title: Cognitive dysfunction and depression in adult kidney transplant recipients: baseline findings from the FAVORIT Ancillary Cognitive Trial (FACT).
abstract: OBJECTIVE
  Hyperhomocysteinemia and B-vitamin deficiency may be treatable risk factors for cognitive impairment and decline. Hyperhomocysteinemia, cognitive impairment, and depression are all common in individuals with kidney disease, including kidney transplant recipients. Accordingly, we assessed the prevalence of cognitive impairment and depressive symptoms in transplant recipients and their association with kidney function, plasma total homocysteine, and B-vitamin concentrations.
  
  
  METHODS
  Cross-sectional analysis of baseline data from the Folic Acid for Vascular Outcome Reduction In Transplantation (FAVORIT) Ancillary Cognitive Trial (FACT), which included 183 participants in FAVORIT who underwent detailed neuropsychological assessment before the study intervention.
  
  
  RESULTS
  The mean age was 54.0 ± 9.5 years (range: 7 to 386 months). Men comprised 55.2% of the cohort, and the mean time between the current transplant and cognitive testing was 7.0 ± 5.8 years. Twenty-four percent of participants reported neurological or psychiatric complaints, and 30% exhibited symptoms of mild to severe depression. Testing revealed evidence of significant and selective deficits in this population: 33% performed more than 1 standard deviation (SD) below normed means on a memory test, 58% fell lower than 1 SD below the norms on a test of attention and mental processing speed, and 33% to 42% fell lower than 1 SD below the norms on several tests of executive function. Lower estimated glomerular filtration rate and lower folate were associated with poorer performance on tests of memory and executive function.
  
  
  CONCLUSIONS
  These observations confirm previous reports of mood and cognitive impairments in adult kidney transplant recipients. Further research is needed to determine the benefit of B-vitamin supplementation and other interventions in this patient population.
authors.affiliation: Nutrition and Neurocognition Laboratory, Jean Mayer USDA Human Nutrition Research Center on Aging, Tufts University, Boston, Massachusetts; Vitamin Metabolism and Aging Laboratory, Jean Mayer USDA Human Nutrition Research Center on Aging, Tufts University, Boston, Massachusetts; Institute of Biochemistry, Food Science and Nutrition, The Robert H. Smith Faculty of Agriculture, Food and Environment, The Hebrew University of Jerusalem, Rehovot, Israel. Electronic address: troen@agri.huji.ac.il.
authors.forename: Aron M
authors.initials: AM
authors.lastname: Troen
authors.affiliation: Department of Psychiatry, Tufts Medical Center, Tufts School of Medicine, Boston, Massachusetts; Nutrition and Neurocognition Laboratory, Jean Mayer USDA Human Nutrition Research Center on Aging, Tufts University, Boston, Massachusetts.
authors.forename: Tammy M
authors.initials: TM
authors.lastname: Scott
authors.affiliation: Nutrition and Neurocognition Laboratory, Jean Mayer USDA Human Nutrition Research Center on Aging, Tufts University, Boston, Massachusetts.
authors.forename: Kristen E
authors.initials: KE
authors.lastname: D'Anci
authors.affiliation: Nutrition and Neurocognition Laboratory, Jean Mayer USDA Human Nutrition Research Center on Aging, Tufts University, Boston, Massachusetts.
authors.forename: Denish
authors.initials: D
authors.lastname: Moorthy
authors.affiliation: Nutrition and Neurocognition Laboratory, Jean Mayer USDA Human Nutrition Research Center on Aging, Tufts University, Boston, Massachusetts.
authors.forename: Beverly
authors.initials: B
authors.lastname: Dobson
authors.affiliation: Nutritional Epidemiology Laboratory, Jean Mayer USDA Human Nutrition Research Center on Aging, Tufts University, Boston, Massachusetts.
authors.forename: Gail
authors.initials: G
authors.lastname: Rogers
authors.affiliation: Division of Nephrology, Tufts Medical Center, Tufts School of Medicine, Boston, Massachusetts.
authors.forename: Daniel E
authors.initials: DE
authors.lastname: Weiner
authors.affiliation: Division of Nephrology, Tufts Medical Center, Tufts School of Medicine, Boston, Massachusetts.
authors.forename: Andrew S
authors.initials: AS
authors.lastname: Levey
authors.affiliation: Biostatistics Laboratory, Jean Mayer USDA Human Nutrition Research Center on Aging, Tufts University, Boston, Massachusetts.
authors.forename: Gerard E
authors.initials: GE
authors.lastname: Dallal
authors.affiliation: Nutritional Epidemiology Laboratory, Jean Mayer USDA Human Nutrition Research Center on Aging, Tufts University, Boston, Massachusetts.
authors.forename: Paul F
authors.initials: PF
authors.lastname: Jacques
authors.affiliation: Vitamin Metabolism and Aging Laboratory, Jean Mayer USDA Human Nutrition Research Center on Aging, Tufts University, Boston, Massachusetts.
authors.forename: Jacob
authors.initials: J
authors.lastname: Selhub
authors.affiliation: Nutrition and Neurocognition Laboratory, Jean Mayer USDA Human Nutrition Research Center on Aging, Tufts University, Boston, Massachusetts.
authors.forename: Irwin H
authors.initials: IH
authors.lastname: Rosenberg
mesh_terms: D003072:Cognition Disorders / Q000209:etiology / Q000503:physiopathology*; D003430:Cross-Sectional Studies; D003863:Depression / Q000209:etiology / Q000503:physiopathology*; D019587:Dietary Supplements; D005260:Female; D005919:Glomerular Filtration Rate; D006710:Homocysteine / Q000097:blood; D006801:Humans; D020138:Hyperhomocysteinemia / Q000503:physiopathology; D007668:Kidney / Q000503:physiopathology; D007674:Kidney Diseases / Q000150:complications / Q000503:physiopathology; D016030:Kidney Transplantation; D016015:Logistic Models; D008297:Male; D008875:Middle Aged; D015337:Multicenter Studies as Topic; D016032:Randomized Controlled Trials as Topic; D014804:Vitamin B Deficiency / Q000503:physiopathology; D014815:Vitamins / Q000008:administration & dosage / Q000097:blood
chemical_list: D014815:Vitamins; D006710:Homocysteine