Cerebral white matter burden is linked to cognitive function in patients undergoing hemodialysis

Abstract

Introduction

Chronic kidney disease is related to neurodegeneration and structural changes in the brain which might lead to cognitive decline. The Fazekas scale used for assessing white matter hyperintensities (WMHs) was associated with poor cognitive performance. Therefore, this study investigated the associations between the mini-mental status examination (MMSE), Montreal cognitive assessment (MoCA), cognitive abilities screening instrument (CASI), and Fazekas scale in patients under hemodialysis (HD).

Methods

The periventricular (PV) WMHs and deep WMHs (DWMHs) in brain magnetic resonance images of 59 patients under dialysis were graded using the Fazekas scale. Three cognition function tests were also performed, then multivariable ordinal regression and logistic regression were used to identify the associations between cognitive performance and the Fazekas scale.

Results

There were inverse associations between the three cognitive function tests across the Fazekas scale of PVWMHs (p = .037, .006, and .008 for MMSE, MoCA, and CASI, respectively), but the associations were attenuated in the DWMHs group. In CASI, significant differences were identified in short-term memory, mental manipulation, abstract thinking, language, spatial construction, and name fluency in the PVWMHs group. However, DWMHs were only significantly correlated with abstract thinking and short-term memory.

Conclusion

An inverse correlation existed between the Fazekas scale, predominantly in PVWMHs, and cognition in patients undergoing HD. The PVWMHs were associated with cognitive performance assessed by MMSE, MoCA, and CASI, as well as with subdomains of CASI such as memory, language and name fluency in patients undergoing HD.

KEY MESSAGES

1. An inverse correlation existed between the Fazekas scale and cognition in patients undergoing hemodialysis, predominantly in periventricular white matter hyperintensities.

2. The periventricular white matter hyperintensities were associated with cognitive performance assessed by mini-mental status examination (MMSE), Montreal cognitive assessment (MoCA), cognitive abilities screening instrument (CASI), as well as with subdomains of CASI such as memory, language and name fluency in patients undergoing HD.

Keywords:

• Brain magnetic resonance imaging
• cognitive function
• Fazekas scale
• hemodialysis

Authors contributions

Conceptualization, Ping-Hsun Wu, Yi-Ting Lin, Hsiu-Fen Lin, and Mei-Chuan Kuo; Data curation, Ping-Hsun Wu, Yi-Ting Lin, Hsiu-Fen Lin, Wen-Ching Chen, and Teng-Hui Huang; Study design and analysis plan, Ping-Hsun Wu, Yi-Ting Lin, Hsiu-Fen Lin, Wen-Ching Chen, and Mei-Chuan Kuo; Statistical analysis, Ping-Hsun Wu, Yi-Ting Lin, and Teng-Hui Huang; Funding acquisition, Ping-Hsun Wu, Yi-Ting Lin, and Mei-Chuan Kuo; Investigation, Ping-Hsun Wu, Hsiu-Fen Lin, Wen-Ching Chen, Ming-Yen Lin, Yi-Wen Chiu, Jer-Ming Chang, Mei-Chuan Kuo, and Yi-Ting Lin; Writing the first draft, Tsai-Shan Wu, Ping-Hsun Wu, and Yi-Ting Lin; Writing, review & editing, Ping-Hsun Wu, Hsiu-Fen Lin, Wen-Ching Chen, Ming-Yen Lin, Yun-Shiuan Chuang, Fan-Pei Gloria Yang, Yi-Wen Chiu, Jer-Ming Chang, Mei-Chuan Kuo, Yi-Ting Lin.

Disclosure statement

No potential conflict of interest was reported by the author(s).

Data availability statement

The data will be provided upon request to the corresponding author.

Additional information

Funding

The study was funded by grants from the Ministry of Science and Technology, Taiwan (MOST 105-2628-B-037-005-MY2, MOST 106-2314-B-037-054, and MOST 109-2314-B-037-102-MY2), Kaohsiung Medical University Hospital, Taiwan (KMUH109-9R81, KMUH109-9R17, KMUH110-0M73, KMUH111-1R73, KMUH111-1M60, KMUH110-0R19, KMUH111-1R14), and a grant from National Tsing Hua University and Kaohsiung Medical University (KT112P012).