Avaliação de comprometimento cognitivo leve em pacientes submetidos à hemodiálise

Abstract

The study addressed the occurrence of mild cognitive impairment (MCI) in patients on hemodialysis (HD). MCI is defined as an intermediate stage of decreased cognitive functions between the milder ones related to aging and a more severe condition that meets the criteria for dementia or Alzheimer's disease. The MCI implies permanent deficits whose prevalence in patients in HD can vary between 16 and 38%. The identified cognitive functions identified encompass a broad spectrum of fundamental skills in daily life activities, such as low concentration, poorer learning, semantic, episodic and work memory impairment. In addition, MCI is associated with increased use of health resources, mortality and hospitalization. Based on these premises, the present study aimed to evaluate the prevalence of MCI and the association between MCI and socioeconomic, clinical, educational, and demographic variables of hemodialysis patients. A group of patients in HD (n = 42) and a control group (n = 43) were submitted to a test battery composed of: Montreal Cognitive Assessment (MoCA), WAIS III Subtests (Vocabulary, Codes, Arithmetic, Matrix Reasoning and Sequence of Numbers and Letters), and Beck Depression Inventory (BDI). Results are presented as mean ± standard deviation or percentages and differences in test performance between groups were assessed by appropriate statistical tests. The hemodialysis time was 61.66±44.5 months. The mean age was similar between the two groups (HD = 37.92 ±12.46 years, Controls = 35.6±13 years, p> 0.05). Although, the cases have had worse performance in all subtests compared to controls, we found statistically significant difference in only three: Vocabulary (7.57±2.13, 8±1.54, p = 0.2906); Codes (7.47±1.77, 8.51±1.84, p = 0.0099); Arithmetic (7.45±1.68, 8.55±2.31, p = 0.0034); Matrix Ratio (8.5±2.17, 9.06±1.48, p = 0.5706), Number and Letter Sequence (7.95±1.88, 8.83±2.58, p = 0.0040). The mean MoCA score of the HD group was 21±3.32. 76.19% of the cases scored below the cutoff number (24) versus 44.19% of the controls with p = 0.003. In the BDI test, which evaluates depression, there was no statistical difference between the groups. The results obtained in this study, in agreement with those reported by other studies, show that hemodialysis patients are a risk group for developing MCI. It is suggested that additional care, with the objective of minimizing the risks or effects of MCI, should be included in the list of current strategies, offered by multidisciplinary teams, to hemodialysis patients.