Cosgrove, Dearbhla and Simpson, Jane (2016) Cognitive impairment in chronic kidney disease : are oculomotor tests an effective detection marker? Masters thesis, Lancaster University.
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Abstract
People with chronic kidney disease (CKD) are at increased risk of developing cognitive impairment (CI) compared to the general population, in fact, it has been estimated that 60% of people with CKD are cognitively impaired. Despite this high percentage, there is no adequate screening process for the detection of CI in this high risk population. Lack of a suitable diagnostic tool therefore allows impairment to go unchecked, increasing the risk of dementia evolution. Previous research has demonstrated that oculomotor tasks may be advantageous over traditional neuropsychological measures for detecting CI in early Alzheimer’s disease, specifically uncorrected error rate in the anti-saccade paradigm. This particular measure examines individuals’ inhibitory control, self-monitoring and executive functioning abilities. Consequently, these facets of cognitive functioning are commonly found to be impaired in people with CKD. This study aimed to investigate the effectiveness of uncorrected error rate in the anti-saccade paradigm as a detection tool for CI in people with CKD. In a cross-sectional design, 44 CKD patients and 25 controls completed the anti-saccade task and a neuropsychological battery that assessed global ability, working memory, and executive function. The prevalence of CI was evaluated, as was the anti-saccade task’s ability in predicting the extent of cognitive impairment. Subsequently, it was found that uncorrected error rate was significantly higher in those with advanced CKD requiring haemodialysis, as was prevalence of CI according to scores in the neuropsychological battery. Furthermore, uncorrected error rate was predictive of deterioration in some cognitive abilities, namely visuospatial memory, verbal working memory, and verbal inhibitory control with small to moderate effect sizes. These results support previous research in that those with advanced CKD are more likely to have CI when compared to the general population. They also represent the first exploration of the anti-saccade paradigm as a monitoring tool for CI in CKD, and indicate that the antisaccade task has the potential to act as a cost and time-effective means of periodically assessing certain domains of cognition in people with CKD. Despite this, further work using the anti-saccade paradigm longitudinally and in larger population sizes is needed to confirm its use in clinical practice.