Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
. 2015 Dec 3;10(12):e0143706.
doi: 10.1371/journal.pone.0143706. eCollection 2015.

Clinical Significance of Fronto-Temporal Gray Matter Atrophy in Executive Dysfunction in Patients with Chronic Kidney Disease: The VCOHP Study

Kazuhiko Tsuruya  1   2 , Hisako Yoshida  1 , Naoki Haruyama  2 , Kiichiro Fujisaki  2 , Hideki Hirakata  3 , Takanari Kitazono  2
Affiliations

Clinical Significance of Fronto-Temporal Gray Matter Atrophy in Executive Dysfunction in Patients with Chronic Kidney Disease: The VCOHP Study

Kazuhiko Tsuruya et al. PLoS One. .

Abstract

Background & objectives: It is well known that cognitive impairment in patients with chronic kidney disease (CKD) is characterized by executive dysfunction, rather than memory dysfunction, although the precise mechanism of this remains to be elucidated. The purpose of the present study is to examine the correlation between gray matter volume (GMV) and executive function in CKD patients.

Design, setting, participants, measurements: This cross-sectional study recruited 95 patients with non-dialysis-dependent CKD (NDD-CKD) with no history of cerebrovascular disease, who underwent brain magnetic resonance imaging (MRI) and Trail Making Test (TMT) in the VCOHP Study. The subjects underwent brain MRI and TMT part A (TMT-A) and part B (TMT-B). The segmentation algorithm from Statistical Parametric Mapping 8 software was applied to every T1-weighted MRI scan to extract tissue maps corresponding to gray matter, white matter, and cerebrospinal fluid. GMV was normalized by dividing by the total intracranial volume, calculated by adding GMV, white matter volume, and cerebrospinal fluid space volume. Then, normalized whole-brain GMV was divided into four categories of brain lobes; frontal, parietal, temporal, and occipital. We assessed the correlation between normalized GMV and TMT using multivariable regression analysis.

Results: Normalized whole-brain GMV was significantly inversely correlated to the scores of TMT-A, TMT-B, and ΔTMT (TMT-B minus TMT-A). These correlations remained significant even after adjusting for relevant confounding factors. Normalized frontal and temporal GMV, but not parietal and occipital GMV, were significantly inversely correlated with TMT-A, TMT-B, and ΔTMT using multivariable regression analysis.

Conclusions: The present study demonstrates the correlation between normalized GMV, especially in the frontal and temporal lobes, and executive function, suggesting that fronto-temporal gray matter atrophy might contribute to executive dysfunction in NDD-CKD.

PubMed Disclaimer

Conflict of interest statement

Competing Interests: The authors have declared that no competing interests exist.

Figures

Fig 1
Fig 1. Segmentation of brain magnetic resonance imaging (MRI) and normalization of gray matter volume (GMV) and white matter volume (WMV).
Representative axial brain image of T1-weighted MRI and segmented images of gray matter, white matter, and cerebrospinal fluid are shown. To normalize for head size variability, GMV and WMV were normalized by dividing by the total intracranial volume, calculated by adding GMV, WMV, and cerebrospinal fluid space volume.
Fig 2
Fig 2. Correlations between age and normalized gray matter volume (GMV) and normalized white matter volume (WMV).
A significant inverse correlation is found between age and normalized GMV (A), while no correlation is found between age and normalized WMV (B).
Fig 3
Fig 3. Correlations between normalized gray matter volume (GMV) and the scores (times in seconds) of Trail Making Test (TMT).
Significant inverse correlations are found between normalized GMV and each score of TMT-A (A), TMT-B (B), and ΔTMT (C).
Fig 4
Fig 4. Correlations between normalized white matter volume (WMV) and the scores (times in seconds) of Trail Making Test (TMT).
No correlations are found between normalized WMV and each score of TMT-A (A), TMT-B (B), and ΔTMT (C).
See this image and copyright information in PMC

References

    1. Kurella Tamura M, Wadley V, Yaffe K, McClure LA, Howard G, Go R, et al. Kidney function and cognitive impairment in US adults: the Reasons for Geographic and Racial Differences in Stroke (REGARDS) Study. Am J Kidney Dis 2008;52: 227–234. 10.1053/j.ajkd.2008.05.004 - DOI - PMC - PubMed
    1. Bugnicourt JM, Godefroy O, Chillon JM, Choukroun G, Massy ZA. Cognitive disorders and dementia in CKD: the neglected kidney-brain axis. J Am Soc Nephrol 2013;24: 353–363. 10.1681/ASN.2012050536 - DOI - PubMed
    1. Fukunishi I, Kitaoka T, Shirai T, Kino K, Kanematsu E, Sato Y. Psychiatric disorders among patients undergoing hemodialysis therapy. Nephron. 2002;91: 344–347. - PubMed
    1. Madero M, Gul A, Sarnak MJ. Cognitive function in chronic kidney disease. Semin Dial. 2008;21: 29–37. 10.1111/j.1525-139X.2007.00384.x - DOI - PubMed
    1. O'Brien JT, Erkinjuntti T, Reisberg B, Roman G, Sawada T, Pantoni L, et al. Vascular cognitive impairment. Lancet Neurol. 2003;2: 89–98. - PubMed

MeSH terms