Dementia Risk Increases in Older Adults Undergoing Dialysis

Dementia rates are higher and so is the associated risk for early death in older patients who are on dialysis, says study.

Highlights:

Older adults who start dialysis for kidney failure are at a higher risk for being diagnosed with dementia and Alzheimer's disease (AD).
Older hemodialysis patients with dementia or AD are also at a higher risk of early death.

Dialysis is an option for people suffering from chronic kidney disease and there is a higher rate of dementia seen in older adults after starting dialysis treatment (hemodialysis), reveals a new study.

The dialysis patients who are diagnosed with dementia are also at a higher risk of early death. The study appears in the Clinical Journal of the American Society of Nephrology (CJASN).

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‘Older kidney disease patients who require the blood-filtering treatment known as dialysis are at high risk of dementia, including Alzheimer’s disease.’

Cognitive decline and dementia including Alzheimer’s disease, are all age-related and relatively common in the elderly. The strongest risk factors for dementia and Alzheimer's disease are old age, black race, female gender, and institutionalization (such as in a nursing home).

Research over the last couple of decades has also found that as kidney function declines, so does cognitive function. Also, older patients on hemodialysis often experience a significant decline in cognitive functions like attention, impulse control and working memory, which puts them at high risk for developing dementia.

Kidney disease has been linked to reduced blood flow into the brain and could be the link or key factor between kidney disease and brain problems.

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Study – To estimate the risk of a dementia diagnosis after initiating dialysis

Mara McAdams-DeMarco, PhD (Johns Hopkins Bloomberg School of Public Health) and her colleagues studied 356,668 US Medicare hemodialysis patients aged 66 years and older, from 2001 to 2013.

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About 47 percent of the participants were female, and 20 percent were African-American.

The 10-year risk of being diagnosed with dementia after beginning dialysis is 19 percent for patients aged 66-70 years that rose to 28 percent for those 76-80 years. (Compare it to a 10-year incidence of dementia of 1.0-1.5% in adults aged 65 years and 7.4-7.6% in adults aged 75 years in a study conducted on residents in a Massachusetts town).
The 1-year risk of being diagnosed with dementia and Alzheimer’s disease after initiating hemodialysis was 4.6% and 0.6% for women, and 3.7% and 0.4% for men.
The 5-year risk of being diagnosed with dementia and Alzheimer’s disease after initiating hemodialysis was 16% and 2.6% for women, and 13% and 2.0% for men.
Older hemodialysis patients who were diagnosed with dementia or Alzheimer's disease were about twice as likely to die at any time in the study period, compared to older dialysis patients without a dementia diagnosis

Even with these alarming figures, McAdams-DeMarco says that only about half of patients with dementia receive diagnosis.

She proposes more in-depth studies to gauge the true extent of the dementia problem among older end-stage kidney disease patients. “Patients starting dialysis generally meet with health care providers a few times per week, so in principle there is ample opportunity to do at least brief cognitive screening,” she says.

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McAdams-DeMarco's lab is currently setting up a large clinical trial to identify appropriate interventions to preserve cognitive function in these patients and recommends more studies of potential measures to prevent dementia among these vulnerable patients.

References:

Mara A. McAdams-DeMarco, Matthew Daubresse, Sunjae Bae, Alden L. Gross, Michelle C. Carlson, Dorry L.Segev. "Dementia, Alzheimer’s Disease, and Mortality after Hemodialysis Initiation". Clinical Journal of the American Society of Nephrology, (2018); CJN.10150917 DOI: 10.2215/CJN.10150917.
Elderly Patients OnDialysis Have A High Risk of Dementia - (https://www.jhsph.edu/news/news-releases/2018/elderly-patients-on-dialysis-have-a-high-risk-of-dementia.html)

Source-Medindia