title: Cognitive Function and White Matter Changes Associated with Renal Transplantation.
abstract: BACKGROUND
  End-stage renal disease (ESRD) is a disease with an aging population and a high prevalence of cognitive impairment affecting quality of life, health care costs and mortality. Structural changes in the brain with decreased white matter integrity have been observed in ESRD. Understanding the changes in cognition and associated changes in brain structure after renal transplantation can help define the mechanisms underlying cognitive impairment in ESRD.
  
  
  METHODS
  We conducted a prospective, observational cohort study in ESRD patients listed for renal transplantation and followed them post-transplantation. We assessed their cognitive function with a battery of neuropsychological tests and brain white matter integrity with diffusion tensor imaging (DTI) both before transplant and 3 months after transplant.
  
  
  RESULTS
  Eleven patients, aged 56.5 ± 10.7 years, completed the study. Cognitive measures of memory and executive function improved after the transplant, specifically on tests of logical memory I (p = 0.004), logical memory II (p = 0.003) and digit symbol (p < 0.0001). DTI metrics also improved post the transplant with an increase in fractional anisotropy (p = 0.01) and decrease in mean diffusivity (p = 0.004). These changes were more prominent in tracts associated with memory and executive function.
  
  
  CONCLUSIONS
  Cognitive function, particularly memory and executive function, improve post the transplant with concurrent improvements in white matter integrity in tracts associated with memory and executive function. These data suggest that abnormalities in cognition and brain structure seen in the ESRD population are at least partially reversible.
authors.affiliation: Division of Nephrology, University of Kansas Medical Center, Kansas City, USA.
authors.forename: Aditi
authors.initials: A
authors.lastname: Gupta
authors.forename: Rebecca J
authors.initials: RJ
authors.lastname: Lepping
authors.forename: Alan S L
authors.initials: AS
authors.lastname: Yu
authors.forename: Rodrigo D
authors.initials: RD
authors.lastname: Perea
authors.forename: Robyn A
authors.initials: RA
authors.lastname: Honea
authors.forename: David K
authors.initials: DK
authors.lastname: Johnson
authors.forename: William M
authors.initials: WM
authors.lastname: Brooks
authors.forename: Jeffrey M
authors.initials: JM
authors.lastname: Burns
mesh_terms: D000368:Aged; D000375:Aging; D003071:Cognition; D060825:Cognitive Dysfunction / Q000209:etiology*; D015331:Cohort Studies; D056324:Diffusion Tensor Imaging; D056344:Executive Function; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D007676:Kidney Failure, Chronic / Q000150:complications / Q000523:psychology* / Q000601:surgery*; D016030:Kidney Transplantation; D008297:Male; D008568:Memory; D008875:Middle Aged; D009483:Neuropsychological Tests; D015995:Prevalence; D011446:Prospective Studies; D011788:Quality of Life; D066127:White Matter / Q000000981:diagnostic imaging / Q000503:physiopathology*