Format

Send to

Choose Destination
Clin J Am Soc Nephrol. 2016 Jan 7;11(1):39-46. doi: 10.2215/CJN.02110215. Epub 2015 Oct 23.

Evaluation of Neurocognition in Youth with CKD Using a Novel Computerized Neurocognitive Battery.

Author information

1
Division of Nephrology, Department of Pediatrics and hartunge@Email.chop.edu.
2
Biostatistics Core, Clinical and Translational Research Center, and.
3
Division of Nephrology.
4
Department of Allied Health Sciences, University of North Carolina School of Medicine, Chapel Hill, North Carolina; and.
5
Department of Pediatrics and Division of Developmental and Behavioral Pediatrics, Children's Hospital of Philadelphia, Philadelphia, Pennsylvania;
6
Brain and Behavior Laboratory, Department of Psychiatry, University of Pennsylvania, Philadelphia, Pennsylvania.
7
Division of Nephrology, Department of Pediatrics and Department of Epidemiology, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, Pennsylvania;

Abstract

BACKGROUND AND OBJECTIVES:

Neurocognitive problems in CKD are well documented; time-efficient methods are needed to assess neurocognition in this population. We performed the first study of the efficient 1-hour Penn Computerized Neurocognitive Battery (CNB) in children and young adults with CKD.

DESIGN, SETTING, PARTICIPANTS, & MEASUREMENTS:

We administered the Penn CNB cross-sectionally to individuals aged 8-25 years with stage 2-5 CKD (n=92, enrolled from three academic nephrology practices from 2011 to 2014) and matched healthy controls (n=69). We analyzed results from 12 tests in four domains: executive control, episodic memory, complex cognition, and social cognition. All tests measure accuracy and speed; we converted raw scores to age-specific z-scores on the basis of Philadelphia Neurodevelopmental Cohort (n=1790) norms. We analyzed each test in a linear regression with accuracy and speed z-scores as dependent variables and with (1) CKD versus control or (2) eGFR as explanatory variables, adjusted for race, sex, and maternal education.

RESULTS:

Patients with CKD (mean±SD eGFR, 48±25 ml/min per 1.73 m(2); mean age, 16.3±3.9 years) and controls (mean eGFR, 98±20 ml/min per 1.73 m(2); mean age, 16.0±4.0 years) were similar demographically. CKD participants had lower accuracy than controls in tests of complex cognition, with moderate to large effect sizes: -0.53 (95% confidence interval [95% CI], -0.87 to -0.19) for verbal reasoning, -0.52 (95% CI, -0.83 to -0.22) for nonverbal reasoning, and -0.64 (95% CI, -0.99 to -0.29) for spatial processing. For attention, patients with CKD had lower accuracy (effect size, -0.35 [95% CI, -0.67 to -0.03]) but faster response times (effect size, 0.44 [95% CI, 0.04 to 0.83]) than controls, perhaps reflecting greater impulsivity. Lower eGFR was associated with lower accuracy for complex cognition, facial and visual memory, and emotion identification tests.

CONCLUSIONS:

CKD is associated with lower accuracy in tests of complex cognition, attention, memory, and emotion identification, which related to eGFR. These findings are consistent with traditional neurocognitive testing in previous studies.

KEYWORDS:

attention; children, adolescents; chronic kidney disease; cognition; executive function; humans; memory; neuropsychological; psychological tests

PMID:
26500247
PMCID:
PMC4702221
DOI:
10.2215/CJN.02110215
[Indexed for MEDLINE]
Free PMC Article

Supplemental Content

Full text links

Icon for HighWire Icon for PubMed Central
Loading ...
Support Center