Research Paper Volume 12, Issue 2 pp 1496—1511

Association of cardiovascular structure and function with cerebrovascular changes and cognitive function in older patients with end-stage renal disease

Laurien E. Zijlstra 1, , Stella Trompet 1, 2, , J. Wouter Jukema 1, , Lucia J. M. Kroft 3, , Jeroen de Bresser 3, , Matthias J. P. van Osch 3, , Sebastiaan Hammer 4, , Marie-Noëlle Witjes 2, , Marjolijn van Buren 5, 6, *, , Simon P. Mooijaart 2, *, ,

  • 1 Department of Cardiology, Leiden University Medical Center, Leiden, The Netherlands
  • 2 Department of Gerontology and Geriatrics, Leiden University Medical Center, Leiden, The Netherlands
  • 3 Department of Radiology, Leiden University Medical Center, Leiden, The Netherlands
  • 4 Department of Radiology, HAGA Hospital, The Hague, The Netherlands
  • 5 Department of Nephrology, Leiden University Medical Center, Leiden, The Netherlands
  • 6 Department of Nephrology, HAGA Hospital, The Hague, The Netherlands
* Equal contribution

received: November 2, 2019 ; accepted: December 26, 2019 ; published: January 7, 2020 ;

https://doi.org/10.18632/aging.102696
How to Cite

Copyright © 2020 Zijlstra et al. This is an open-access article distributed under the terms of the Creative Commons Attribution License (CC BY 3.0), which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.

Abstract

The Dutch prospective multicenter cohort study COPE (Cognitive decline in Older Patients with End stage renal disease) aimed to investigate the association of cardiovascular structure and function with cerebrovascular changes and cognitive function in 85 older patients with chronic kidney disease stage 4 and 5, awaiting either dialysis or conservative care. MRI was performed measuring aortic stiffness (pulse wave velocity [PWV]) and cardiac systolic function (ejection fraction and cardiac index). Outcomes were MRI-derived cerebrovascular changes (microbleeds, lacunes and white matter hyperintensities) and cognitive function (memory, executive function and psychomotor speed). Mean age was 76 years and 66% were male. No statistically significant associations were observed between cardiovascular parameters and cerebrovascular changes. Cognitive function was worse in patients with high compared to low PWV in all three cognitive domains. Although there were clinically relevant associations of high PWV with poor cognition in all domains, after adjustment for age, sex and education only the Trail Making Test A remained statistically significant (p=0.030). In conclusion, this study suggests that a higher PWV might be associated with lower cognitive function, suggesting that arterial stiffness may be an underlying mechanism of development of cognitive impairment in older patients with ESRD. Larger studies should replicate and extend these findings.

Abbreviations

15-WVLT: 15-Word Verbal Learning Test, immediate and delayed; BMI: body mass index; CI: cardiac index; COPE: Cognitive decline in Older Patients with End stage renal disease; EF: ejection fraction; eGFR: estimated glomerular filtration rate; ESRD: end-stage renal disease; IQR: interquartile range; LDST: Letter Digit Substitution Test; MMSE: Mini-Mental State Examination; MRI: magnetic resonance imaging; PWV: pulse wave velocity; SCWT: Stroop Color and Word Test; SD: standard deviation; SE: standard error; TMTA/TMTB: Trail Making Test A&B ; VAT: Visual Association Test ; WMH: white matter hyperintensities.