Diagnosis and Management of Dementia for the Nephrology Clinician: A Review

Abstract

Dementia describes when a person has cognitive limitations that impede function. Persons with kidney disease are unduly impacted by dementia: up to 87% of the dialysis population has cognitive impairment. In this review, we discuss the diagnosis and management of dementia, including the role of cerebrovascular disease and other risk factors. We review the available screening tools for the diagnosis of dementia. We discuss how the diagnosis of dementia differs from the diagnosis of mild cognitive impairment and also detail how delirium and depression can mimic dementia. In terms of treatments for dementia, we highlight 4 components. First, we describe pharmacologic treatments for the management of dementia, including the cholinesterase inhibitors N-methyl-d-aspartate antagonists as well as the newer antiamyloid antibody drugs for Alzheimer dementia. Second, we discuss the importance of nonpharmacologic interventions for the management of dementia, especially exercise. Third, we review approaches for the behavioral and neuropsychiatric symptoms associated with dementia, including potential medication management. Fourth, we highlight the essential and valuable role of caregivers in both the diagnosis and management of dementia. We conclude with key considerations about the impact of dementia for persons receiving dialysis and the role of dementia in kidney transplant evaluation.

Keywords: Alzheimer’s disease; Alzheimer’s disease and related dementias; NMDA agonist; anti-amyloid; care partners; caregivers; cholinesterase inhibitors; chronic kidney disease; cognition; cognitive impairment; delirium; dementia; depression; dialysis; kidney; kidney transplant; mild cognitive impairment; mixed dementia; renal; renal transplant; uremia; vascular dementia.