Hypoalbuminemia and not hyperhomocysteinemia as a risk factor for dementia in hemodialysis patients.
BACKGROUND
The most common causes of morbidity and mortality in uremic patients are cardiovascular disease and central nervous system dysfunction. However, the exact causes of dementia in uremic patients remain unclear. This study attempted to determine which risk factors are associated with dementia in hemodialysis patients.


METHODS
In total, 147 chronic uremic patients receiving regular hemodialysis treatment were recruited. Data for risk factors regarding cardiovascular disease and dementia, such as hypertension, diabetes mellitus, smoking, age, illiteracy, serum levels of albumin, cholesterol, triglycerides, and homocysteine, and liver function, were recorded. The Mini-Mental Status examination was used to assess mental function, and the Hachinski ischemic scale was applied to differentiate among dementia types. The diagnosis of dementia was based on criteria from the Diagnostic and Statistical Manual of Mental Disorders-Fourth Edition.


RESULTS
Twenty-six patients were diagnosed as manifesting dementia. Of all patients with dementia, 21 had a Hachinski score of 0 to 4, and 5 had a score of 7 to 10. In a multiple logistic regression analysis, low serum albumin and illiteracy were significantly associated with dementia. However, no difference existed between the two groups in terms of homocysteine levels.


CONCLUSIONS
This study demonstrated that uremic patients were prone to nonvascular dementia. We conclude that hypoalbuminemia and not hyperhomocysteinemia is a risk factor for dementia in hemodialysis patients.
Department of Neurology, Chang Gung Memorial Hospital, Chang Gung Institute of Technology, Chiayi, Taiwan.
Ying-Chih
YC
Huang
Ya-Wen
YW
Kuo
Tsong-Hai
TH
Lee
Meng
M
Lee
Ming-Chang
MC
Hsiao
Chia-Lian
CL
Wang
Jiann-Der
JD
Lee
D000328:Adult; D000367:Age Factors; D000368:Aged; D000369:Aged, 80 and over; D003704:Dementia / Q000453:epidemiology / Q000209:etiology*; D005260:Female; D006801:Humans; D020138:Hyperhomocysteinemia / Q000150:complications* / Q000523:psychology; D034141:Hypoalbuminemia / Q000150:complications* / Q000523:psychology; D016015:Logistic Models; D008297:Male; D008875:Middle Aged; D006435:Renal Dialysis; D012307:Risk Factors; D014511:Uremia / Q000150:complications / Q000523:psychology