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Abstract：
BACKGROUND: Cognitive impairment (CI) is common in both end-stage kidney disease (ESKD) and alcohol-related liver cirrhosis. The aim of this study was to assess the prevalence and patterns of CI in patients awaiting kidney and liver transplantation, and to identify its determinants.
METHODS: In this cross-sectional, prospective study, 31 consecutive patients with ESKD and 31 consecutive patients with alcohol-related liver cirrhosis, all currently on transplant waiting lists, were screened for cognitive decline using the Addenbrooke\'s Cognitive Examination. Medical history, demographics, and laboratory test results were also collected.
RESULTS: The prevalence of CI among patients with ESKD and alcohol-related liver cirrhosis was 26% and 90%, respectively. In both groups, memory was the most affected cognitive domain, along with verbal fluency in patients with ESKD, and visuospatial abilities in patients with alcoholic cirrhosis. The most statistically significant increase in the prevalence of CI was found in patients with lower educational attainment, in both alcohol-related liver cirrhosis and ESKD populations as well as in older patients with alcoholic cirrhosis. Furthermore, better cognitive functioning in ESKD patients was associated with higher levels of total lymphocyte count and alanine transaminase (ALT), and in alcohol-related liver cirrhosis patients with higher levels of ALT and aspartate transaminase. A nonsignificant trend toward lower memory domain scores was also observed with increasing ammonia levels and increasing severity of liver disease (higher Child-Pugh scores). Finally, suboptimal performance on the screening test was correlated with the severity of liver disease as assessed by the Model for End-Stage Liver Disease Sodium (MELD-Na), but not at the statistically significant level.
CONCLUSIONS: The prevalence of CI, especially in patients with alcohol-related liver cirrhosis, is high and can be a significant clinical problem, negatively affecting the transplantation process. Routine screening tests in this group would contribute to the implementation of appropriate management, such as rehabilitation program or psychosocial treatments and facilitate the provision of specialized health care.
METHODS: In this cross-sectional, prospective study, 31 consecutive patients with ESKD and 31 consecutive patients with alcohol-related liver cirrhosis, all currently on transplant waiting lists, were screened for cognitive decline using the Addenbrooke\'s Cognitive Examination. Medical history, demographics, and laboratory test results were also collected.
RESULTS: The prevalence of CI among patients with ESKD and alcohol-related liver cirrhosis was 26% and 90%, respectively. In both groups, memory was the most affected cognitive domain, along with verbal fluency in patients with ESKD, and visuospatial abilities in patients with alcoholic cirrhosis. The most statistically significant increase in the prevalence of CI was found in patients with lower educational attainment, in both alcohol-related liver cirrhosis and ESKD populations as well as in older patients with alcoholic cirrhosis. Furthermore, better cognitive functioning in ESKD patients was associated with higher levels of total lymphocyte count and alanine transaminase (ALT), and in alcohol-related liver cirrhosis patients with higher levels of ALT and aspartate transaminase. A nonsignificant trend toward lower memory domain scores was also observed with increasing ammonia levels and increasing severity of liver disease (higher Child-Pugh scores). Finally, suboptimal performance on the screening test was correlated with the severity of liver disease as assessed by the Model for End-Stage Liver Disease Sodium (MELD-Na), but not at the statistically significant level.
CONCLUSIONS: The prevalence of CI, especially in patients with alcohol-related liver cirrhosis, is high and can be a significant clinical problem, negatively affecting the transplantation process. Routine screening tests in this group would contribute to the implementation of appropriate management, such as rehabilitation program or psychosocial treatments and facilitate the provision of specialized health care.
摘要：
背景：认知功能障碍（CI）在终末期肾病（ESKD）和酒精相关性肝硬化中都很常见。这项研究的目的是评估等待肾脏和肝脏移植的患者中CI的患病率和模式。并确定其决定因素。
方法：在此横截面中，前瞻性研究，31例ESKD患者和31例酒精相关性肝硬化患者，目前都在移植等待名单上，使用Addenbrooke的认知检查筛查认知能力下降。病史,人口统计，并收集了实验室测试结果。
结果：在ESKD和酒精性肝硬化患者中，CI的患病率分别为26%和90%，分别。在这两组中,记忆是受影响最大的认知领域，随着ESKD患者的言语流利，酒精性肝硬化患者的视觉空间能力。在受教育程度较低的患者中，CI患病率的统计学差异最大。在酒精相关性肝硬化和ESKD人群以及老年酒精性肝硬化患者中。此外，在ESKD患者更好的认知功能与更高水平的总淋巴细胞计数和丙氨酸转氨酶（ALT），和酒精相关性肝硬化患者ALT和天冬氨酸转氨酶水平较高。随着氨水平的增加和肝脏疾病的严重程度的增加（较高的Child-Pugh评分），也观察到了较低的记忆域评分的不显着趋势。最后,筛选试验的次优性能与终末期肝病钠模型（MELD-Na）评估的肝病严重程度相关，但没有达到统计学上的显著水平。
结论：CI的患病率，尤其是在酒精相关性肝硬化患者中，很高，可能是一个重大的临床问题，对移植过程产生负面影响。该组的常规筛选测试将有助于实施适当的管理,例如康复计划或社会心理治疗，并促进提供专门的医疗保健。
方法：在此横截面中，前瞻性研究，31例ESKD患者和31例酒精相关性肝硬化患者，目前都在移植等待名单上，使用Addenbrooke的认知检查筛查认知能力下降。病史,人口统计，并收集了实验室测试结果。
结果：在ESKD和酒精性肝硬化患者中，CI的患病率分别为26%和90%，分别。在这两组中,记忆是受影响最大的认知领域，随着ESKD患者的言语流利，酒精性肝硬化患者的视觉空间能力。在受教育程度较低的患者中，CI患病率的统计学差异最大。在酒精相关性肝硬化和ESKD人群以及老年酒精性肝硬化患者中。此外，在ESKD患者更好的认知功能与更高水平的总淋巴细胞计数和丙氨酸转氨酶（ALT），和酒精相关性肝硬化患者ALT和天冬氨酸转氨酶水平较高。随着氨水平的增加和肝脏疾病的严重程度的增加（较高的Child-Pugh评分），也观察到了较低的记忆域评分的不显着趋势。最后,筛选试验的次优性能与终末期肝病钠模型（MELD-Na）评估的肝病严重程度相关，但没有达到统计学上的显著水平。
结论：CI的患病率，尤其是在酒精相关性肝硬化患者中，很高，可能是一个重大的临床问题，对移植过程产生负面影响。该组的常规筛选测试将有助于实施适当的管理,例如康复计划或社会心理治疗，并促进提供专门的医疗保健。
