Neurobehavioral dysfunction in uremia

Abstract

To summarize our concepts relating to impaired function of the mind in uremic patients before and during treatment with maintenance dialysis, the emphasis had gradually shifted from the use of "static taxonomy", the diagnostic labels of mental illness, to a more dynamic and sympathetic appreciation that the observed behaviors represent patients' attempts to cope with disease and threats of disability and death, as influenced by varying levels of intelligence, education, cultural conditioning, life experiences and organization of personality defense mechanisms. The dialysis patient is aware that his behavior evokes reciprocal and complicating responses from important people in his environment. These interactions are perceived and conducted by neurochemical mechanisms of the brain which may be impaired in the abnormal chemical environment imposed by renal failure. It is the behaviors we perceive as indicators of disordered nervous mechanisms. Therefore, it is logical that neurobehavioral phenomena should be measured quantitatively in order 1) to estimate objectively the patients' success in achieving the goal of maintenance dialysis treatment, 2) to assess the comparative adequacy of dialysis regimens and 3) to provide objective end-point measures which are relevant to uremia for further investigations of the etiology and pathogenesis of these critically significant uremic manifestations. Our experimental results using ipsitive cognition performance tasks clearly suggest that discrete human performances may be evoked and employed to detect mentational impairments of uremia in quantitative terms, a fundamental step having central relevance to what dialysis does in controlling uremic symptoms.