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. 2022 Jun;31(2):e1909.
doi: 10.1002/mpr.1909. Epub 2022 Mar 15.

Cognitive impairment and microvascular function in end-stage renal disease

Susanne Angermann  1 , Roman Günthner  1 , Henner Hanssen  2 , Georg Lorenz  1 , Matthias C Braunisch  1 , Dominik Steubl  1 , Julia Matschkal  1 , Stephan Kemmner  1   3 , Renate Hausinger  1 , Zenonas Block  1 , Bernhard Haller  4 , Uwe Heemann  1 , Konstantin Kotliar  5 , Timo Grimmer  6 , Christoph Schmaderer  1
Affiliations

Cognitive impairment and microvascular function in end-stage renal disease

Susanne Angermann et al. Int J Methods Psychiatr Res. 2022 Jun.

Abstract

Objective: Hemodialysis patients show an approximately threefold higher prevalence of cognitive impairment compared to the age-matched general population. Impaired microcirculatory function is one of the assumed causes. Dynamic retinal vessel analysis is a quantitative method for measuring neurovascular coupling and microvascular endothelial function. We hypothesize that cognitive impairment is associated with altered microcirculation of retinal vessels.

Methods: 152 chronic hemodialysis patients underwent cognitive testing using the Montreal Cognitive Assessment. Retinal microcirculation was assessed by Dynamic Retinal Vessel Analysis, which carries out an examination recording retinal vessels' reaction to a flicker light stimulus under standardized conditions.

Results: In unadjusted as well as in adjusted linear regression analyses a significant association between the visuospatial executive function domain score of the Montreal Cognitive Assessment and the maximum arteriolar dilation as response of retinal arterioles to the flicker light stimulation was obtained.

Conclusion: This is the first study determining retinal microvascular function as surrogate for cerebral microvascular function and cognition in hemodialysis patients. The relationship between impairment in executive function and reduced arteriolar reaction to flicker light stimulation supports the involvement of cerebral small vessel disease as contributing factor for the development of cognitive impairment in this patient population and might be a target for noninvasive disease monitoring and therapeutic intervention.

Keywords: cerebral small vessel disease; cognitive impairment; dialysis; retinal vessels.

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Conflict of interest statement

Nothing to report.

Figures

FIGURE 1
FIGURE 1
a: Screenshot of dynamic retinal vessel analysis with examined arteriole (red), venule (blue), as well as optic nerve head (#) and macula (*). b and c: Example for median time‐diameter curves of arteriolar and venular diameters in one of the examined patients. aMax and vMax are detected near the end of flickering episode. Thick lines represent median of three measurements; thin lines represent single measurements
FIGURE 2
FIGURE 2
Relationship between MoCA and Visuospatial Executive VSE results and parameters of dynamic retinal vessel analysis. Scatter‐Dot Plots for MoCA score with aMax (a) and vMax (b), as well as VSE functions with aMax (c) and vMax (d). Spearman rho is displayed for each association. Lines represent linear regression (a,b) and mean for each category (c,d). MoCA: Montreal Cognitive Assessment, VSE: Visuospatial Executive (0–5 points attainable), aMax: maximum arteriolar dilation, vMax: maximum venular dilation
See this image and copyright information in PMC

References

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