Avaliação neuropsicológica, marcadores inflamatórios e de neuroimagem no comprometimento cognitivo em indivíduos com doença renal crônica não dialítica

Abstract

Cognitive impairment (CI) is the decline of one or more cognitive domains. There are pathophysiological factors common between chronic kidney disease (CKD) and CI. The aim of this study was to compare the results of neuropsychological assessment with findings of inflammatory markers and brain magnetic resonance (MRI) in patients with CKD. This is a cross-sectional study in patients with CKD not on dialysis in categories 1 to 5 in a secondary care clinic, from 2013 to 2014. The project was approved by the Research Ethics Committee. Structured anamnesis, application of clinical depression questionnaires, comprehensive neuropsychological screening and Pfeffer's functionality questionnaire were performed. Sociodemographic and clinical data were collected from medical records. Laboratory data were collected including the dosage of IL-4, IL-6, IL-17, TNF- and us-CRP. Brain MRI images were performed in a 1.5 Teslas high-field device, without the use of paramagnetic contrast. The Fazekas scale was used to quantify white matter lesions, the MTA scale to quantify hippocampal involvement, the ACG scale for global cortical atrophy. A total of 111 patients were invited, eighty completed the neuropsychological assessment and 56 patients underwent MRI and the other stages of the study. Mean age was 56.3 ± 8.3 years, 55.4% men, 51.8% had altered MoCA. Comparing those with changed MoCA vs. normal, it was observed that there was less education (p = 0.04), greater use of diuretics (p = 0.04) and aspirin (p = 0.002); in addition to higher levels of IL-6 (p = 0.02) and IL-17 (p = 0.05) among those with altered MoCA. There was no correlation between MoCA and eGFR. MoCA correlated with IL-6 (R -0.201, p = 0.04). There was a correlation between eGFR (IL-4 [R -0.467, p = 0.005]; IL-6 [R -0.652, p < 0.001]; IL-17 [R -0.554, p = 0.001]), TNF- (R -0.684, p < 0.001). In a linear regression model, the variables IL-17 and IL-6 were independent predictors of lower MoCA values (CI -0.031 to -0.002, p = 0.002; CI -0.012 to -0.001, p = 0.002). The other neuropsychological tests showed differences and associations with sociodemographic, laboratory and imaging data, with no single pattern of relationships having been determined. It was concluded that the prevalence of changes in MoCA in this population was 51.8%, eGFR was correlated with inflammation, MoCA was negatively correlated with IL-6. There was no association between MRI findings and eGFR or inflammatory variables, and unlike IL-17 and IL6, eGFR was not a predictor of MoCA values.