Prevalence, associated factors and clinical implications of subjective cognitive decline linked to frailty in patients receiving maintenance hemodialysis: A cross-sectional study

Abstract

Background Subjective cognitive decline (SCD) significantly increases a patient's risk of long-term cognitive decline and is common in adults. However, few studies have evaluated patients with end-stage renal disease receiving maintenance hemodialysis (MHD). In addition, the relationship between frailty and SCD in MHD patients remains unclear. Therefore, this study aims to assess the potential factors affecting SCD in MHD patients and to investigate the relationship between frailty and SCD. Methods This is a cross-sectional study. From December 2023 to April 2024, using convenience sampling method, a total of 171 patients from West China Hospital of Sichuan University were recruited to participate in this study. The demographic and sociological characteristics of the participants were assessed using a general information questionnaire. The subjective cognitive decline - questionnaire 9 (SCD - Q9), the Tilburg frailty indicator (TFI), the subjective global nutritional assessment (SGA) and grip dynamometer were used to assess participants' subjective cognitive level, frailty, nutrition status, and grip strengh, respectively. Univariate analyses examined potential factors associated with SCD. Linear regression was used to analyze the relationship between these factors and SCD. Spearman's correlation was used to assess the association between SCD and frailty. Results The 171 maintenance hemodialysis patients with subjective cognitive decline scores were 4.00 (2.00–7.00), and 95 patients (55.56%) with scores > 3 presented SCD. Linear regression analysis showed that gender, work status, grip strength, SGA, and frailty were influential factors in MHD, explaining a total of 38.80% of the total variation in SCD. Spearman's analysis showed that SCD was positively correlated with frailty in MHD patients (r = 0.431, P<0.001). Conclusions The prevalence of SCD in patients with MHD is common and correlates with certain patient characteristics, including gender, work status, grip strength, SGA, and frailty. Healthcare workers should pay attention to the assessment of subjective cognitive function in this population, stay alert to the risk factors of SCD, and take targeted interventions as early as possible, which can help to improve the quality of survival and slow down the occurrence of cognitive impairment.