title: Prevalence and significance of stroke symptoms among patients receiving maintenance dialysis.
abstract: OBJECTIVE
  The purpose of this cross-sectional study was to determine the prevalence and potential significance of stroke symptoms among end-stage renal disease (ESRD) patients without a prior diagnosis of stroke or TIA.
  
  
  METHODS
  We enrolled 148 participants with ESRD from 5 clinics. Stroke symptoms and functional status, basic and instrumental activities of daily living (ADL, IADL), were ascertained by validated questionnaires. Cognitive function was assessed with a neurocognitive battery. Cognitive impairment was defined as a score 2 SDs below norms for age and education in 2 domains. IADL impairment was defined as needing assistance in at least 1 of 7 IADLs.
  
  
  RESULTS
  Among the 126 participants without a prior stroke or TIA, 46 (36.5%) had experienced one or more stroke symptoms. After adjustment for age, sex, race, education, language, diabetes, and cardiovascular disease, participants with stroke symptoms had lower scores on tests of attention, psychomotor speed, and executive function, and more pronounced dependence in IADLs and ADLs (p ≤ 0.01 for all). After adjustment for age, sex, race, education, language, diabetes, and cardiovascular disease, participants with stroke symptoms had a higher likelihood of cognitive impairment (odds ratio [OR] 2.47, 95% confidence interval [CI] 1.03-5.92) and IADL impairment (OR 3.86, 95% CI 1.60-9.28).
  
  
  CONCLUSIONS
  Stroke symptoms are common among patients with ESRD and strongly associated with impairments in cognition and functional status. These findings suggest that clinically significant stroke events may go undiagnosed in this high-risk population.
authors.affiliation: Division of Nephrology, Stanford University School of Medicine, Palo Alto, CA, USA. mktamura@stanford.edu
authors.forename: Manjula
authors.initials: M
authors.lastname: Kurella Tamura
authors.forename: Jaclyn Biada
authors.initials: JB
authors.lastname: Meyer
authors.forename: Anjali B
authors.initials: AB
authors.lastname: Saxena
authors.forename: J W Terri
authors.initials: JW
authors.lastname: Huh
authors.forename: Virginia G
authors.initials: VG
authors.lastname: Wadley
authors.forename: Brigitte
authors.initials: B
authors.lastname: Schiller
mesh_terms: D000203:Activities of Daily Living; D000328:Adult; D000367:Age Factors; D000368:Aged; D000369:Aged, 80 and over; D001288:Attention; D003072:Cognition Disorders / Q000150:complications / Q000453:epidemiology* / Q000523:psychology; D003430:Cross-Sectional Studies; D056344:Executive Function; D005260:Female; D006304:Health Status; D006801:Humans; D008297:Male; D008875:Middle Aged; D009483:Neuropsychological Tests; D015995:Prevalence; D011597:Psychomotor Performance; D006435:Renal Dialysis; D020521:Stroke / Q000150:complications / Q000453:epidemiology* / Q000523:psychology; D011795:Surveys and Questionnaires