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Intradialytic Cognitive and Exercise Training May Preserve Cognitive Function
McAdams-DeMarco MA, Konel J, Warsame F, Ying H, González Fernández M, Carlson MC, Fine DM, Appel LJ et al.. Kidney international reports, 2017-08-19
Topic: Risk, prevention and care in population studies
Introduction Cognitive decline is common and increases mortality risk in hemodialysis patients. Intradialytic interventions like cognitive training (CT) and exercise training (ET) may preserve cognitive function. Methods We conducted a pilot randomized controlled trial of 20 hemodialysis patients to study the impact of 3 months of intradialytic CT (tablet-based brain games) (n = 7), ET (foot peddlers) (n = 6), or standard of care (SC) (n = 7) on cognitive function. Global cognitive function was measured by the Modified Mini Mental Status Exam (3MS), psychomotor speed was measured by Trail Making Tests A and B (TMTA and TMTB), and executive function was assessed by subtracting (TMTB - TMTA). Lower 3MS scores and slower TMTA and TMTB times reflected worse cognitive function. P values for differences were generated using analysis of variance, and 95% confidence intervals (CIs) and P values were generated from linear regression. Results Patients with SC experienced a decrease in psychomotor speed and executive function by 3 months (TMTA: 15 seconds; P = 0.055; TMTB: 47.4 seconds; P = 0.006; TMTB - TMTA; 31.7 seconds; P = 0.052); this decline was not seen among those with CT or ET (all P > 0.05). Compared with SC, the difference in the mean change in 3MS score was -3.29 points (95% CI: -11.70 to 5.12; P = 0.42) for CT and 4.48 points (95% CI: -4.27 to 13.22; P = 0.30) for ET. Compared with SC, the difference in mean change for TMTA was -15.13 seconds (95% CI: -37.64 to 7.39; P = 0.17) for CT and -17.48 seconds (95% CI: -41.18 to 6.22; P = 0.14) for ET, for TMTB, the difference was -46.72 seconds (95% CI: -91.12 to -2.31; P = 0.04) for CT and -56.21 seconds (95% CI: -105.86 to -6.56; P = 0.03) for ET, and for TMTB - TMTA, the difference was -30.88 seconds (95% CI: -76.05 to 14.28; P = 0.16) for CT and -34.93 seconds (95% CI: -85.43 to 15.56; P = 0.16) for ET. Conclusion Preliminary findings of our pilot study suggested that cognitive decline in psychomotor speed and executive function is possibly prevented by intradialytic CT and ET. These preliminary pilot findings should be replicated.
Key findings
- Results Patients with SC experienced a decrease in psychomotor speed and executive function by 3 months (TMTA: 15 seconds; P = 0.055; TMTB: 47.4 seconds; P = 0.006; TMTB - TMTA; 31.7 seconds; P = 0.052); this decline was not seen among those with CT or ET (all P > 0.05).
- Compared with SC, the difference in the mean change in 3MS score was -3.29 points (95% CI: -11.70 to 5.12; P = 0.42) for CT and 4.48 points (95% CI: -4.27 to 13.22; P = 0.30) for ET.
- Compared with SC, the difference in mean change for TMTA was -15.13 seconds (95% CI: -37.64 to 7.39; P = 0.17) for CT and -17.48 seconds (95% CI: -41.18 to 6.22; P = 0.14) for ET, for TMTB, the difference was -46.72 seconds (95% CI: -91.12 to -2.31; P = 0.04) for CT and -56.21 seconds (95% CI: -105.86 to -6.56; P = 0.03) for ET, and for TMTB - TMTA, the difference was -30.88 seconds (95% CI: -76.05 to 14.28; P = 0.16) for CT and -34.93 seconds (95% CI: -85.43 to 15.56; P = 0.16) for ET.
- Conclusion Preliminary findings of our pilot study suggested that cognitive decline in psychomotor speed and executive function is possibly prevented by intradialytic CT and ET.
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Study details
- Study designrandomized controlled trial
- Evidence strengthHigh
How this study scored 69/100
Published in a peer-reviewed journal, and it is a randomised controlled trial. Scored zero for sample size, effect reported and studied in people because the record does not state it. We have no data on journal's citation record, times cited, citations per year, impact for its field and year, cited by studies here, still being cited, senior author's track record, institution's track record and multi-centre collaboration, so those were left out: it earned 40 of the 58 points we could judge it on, which is 69 out of 100.
| Component | Points | Why |
|---|---|---|
| Journal tier | 7 / 10 | Tier 3 — peer-reviewed journal (Kidney international reports) |
| Journal's citation record | — / 4 | No journal record from OpenAlex — left out of this score |
| Study design | 11 / 12 | A randomised controlled trial |
| Strength of evidence | 5 / 5 | Rated “high” in our summary |
| Peer-review validation | 10 / 10 | Peer-reviewed. Published as an article in a named peer-reviewed journal. |
| How recent | 2 / 5 | 2018 — within 10 year(s) of the newest study here |
| Sample size | 0 / 4 | Participant count not stated — scores zero (not stated in the record — scored 0) |
| Effect reported | 0 / 3 | No effect size reported — scores zero (not stated in the record — scored 0) |
| Studied in people | 0 / 3 | Not stated whether this was studied in people — scores zero (not stated in the record — scored 0) |
| Randomised / blinded | 1 / 2 | Randomised (as stated in the record) |
| Times cited | — / 7 | No citation count (not found in OpenAlex) — left out of this score |
| Citations per year | — / 5 | No citation count or no year — left out of this score |
| Impact for its field and year | — / 6 | No field-weighted citation impact (OpenAlex has none yet) — left out of this score |
| Cited by studies here | — / 6 | Not yet checked against this library's citation graph — left out of this score |
| Still being cited | — / 4 | No yearly citation counts — left out of this score |
| Senior author's track record | — / 4 | Senior author's record not available — left out of this score |
| Institution's track record | — / 3 | No institution listed in OpenAlex — left out of this score |
| Multi-centre collaboration | — / 3 | Institutions not listed — left out of this score |
| Indexed in PubMed | 2 / 2 | Indexed in PubMed (PMID 29340317) |
| Free to read | 2 / 2 | Free to read |
| Points | 40 / 58 | Scored on 11 of 20 parts. We have no data for the rest, so they are left out: 40 of the 58 points we could judge it on is 69 out of 100. |
| Total | 69 / 100 | — |
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APA 7th
McAdams-DeMarco, M. A., Konel, J., Warsame, F., Ying, H., González Fernández, M., Carlson, M. C., et al. (2018). Intradialytic Cognitive and Exercise Training May Preserve Cognitive Function. Kidney international reports. https://doi.org/10.1016/j.ekir.2017.08.006
Vancouver
McAdams-DeMarco MA, Konel J, Warsame F, Ying H, González Fernández M, Carlson MC, et al. Intradialytic Cognitive and Exercise Training May Preserve Cognitive Function. Kidney international reports. 2018. doi:10.1016/j.ekir.2017.08.006. PMID: 29340317.
BibTeX
@article{mcadamsdemarco2018-29340317,
author = {McAdams-DeMarco, M. A. and Konel, J. and Warsame, F. and Ying, H. and González Fernández, M. and Carlson, M. C. and Fine, D. M. and Appel, L. J. and others},
title = {{Intradialytic Cognitive and Exercise Training May Preserve Cognitive Function}},
journal = {Kidney international reports},
year = {2018},
doi = {10.1016/j.ekir.2017.08.006},
pmid = {29340317},
url = {https://doi.org/10.1016/j.ekir.2017.08.006}
}
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