| Objective: To explore the cognitive function status and identify its influencing factors among populations with diabetic maintenance hemodialysis(D-MHD).Methods: The present study was a cross-sectional study.From August 2018 to January 2019,the convenience sampling method was used to recruit participants who underwent maintenance hemodialysis(MHD)treatment at the blood purification centers of two secondary hospitals in Jiangsu Province.Before dialysis,general information questionnaires were collected and the Chinese version of the Montreal Cognitive Assessment(Mo CA)scale was used to assess cognitive function.MHD patients with type 2 diabetes were included in the observational group,those without type 2diabetes included in the control group.After utilizing the propensity score matching method to control confounding factors,the differences in cognitive function scores,prevalence of cognitive impairment and the number of impairing dimension were compared between the two groups to analyze the cognitive function of D-MHD patients.By comparative analysis of cognitive scores in patients with different characteristics,correlation analysis between general data and cognitive scores and binary logistic regression analysis to explore influencing factors of cognitive function in D-MHD patients.Results1.203 MHD patients were included in this study,including 64 patients in the observational group and 139 patients in the control group.After utilizing the propensity score matching method,60 patients were included in each group.2.Measurement findings of cognitive ability:(1)The overall cognitive function,visuospatial/executive ability,naming and language scores in D-MHD patients were significantly lower than those in the control group(all P<0.05).(2)The prevalence of overall cognitive impairment of D-MHD patients was 95.0%,the prevalence of visuospatial/executive ability,delayed recall,language and abstract impairment was not less than 90% and the prevalence of naming impairment was not less than 70%.D-MHD patients had higher prevalence of cognitive impairment in overall and visuospatial/executive ability,naming,and language than subjects in the control group(all P<0.05).(3)Among the 7 sub-dimensions measured by the Mo CA scale,MHD patients who had 5,6 and7 impaired sub-dementions respectively accounted for 21.7%,38.3% and 23.3%.D-MHD patients statistically had more damaged cognitive dimensions than subjects in the control group(P <0.05).3.Cognitive function influencing factors:(1)Comparative analysis of cognitive scores in patients with different characteristics showed:D-MHD patients with different ages,genders,educational levels,diabetes duration,glycated albumin(GA),pre-diabetic blood glucose levels,consultation department when blood glucose fluctuating and pre-dialysis systolic blood pressure had significantly different cognitive scores of overall or some specific areas(all P<0.05): the older patients had lower overall,attention/computation,language,abstract,and delayed recall cognitive function score;the female had lower visuospatial/executive ability score than the male;patients with lower educational level had lower overall,visuospatial/executive ability,language and abstract scores;patients with longer duration of diabetes had lower visuospatial/executive ability and naming scores;patients with higher GA levels had lower overall,visuospatial/executive ability and naming scores;patents with higher pre-dialysis blood glucose levels had lower visuospatial/executive ability score;patients who resorted to the endocrinology department when blood glucose fluctuating had higher language score;patients with lower pre-dialysis systolic blood pressure had higher delayed recall scores.(2)Correlation analysis showed: age was negatively related to overall cognition(r=-0.367),attention/computation(r=-0.293)and delayed recall(r=-0.257)scores;educational level was positively related to overall cognition(r=0.328),visuospatial/executive ability(r=0.338),attention/computation(r=0.244)and abstraction(r=0.252)scores;duration of diabetes was negatively related to naming score(r=-0.226);GA level was negatively related to overall cognition(r=-0.245),visuospatial/executive ability(r=-0.261),naming(r=-0.218),abstraction(r=-0.245)and delayed recall(r=-0.233)score;the pre-dialysis blood glucose level was negatively related to visuospatial/executive ability(r=-0.263)and naming(r=-0.219)scores(all P<0.05).(3)The logistic regression analysis indicated: GA levels were statistically related to overall cognition and naming impairment;diabetes duration was statistically related to naming impairment;pre-transition systolic blood pressure was statistically related to overall cognitive impairment;after adjustment for age,gender and educational level,the duration of diabetes was statistically associated with naming impairment and dyslipidemia was statistically associated with delayed recall impairment(all P <0.05).Conclusions1.D-MHD patients suffer from severe cognitive decline with simultaneous impairment in multiple dementions.2.Diabetes duration,blood glucose level and high blood lipid are the influencing factors of the overall or sub-domain cognitive function of D-MHD patients.Age,gender,educational level,blood pressure level and consultation department when blood glucose fluctuating are the potential influencing factors of overall or sub-domain cognitive function in D-MHD patients. |
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