Depression and cognitive function in maintenance hemodialysis patients.
BACKGROUND
Both depression and cognitive impairment are common in hemodialysis patients, are associated with adverse clinical outcomes, and place an increased burden on health care resources.


METHODS
Cross-sectional cohort.


METHODS
241 maintenance hemodialysis patients in the Boston, MA, area.


METHODS
Depressive symptoms, defined as a Center for Epidemiological Studies Depression Scale (CES-D) score ≥16.


RESULTS
Performance on a detailed neurocognitive battery.


RESULTS
Mean age was 63.8 years, 49.0% were women, 21.6% were African American, and median dialysis therapy duration was 13.8 months. There were 57 (23.7%) participants with significant depressive symptoms. In multivariable analysis adjusting for age, sex, education, and other comorbid conditions, participants with and without depressive symptoms performed similarly on the Mini-Mental State Examination (P = 0.4) and tests of memory. However, participants with greater depressive symptoms performed significantly worse on tests assessing processing speed, attention, and executive function, including Trail Making Test B (P = 0.02) and Digit-Symbol Coding (P = 0.01). Defining depression using a CES-D score ≥18 did not substantially change results.


CONCLUSIONS
Cross-sectional design, absence of brain imaging.


CONCLUSIONS
Hemodialysis patients with a greater burden of depressive symptoms perform worse on tests of cognition related to processing speed and executive function. Further research is needed to assess the effects of treating depressive symptoms on cognitive performance in dialysis patients.
Agganis
Brian T
BT
Division of Nephrology, Tufts Medical Center, Boston, MA, USA.
Weiner
Daniel E
DE
Giang
Lena M
LM
Scott
Tammy
T
Tighiouart
Hocine
H
Griffith
John L
JL
Sarnak
Mark J
MJ
D000328:Adult; D017677:Age Distribution; D000368:Aged; D000704:Analysis of Variance; D003072:Cognition Disorders / Q000175:diagnosis / Q000453:epidemiology* / Q000628:therapy; D015897:Comorbidity; D003430:Cross-Sectional Studies; D003866:Depressive Disorder / Q000175:diagnosis / Q000453:epidemiology* / Q000628:therapy; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D015994:Incidence; D007676:Kidney Failure, Chronic / Q000175:diagnosis / Q000453:epidemiology* / Q000628:therapy*; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D009483:Neuropsychological Tests; D011569:Psychiatric Status Rating Scales; D012016:Reference Values; D006435:Renal Dialysis / Q000009:adverse effects / Q000523:psychology / Q000706:statistics & numerical data*; D018570:Risk Assessment; D012720:Severity of Illness Index; D017678:Sex Distribution