Brain magnetic resonance imaging and cognitive function in patients receiving hemodialysis

Abstract Background and Aims Chronic kidney disease is high risk to adverse events including stroke, cardiovascular diseases and cognitive decline. Cognitive function was known to be linked to chronic kidney disease. The Fazefa's scale, which was used for assessing white matter hyperdensities(WMH), has been reported to associate with poor cognitive performance. We aim to investigate the associations between mini-mental status examination (MMSE), Montreal cognitive assessment (MoCA), cognitive abilities screening instrument (CASI) and Fazefa's scale in patients under hemodialysis (HD). Method The periventricular (PV) and deep white matter (DWM) lesions in brain MR images of 59 patients under dialysis for at least 90 days were graded by Fazefa's scale. Cognition function tests including MMSE, MoCA, and CASI were performed. Multivariable ordinal regression and logistic regression were used for identifying the associations between cognitive performance and Fazekas scale. Results Inverse associations were found between three cognitive function tests across the Fazekas scale of PV lesions (p = 0.037, 0.006 and 0.008 for MMSE, MoCA, and CASI, respectively), and higher scales were associated with lower cognitive function scores in trend; however, the association attenuated in the DWM group. In subdomains of CASI, significant differences were identified in five subdomains, including short-term memory, mental manipulation, abstract thinking, spatial construction, and name fluency; nevertheless, in DWM hyperdensities, only abstract thinking and short-term memory showed obvious correspondence. Conclusion Inverse correlation between the Fazefa's scale, predominantly in PV lesions, and cognition was detected in HD patients. The Fazefa's scale of PV lesions were associated with cognitive performance assessed by MMSE, MoCA and CASI, as well as with subdomains of CASI such as memory, language, and name fluency in HD patients.