The Study Of Cognitive Impairment And Influencing Factors In Maintenance Hemodialysis Patients

ObjectivesTo investigate the cognitive function in CRF patients who get maintenance hemodialysis(MHD)treatment, explore the incidence of cognitive impairment and its characteristics in this population, analyse its influencing factors.MethodsA cross-sectional study was used in this research.138participants were recruited between October2011to August2012from one dialysis unite under the direction of Tianjin First Medical Center. Baseline questionnaires and assessment scales were used to collect patients’ demographic characteristics, disease history, dialysis related information, social psychological factors. The questionnaires and scales included Demographic Data Recording Form, Self-Rating Anxiety Scale(SAS), Self-Rating Depression Scale(SDS), Social Support Rating Scale. Blood specimen was obtained before the hemodialysis, the laboratory index including blood urea nitrogen, serum creatinine, potassium, calcium, phosphate, albumin and hemoglobin.Chinese version of the Montreal Cognitive Assessment was used to assess the cognitive function, according to the classification standard, MHD patients can be divided into two groups, normal cognition group (NC) and cognitive impairment group(CI). T-test, chi-square test, non-parametric analysis and binary logistic regression analysis were performed to analyse the data with SPSS17.0.Results1Baseline characteristics of study populationThe total study sample surveyed included138participants,85(61.6%) were males and53(38.4%) were female, aged range from26years to63years, the average age was54.71±10.66; The average dialysis duration was46.43±28.52months; the condition of primary kidney didease:84(60.9%) were glomerulonephritis;17(12.3%) were hypertension;7(5.1%) were diabetic nephropathy;8(5.7%) were polycystic kidney;11(8.0%) were other reasons, such as systemic lupus erythenlatosus nephritis, sponge kidney and medicinal nephropathy;11(8.0%) were uncertain.2Result of cognitive function assessment The average score of MoCA in MHD patients was20.88±4.49, which was at a low level. According to the classification standard of cognitvie impairment, among these138cases, only49(35.5%)patients’cognitive function were normal,89patients (64.5%) had different degree of cognitive impairment.In each cognitive domain of MoCA, except for the naming and language abilities, patients in CI group had lower scores in all of the rest domains than NC group, including visuospatial ability&executive function, attention&calculation, abstraction, delayed recall and orientation(P<0.05or P<0.001). The number of patients combined with every impaired cognitive domain, from most to least was: delayed recall64cases(71.9%), visuospatial ability&executive function60cases(67.4%), attention&calculation41cases(46.1%), abstraction38cases(42.7%), orientation26cases(29.2%), language abilities16cases(18.0%), naming9cases(10.1%).We anlysed the total number of impaired cognitive domain of every patient, the distribution was:n=7(4cases,4.5%), n=6(10cases,11.2%), n=5(43cases,48.3%), n=4(21cases,23.6%), n=3(11cases,12.4%), n=2(4cases,4.5%), n=1(0cases)。3Result of binary logistic regression analysisBinary logistic regression analysis showed that age, hypertension, hemoglobin level, anxiety, depression and the utilization of social support were the main influencing factors. Among these factors, age(OR=4.038,95%CI:0.721-0.926), hypertension(OR=2.316,95%CI:1.061-2.252)、anxiety(OR=2.698,95%CI:1.200-2.759)、depression(OR=1.666,95%CI:1.037-2.678)were risk factors, hemoglobin level(OR=0.817,95%CI:1.777-2.241)and the utilization of social support(OR=0.372,95%CI:0.155-0.893)were protective factors.ConclusionsCognitive impairmen is particularly common in MHD patients, its characteristic in this population was that multiple cognitive domains impaired at the same time. In this study, MHD patients had various degree impairment in most cognitive domains, including visuospatial ability&executive function, attention&calculation, abstraction, delayed recall and orientation, in particular with delayed recall and visuospatial ability&executive function. Age, hypertension, hemoglobin level, anxiety, depression, and utilization of social support were the main influencing factors. Clinical nursing staff should pay more attention to the cognitive impairment in MHD patients, giving corresponding intervention measures to avoid the decline of cognitive function. Meanwhile, for the patients with CI,effective nursing measures should be adopted to improve their level of cognitive function, promote their physical and mental health, and improve their quality of life finally.