Interventions to Preserve Cognitive Functioning among Older Kidney Transplant Recipients
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FRAILTY AND GERONTOLOGY (M MCADAMS-DEMARCO, SECTION EDITOR)
Interventions to Preserve Cognitive Functioning among Older Kidney Transplant Recipients Nadia M. Chu 1 & Dorry Segev 1 & Mara A. McAdams-DeMarco 1 Accepted: 7 October 2020 # Springer Nature Switzerland AG 2020
Abstract Purpose of Review To summarize the research on effective interventions for preserving cognitive function and prevent cognitive decline in patients with end-stage kidney disease (ESKD) who are undergoing dialysis and/or kidney transplantation (KT). Recent Findings Among ESKD patients undergoing hemodialysis, exercise training has been administered through home-based and intradialytic interventions. Additionally, one pilot study identified intradialytic cognitive training, electronic brain games, as an intervention to preserve cognitive function among patients undergoing hemodialysis. Fewer studies have investigated interventions to preserver cognitive function among KT recipients. To date, the only randomized controlled trial in this population identified B-vitamin supplements as an intervention to preserve cognitive function. The evidence from these trials support a short-term benefit of cognitive and exercise training as well as B-vitamin supplementation among patients with ESKD. Future studies should (1) replicate these findings, (2) identify interventions specific to KT candidates, and (3) investigate the synergistic impact of both cognitive and exercise training. Summary Cognitive prehabilitation, with cognitive and/or exercise training, may be novel interventions for KT candidates that not only reduces delirium risk and long-term post-KT cognitive decline but also prevents dementia. Keywords Kidney Transplantation . Cognitive Function . Interventions
Introduction Aging Patients with End-Stage Kidney Disease (ESKD) Older adults bear a higher burden of end-stage kidney disease (ESKD). In the USA, there has been a steady increase in the number of older adults (age ≥ 65 years) initiating hemodialysis such that in 2014, 49.6% of patients initiating HD were older adults [1]. In the last two decades, kidney transplantation (KT) has become a common treatment option for older patients with ESKD, approximately 19% of all KT recipients occurring among older adults. Furthermore, these patients live longer with a functioning graft, resulting in more older adults with a history of KT [2]. Consequently, many transplant centers have begun to recognize the importance of screening for This article is part of the Topical Collection on Frailty and Gerontology * Mara A. McAdams-DeMarco [email protected] 1
Department of Surgery, Johns Hopkins University School of Medicine, Baltimore, MD, USA
age-related vulnerability, and 75% of centers reported that screening for cognitive impairment was very important [3]. Below we summarize (1) the epidemiology of cognitive impairment in ESKD patients, (2) the tools used to screen for cognitive function and their applicability to ESKD patients, and (3) what interventions may apply to KT candidates and recipients for prev
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