Yonsei Med J.  2013 Nov;54(6):1447-1453. 10.3349/ymj.2013.54.6.1447.

Relationship between Cognitive Impairment and Depression in Dialysis Patients

• Jung S
• Lee YK
• Choi SR
• Hwang SH
• Noh JW

• KMID: 1798142
• DOI: http://doi.org/10.3349/ymj.2013.54.6.1447

Abstract

PURPOSE
Patients with chronic kidney disease frequently show cognitive dysfunction. The association of depression and cognitive function is not well known in maintenance dialysis patients. We evaluated cognitive impairment and depression, as well as their relationship in regards to methods of dialysis, maintenance hemodialysis (MHD) and chronic peritoneal dialysis (CPD).
MATERIALS AND METHODS
Fifty-six maintenance dialysis patients were recruited and their clinical and laboratory data were collected. The Korean version of the mini-mental state exam (K-MMSE) was applied to screen the patient's cognitive function, while the Korean version of the Beck Depression Inventory (K-BDI) was used for depression screening.
RESULTS
The average age of the participants was 54.2+/-10.2 years; 29 (51.8%) were female. The average dialysis vintage was 4.2+/-3.8 years. The CPD group showed significantly higher K-MMSE score (27.8+/-2.9 vs. 26.1+/-3.1, p=0.010) and lower K-BDI score (12.0+/-8.4 vs. 20.2+/-10.4, p=0.003) compared with the MHD group. The percentage of patients with depression symptoms was higher in the MHD group (51.7% vs. 18.5%). There was a negative correlation between cognitive function and prevalence of depressive symptoms. Depression and education level were shown to be independent predictors for cognitive impairment in multivariate analysis.
CONCLUSION
Cognitive impairment was closely correlated with depression. It is important to detect cognitive impairment and depression early in maintenance dialysis patients with simple bedside screening tools.

Keyword

Cognitive impairment; depression; hemodialysis; peritoneal dialysis

MeSH Terms

Adult
Cognition Disorders/etiology/*physiopathology
Depression/etiology/*physiopathology
Female
Humans
Kidney Failure, Chronic/physiopathology/psychology/therapy
Male
Middle Aged
Renal Dialysis/*adverse effects/*psychology

Figure

• 

  Fig. 1 Correlation analysis between K-MMSE and K-BDI in dialysis patients (r=-0.296, p=0.026). K-MMSE, Korean version of the mini-mental state exam; K-BDI, Korean version of the Beck Depression Inventory.

Reference

1. Kurella M, Chertow GM, Luan J, Yaffe K. Cognitive impairment in chronic kidney disease. J Am Geriatr Soc. 2004; 52:1863–1869.

2. Buchman AS, Tanne D, Boyle PA, Shah RC, Leurgans SE, Bennett DA. Kidney function is associated with the rate of cognitive decline in the elderly. Neurology. 2009; 73:920–927.

3. Pereira AA, Weiner DE, Scott T, Sarnak MJ. Cognitive function in dialysis patients. Am J Kidney Dis. 2005; 45:448–462.

4. Murray AM, Tupper DE, Knopman DS, Gilbertson DT, Pederson SL, Li S, et al. Cognitive impairment in hemodialysis patients is common. Neurology. 2006; 67:216–223.

5. Begum A, Tsopelas C, Lindesay J, Stewart R. Cognitive function and common mental disorders in older people with vascular and non-vascular disorders: a national survey. Int J Geriatr Psychiatry. 2009; 24:701–708.

6. Madero M, Gul A, Sarnak MJ. Cognitive function in chronic kidney disease. Semin Dial. 2008; 21:29–37.

7. Murray AM. Cognitive impairment in the aging dialysis and chronic kidney disease populations: an occult burden. Adv Chronic Kidney Dis. 2008; 15:123–132.

8. Koo JR, Yoon JW, Kim SG, Lee YK, Oh KH, Kim GH, et al. Association of depression with malnutrition in chronic hemodialysis patients. Am J Kidney Dis. 2003; 41:1037–1042.

9. Brayne C. The mini-mental state examination, will we be using it in 2001? Int J Geriatr Psychiatry. 1998; 13:285–290.

10. Murray AM, Knopman DS. Cognitive impairment in CKD: no longer an occult burden. Am J Kidney Dis. 2010; 56:615–618.

11. Tilki HE, Akpolat T, Tunali G, Kara A, Onar MK. Effects of haemodialysis and continuous ambulatory peritoneal dialysis on P300 cognitive potentials in uraemic patients. Ups J Med Sci. 2004; 109:43–48.

12. Buoncristiani U, Alberti A, Gubbiotti G, Mazzotta G, Gallai V, Quintaliani G, et al. Better preservation of cognitive faculty in continuous ambulatory peritoneal dialysis. Perit Dial Int. 1993; 13:Suppl 2. S202–S205.

13. Chilcot J, Wellsted D, Da Silva-Gane M, Farrington K. Depression on dialysis. Nephron Clin Pract. 2008; 108:c256–c264.

14. Lopes AA, Bragg J, Young E, Goodkin D, Mapes D, Combe C, et al. Depression as a predictor of mortality and hospitalization among hemodialysis patients in the United States and Europe. Kidney Int. 2002; 62:199–207.

15. Juergensen PH, Wuerth DB, Juergensen DM, Finkelstein SH, Steele TE, Kliger AS, et al. Psychosocial factors and clinical outcome on CAPD. Adv Perit Dial. 1997; 13:121–124.

16. Condé SA, Fernandes N, Santos FR, Chouab A, Mota MM, Bastos MG. Cognitive decline, depression and quality of life in patients at different stages of chronic kidney disease. J Bras Nefrol. 2010; 32:242–248.

17. Mungas D. In-office mental status testing: a practical guide. Geriatrics. 1991; 46:54–58. 6366

18. Kurella M, Mapes DL, Port FK, Chertow GM. Correlates and outcomes of dementia among dialysis patients: the Dialysis Outcomes and Practice Patterns Study. Nephrol Dial Transplant. 2006; 21:2543–2548.

19. Cohen LM, Ruthazer R, Moss AH, Germain MJ. Predicting six-month mortality for patients who are on maintenance hemodialysis. Clin J Am Soc Nephrol. 2010; 5:72–79.

20. Kalirao P, Pederson S, Foley RN, Kolste A, Tupper D, Zaun D, et al. Cognitive impairment in peritoneal dialysis patients. Am J Kidney Dis. 2011; 57:612–620.

21. Radić J, Ljutić D, Radić M, Kovaĉić V, Sain M, Curković KD. The possible impact of dialysis modality on cognitive function in chronic dialysis patients. Neth J Med. 2010; 68:153–157.

22. Griva K, Stygall J, Hankins M, Davenport A, Harrison M, Newman SP. Cognitive impairment and 7-year mortality in dialysis patients. Am J Kidney Dis. 2010; 56:693–703.

23. Burn DJ, Bates D. Neurology and the kidney. J Neurol Neurosurg Psychiatry. 1998; 65:810–821.

24. Okada J, Yoshikawa K, Matsuo H, Kanno K, Oouchi M. Reversible MRI and CT findings in uremic encephalopathy. Neuroradiology. 1991; 33:524–526.

25. Marsh JT, Brown WS, Wolcott D, Carr CR, Harper R, Schweitzer SV, et al. rHuEPO treatment improves brain and cognitive function of anemic dialysis patients. Kidney Int. 1991; 39:155–163.

26. Herrmann FR, Safran C, Levkoff SE, Minaker KL. Serum albumin level on admission as a predictor of death, length of stay, and readmission. Arch Intern Med. 1992; 152:125–130.

27. Bruscoli M, Lovestone S. Is MCI really just early dementia? A systematic review of conversion studies. Int Psychogeriatr. 2004; 16:129–140.

28. Crum RM, Anthony JC, Bassett SS, Folstein MF. Population-based norms for the Mini-Mental State Examination by age and educational level. JAMA. 1993; 269:2386–2391.

29. Kang Y, Na DL, Hahn S. A validity study on the Korean Mini-Mental State Examination (K-MMSE) in dementia patients. J Korean Neurol Assoc. 1997; 15:300–308.

30. Hahn HM, Yum YH, Shin YW, Kim KH, Yoon DJ, Chung KJ. A Standardization study of Beck depression inventory in Korea. J Korean Neuropsychiatr Assoc. 1986; 25:487–500.

31. Rhee MK, Lee YH, Park SH, Sohn CH, Chung YC, Hong SK, et al. A standardization study of Beck Depression Inventory I-Korean version (K-BDI): reliability and factor analysis. Korean J Psychopathol. 1995; 4:77–95.

32. Agganis BT, Weiner DE, Giang LM, Scott T, Tighiouart H, Griffith JL, et al. Depression and cognitive function in maintenance hemodialysis patients. Am J Kidney Dis. 2010; 56:704–712.