Cognitive Dysfunction and Depression in Adult Kidney Transplant Recipients: Baseline Findings from the FAVORIT Ancillary Cognitive Trial (FACT)

Aron M. Troen*, Tammy M. Scott, Kristen E. D'Anci, Denish Moorthy, Beverly Dobson, Gail Rogers, Daniel E. Weiner, Andrew S. Levey, Gerard E. Dallal, Paul F. Jacques, Jacob Selhub, Irwin H. Rosenberg

*Corresponding author for this work

Research output: Contribution to journalArticlepeer-review

28 Scopus citations

Abstract

Objective: Hyperhomocysteinemia and B-vitamin deficiency may be treatable risk factors for cognitive impairment and decline. Hyperhomocysteinemia, cognitive impairment, and depression are all common in individuals with kidney disease, including kidney transplant recipients. Accordingly, we assessed the prevalence of cognitive impairment and depressive symptoms in transplant recipients and their association with kidney function, plasma total homocysteine, and B-vitamin concentrations. Setting: Cross-sectional analysis of baseline data from the Folic Acid for Vascular Outcome Reduction In Transplantation (FAVORIT) Ancillary Cognitive Trial (FACT), which included 183 participants in FAVORIT who underwent detailed neuropsychological assessment before the study intervention. Results: The mean age was 54.0 ± 9.5 years (range: 7 to 386 months). Men comprised 55.2% of the cohort, and the mean time between the current transplant and cognitive testing was 7.0 ± 5.8 years. Twenty-four percent of participants reported neurological or psychiatric complaints, and 30% exhibited symptoms of mild to severe depression. Testing revealed evidence of significant and selective deficits in this population: 33% performed more than 1 standard deviation (SD) below normed means on a memory test, 58% fell lower than 1 SD below the norms on a test of attention and mental processing speed, and 33% to 42% fell lower than 1 SD below the norms on several tests of executive function. Lower estimated glomerular filtration rate and lower folate were associated with poorer performance on tests of memory and executive function. Conclusions: These observations confirm previous reports of mood and cognitive impairments in adult kidney transplant recipients. Further research is needed to determine the benefit of B-vitamin supplementation and other interventions in this patient population.

Original languageAmerican English
Pages (from-to)268-276.e3
JournalJournal of Renal Nutrition
Volume22
Issue number2
DOIs
StatePublished - Mar 2012

Bibliographical note

Funding Information:
Funding Supported: This research was supported by grant RO1 DK65114 and Cooperative agreement UO1 DK61700 from the National Institute of Diabetes and Digestive and Kidney Diseases , with additional financial support from the Office of Dietary Supplements, National Institutes of Health, Department of Health and Human Services , and by cooperative research agreement 58-1950-4-401 with the U.S. Department of Agriculture.

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