patients. Dementia is associated with high risks of death, dialysis withdrawal, hospitalization, and disability among patients with ESRD; thus, recognizing and effectively managing cognitive impairment may improve clinical care. Modification of ESRD-associated factors such as anemia and dialysis dose or frequency require further study before they can be recommended for treatment or prevention of cognitive impairment. Screening must be done as early as possible. Atherosclerosis is a major cause of mortality and morbidity among hemodialysis patients, Carotid artery atherosclerosis is a major risk factor for stroke and subsequent cognitive impairment. Recent studies indicate that carotid atherosclerosis without clinical stroke may also be an independent risk factor for cognitive decline and dementia.
We aimed to study the relationship between atherosclerosis assessed by Carotid Doppler and cognitive function in prevalent hemodialysis patients.
In the current study 30 stable prevelant hemodialysis patients were included from Ain Shams university dialysis unit. All patients were on regular hemodialysis thrice weekly for at least 6 month, each dialysis session will last four hours using bicarbonate dialysate, low flux dialyzers and heparin as anticoagulant with clinically stable condition and urea reduction ratio more than 60% for all patients.all patient at least more than eight years of education.
In our study we exclude patient with disturbed conscious level, cerebrovascular disease, unstable coronary heart disease, collagen disease, vasculitis, thyroid disease, Diabetes mellitus, major cardiovascular surgeries ,Uncontrolled hypertension, Positive family history of psychiatric disorders, Previous psychiatric illness ,major visual or hearing impairment, Substance abuse, CNS-active medications,history of severe head injuries, Severe anemia ≤ 9mg/dl and hypoalbuminemia ≤ 3g/dl,Decompensated chronic liver disease, Malignancy,active inflammation and mental retardation.
All patients were subjected to clinical examination, Laboratory investigations. Carotid Doppler was done for assessment of Intima Media Thickness and Atherosclerosis Score (this score is the first time to be used) It depend on Intima media thickness, Peak systolic velocity of Common carotid artery, degree of stenosis and calcification and plaque type and site.
Assesment of cognitive function were done by the following tests. Cognitive tests including: The Mini Mental State Examination MMSE to estimate the overall cognitive status of a patients, Benton Visual Retension that measures visual perception and visual memory., Trail Making Test part A and B which is neuropsychological test working memory and task switching., Wechsler Adult intelligence Test for IQ and intelligence evaluation and Wechsler Memory Scale Test which is neuropsychological test designed to measure different memory functions in a person.
This study include 12 (40%) female patients and 18 (60%) male patients with mean of hemodialysis duration were 127.8±11.8 months, with mean of BMI were 22.13±2.27 and mean of intima media thickness 0.9 mm in both male and female group.
We divided the patient regarding Atherosclerotic score into three groups 18 (60%) patients with normal atherosclerotic score. 7 (23.3%)patients with mild atherosclerotic score and 5(16.6%) patients with moderate atherosclerotic score.
Our results from Current study contributed statistically significant difference across the different groups regarding sex with (P<0.03). Comparison between duration of hemodialysis (ms), systolic blood pressure ,diastolic blood pressure, MAP and intra dialytic weight gain in three groups of atherosclerosis score showing statistically significant difference across the different groups regarding Systolic blood pressure and MAP with (P<0.03) and co-morbidities with (P<0.03). As regard comparsion between three groups of atherosclerosis score as regard laboratory data we found statistically significant difference regarding Ca, Po4 products and CRP titre and Urea 2 level with (P< 0.03).
Regarding Mini Mental test 6 (20%) patients had mild impairment. The rest of patients 24 (80%) had normal Mini Mental test score, The present study showed no significant difference across three groups of Atherosclerosis score and the Mini Mental Test. In the current study, comparison between Laboratory data of patients and Mini Mental test analysis showed significant difference across groups regarding BUN level and LDL level with (P < 0.03).
We also reported from our study that 40% of group Ш of atherosclerotic score (moderate group) were with mild impairment of Mini Mental test which were a high percent but statistically founded insignificant.
Regarding Trail make test (A)16(53.5%) with normal test score and 14(46.67% ) patients showed functional Impairment 60% of patients of group Ш of atherosclerosis showing impaired trail make test (A) which report relation between atherosclerosis and this test which reflect execuative function and attention but statistically insignificant, Trail make test (B) which reflect set shifting showed 24(80.00%) patients with normal test score and 6 (20%)patients with functional Impairment.
Benton Visual Retension test were normal in 8 (26.67%) patients, and Impaired in 22 (73.33%) patients, 100% of patients with group Ш showing impairment of this test which denoted relation between atherosclerosis in hemodialysis patients and this test which examine visual perception and memory but of statistically insignificant.
Wechsler test for intelligence and IQ measurement Normal in 8 (26.67%) patients, high Average include 14 (46.67%) patients, and superior in 8 (26.67%) patients.
Regarding Wechsler Memory Scale test only 5 subsets from this test were included, as regard information and orientation subset all patients were with normal score, regarding Digit span forward test subset which examine working memory and attention 8(30%) of patients with normal score and 22(70%) patients showing impaired test score, regarding Digit span backward test subset which examine working memory and attention 7(26.5%)of patient with normal score and 23(73.5%) patients showing impaired test score,
Regarding verbal associate Ι test subset which assess verbal memory for associated word pairs with 16 (52%)patients with normal score and14 (47.5%)patients showing impaired test score and finally regarding verbal associate П 18(60%) patients with normal score and 12(40%) patients showing impaired test score,.