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The relationship between MCI and physical function, including handgrip strength and gait speed, has been previously evaluated among older adults with predialysis CKD 16 however, it was reported that gait speed, but not handgrip strength, was significantly associated with MCI.
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Handgrip strength is used as a reliable test to determine the functioning of skeletal muscle and is an independent predictor of all-cause mortality in patients on maintenance dialysis 15 additionally, it can be easily measured. The reliability and validity of the Japanese version of the MoCA (MoCA-J) have been proven, and it has been recommended for geriatric health screening in the Japanese community 12 using a cut-off point of 25/26, the MoCA-J demonstrated a sensitivity of 93.0% and specificity of 87.0% for screening MCI.įrailty has also been associated with poor cognitive function in patients on HD 13, while physical exercise has been shown to improve cognitive function in patients with end-stage kidney disease 14. A MoCA score ≤ 21 demonstrated a high predictive ability, sensitivity of 86%, and specificity of 55% for severe cognitive impairment, with a negative predictive value of 91% 11. The Montreal Cognitive Assessment (MoCA) is a screening test for cognitive impairment that evaluates major cognitive domains-including episodic memory, language, attention, orientation, visuospatial ability, and executive functions,-while remaining brief and easy to administer 10. MCI is also considered a transitional stage, preceding clinical dementia. MCI is characterized by mild disorders in several key cognitive domains, including the executive functions of memory (learning and attention), problem solving (processing), and self-control (emotion-depression) 8 it has been reported that dialysis initiation is associated with the loss of executive function, with no change in other aspects of cognition 9. To identify dementia, it is essential to detect mild cognitive impairment (MCI) as early as possible. A kidney-brain axis has been proposed based on many reports therefore, it is plausible that the prevalence of cognitive dysfunction is higher in patients with CKD than in patients with normal kidney function 7. Additionally, neurotoxicity is well known to be directly caused by uremic toxins 4. We previously reported that hippocampal atrophy significantly correlated with hyperhomocysteinemia in patients on hemodialysis (HD) 5, and demonstrated that regional cerebral blood flow decreased in all these patients, irrespective of their clinical symptoms or Mini-Mental State Examination (MMSE) scores 6. Furthermore, nontraditional vascular risk factors-such as hyperhomocysteinemia, hypercoagulable states, inflammation, and oxidative stress-which are common in CKD, have been linked to cognitive impairment. The brain and kidneys have many common anatomic and vasoregulatory features as they are low-resistance end organs exposed to high-volume blood flow, and susceptible to vascular damage 4. While silent brain infarcts and lacunar infarcts are well known to be associated with dementia 2, we previously demonstrated that lacunar infarctions were more prevalent in patients with CKD, particularly those with decreased renal function and a creatinine clearance of < 40 mL/min/1.73m 2 3. A decrease in handgrip strength would allow for the early detection of MCI, especially among patients on HD aged under 70 years with a history of CVA.Ĭognitive impairment is commonly observed in patients with chronic kidney disease (CKD) 1.
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Handgrip strength may be useful for the easy detection of MCI. A high prevalence of MCI and decreased handgrip strength were observed in patients on HD. We found, among patients on HD aged under 70 years with a history of CVA, a handgrip strength < 90% (25.2 kg in males and 16.2 kg in females) correlated with significantly lower MoCA-J scores. Both the MoCA-J score and MoCA-J executive score were associated with age, history of cerebrovascular disease (CVA), and handgrip strength after adjustments. The median MoCA-J score was 25 (IQR 21–27), and MCI was confirmed in 245 (58.2%) patients.
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The mean age was 69.8 ± 11.2 years, and the median dialysis vintage 74.5 (IQR 30–150) months. The Montreal Cognitive Assessment-Japan (MoCA-J) score and handgrip strength were measured. We retrospectively evaluated the prevalence of mild cognitive impairment (MCI) in 421 patients on maintenance HD across nine facilities and investigated whether decreased handgrip strength was associated with decreased cognitive function. Dementia is associated with a high risk of death and hospitalization among patients on hemodialysis (HD).