How Can You Limit Your Risk Of Dementia With Kidney Disease
There are several ways to minimize the risk of dementia with kidney disease, such as home dialysis treatment. Peritoneal dialysis has consistently proven to have fewer negative effects on cognitive function. The existing studies that outline positive effects of more frequent hemodialysis are promising as well, despite limited research. What is available suggests that more frequent hemodialysis has significant benefits for blood pressure and other organ health.
In the meantime, patients should consider the following lifestyle adjustments:
What Are Anxiety Disorders
A person with an Anxiety disorder feels distressingly worried a lot of the time for no apparent reason, interfering with their ability to function and to take pleasure in life.There are several types of Anxiety disorders.
- Generalised anxiety disorder is characterised by worry that is persistent, excessive or unrealistic. It can be about almost anything money, work, health, relationships or being harmed.
- Social anxiety disorder involves intense anxiety associated with social situations. For example, someone affected may become nauseous with fear at the thought of attending a work function or a family gathering.
- Obsessive compulsive disorders make people feel compelled to act or think in a certain way to avoid irrational feelings of anxiety. For example, someone with a clean house may become convinced that it is dirty. They might react by obsessively cleaning the kitchen, making them late for work.
Other forms of Anxiety disorders include Panic disorder and phobias extreme fears of everyday situations, or of needles, for example.Other symptoms of an anxiety disorder may include:
- Worrying excessively or persistently.
- Racing heart, headaches or stomach aches.
Develop A Plan For Crisis Situations
Work out a plan for coping day-by-day and for when a crisis occurs. Involve the person with the illness and the treating health professionals in the process. See How to help in a crisis.Discuss strategies for when symptoms begin to recur or when the person talks about suicide, for example. Suicidal thoughts should always be taken seriously and discussed with the treating professionals. If possible it helps to collaborate on a plan for how to support a person with their distress and suicidal thoughts. Our factsheet and guide for Families, Friends and Carers can help with this process.
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Recognise The Warning Signs
Depression and Anxiety can come and go. This means we need to recognise early warning signs that an episode is coming on, so that it is not allowed to develop if possible.Anticipate a situation that will be particularly stressful having a transplant is a major example. Are there certain thoughts or attitudes associated with a period of Depression or Anxiety starting? Do we become more short-tempered? If others observe a change in us, we should take these concerns seriously and not dismiss them.When you notice these signs, dont dwell on them and worry, but do things you know will relax you, and make an appointment to see a doctor so that action can be taken to avert or alleviate the episode.
Depression Can Also Be A Result Of Physical Changes
Some depression symptoms may be the result of physical changes caused by kidney failure, such as anaemia. The build up of waste products in your blood can also cause changes in:
- Behaviour including irritability, edginess, moodiness, memory loss and confusion.
- Problems with sleep resulting in fatigue, low energy levels, depression and anger.
Many people are not aware that certain medications, such as those used to counter rejection of a transplant, can also have Depression, Anxiety and moodiness as direct side-effects.Discuss your concerns with your nephrologist or pharmacist, and ask for a Medicines Information Pamphlet to see a full list of side-effects.Finally, Anxiety and Depression are common, and affect many people anyway. You may just happen by chance to become anxious or depressed at the same time as you become physically ill.There are a number of factors that can help to protect you from the effects of depression and anxiety. These include trying to have an easy-going approach to life, a social support network, support through ongoing medical and mental health care, having stable relationships, and being willing to adapt and work on problems.
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Is The Kidney Connected To The Brain
Physicist and technologist discuss a direct link between the brain and the kidney.Organisms within the central nervous system and the kidneys have significant overlap.Afferents within the central nervous system increase kidney blood flow, speed up glomerular filtration rate , and make dialysis difficult and inefficient.
How To Get Professional Help
Professional treatment for mental health depends on how severe your issues are and what works best for you. There are two main types of treatment available: therapy and medicine. It is important to work with a qualified mental health provider to find the right treatment plan. Mental health providers include psychologists, psychiatrists, social workers, therapists and counselors. They will help diagnose your mental health condition and provide treatment.Therapy or counseling: involves talking with a mental health provider about your condition, feelings, thoughts and behaviors. For many people, therapy alone may be the best option for treatment.
One type of talk therapy that is effective at treating depression, anxiety and drug and alcohol overuse is cognitive behavioral therapy . This therapy uses different strategies to change your thinking and behavior patterns.
You have several options for finding a mental health provider:
- Ask your doctor or social worker for a referral or recommendation
- Ask your health insurance company for a list of covered providers
- Ask a trusted family member, friend or religious leader for recommendations
- Check out the list of resources below for professional organizations that provide directories of mental health providers across the country
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How To Prevent A Kidney Infection
Preventing a kidney infection is really all about preventing urinary tract infections and getting prompt treatment if you ever get one. Sorry, but dont rely on cranberry juice or supplements for thisthe science is far too mixed to consider either of these a definitive UTI-prevention method. Instead, whenever you feel a bladder infection coming on, make it a habit to drink enough water every day to stay hydrated. That will ensure youre peeing often enough to help flush out bacteria that could lead to an infection. The NIDDK recommends peeing as often as you get the urge, but definitely at least every three to four hours, since urine hanging out in your bladder for too long may help bacteria to grow, the organization says.
Kaufman also stresses the importance of urinating like a fire hose after sex. It might even be helpful to skip peeing before sex as long as that doesnt make you uncomfortable, he says. This allows you to build up a forceful stream that may better help remove any bacteria that might have been pushed up there during sex.
Also, we referenced this above, but its important to reiterate: After you pee , you should be sure to wipe from front to back, as wiping back to front can spread harmful bacteria from your rectum to your urethra, where it can cause an infection.
Why Can Depression And Anxiety Disorders Be Difficult To Recognise Sometimes
Some of the physical symptoms of Depression and Anxiety such as feeling tired, poor sleep and loss of appetite may be similar to those caused by CKD or its treatment. When the focus is on treating the kidney disease, symptoms of Depression and Anxiety may not be recognised.Symptoms of Depression or Anxiety may also seem hard to describe. Fear of being dismissed as neurotic or not listened to, can make people reluctant to discuss symptoms. It can take courage to talk openly about how you feel and to ask for help.Discuss these feelings with a social worker or doctor they can help to sort out whether it is your physical illness, Depression or Anxiety that is responsible for them. See the Life Options Factsheet, Work with your Doctor.Sometimes we might disregard how we feel because we think that intense sadness or worry are simply to be expected with CKD. This is not true. Just because someone has kidney disease doesnt mean they will experience actual Depression or an Anxiety disorder.If you are concerned that you, or someone you know, may have Depression or an Anxiety disorder, and want to speak to someone confidentially, contact the SANE Help Centre on 1800 18 SANE or call the Kidney Health Information Service on 1800 682 531.
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Subclinical Cerebrovascular Disease: Silent Infarcts And White Matter Disease
In addition to clinically evident acute stroke, hemodialysis patients are at increased risk for subclinical cerebrovascular disease , manifested by silent or asymptomatic strokes, and white matter disease, or leukoariosis. Silent strokes are diagnosed on brain magnetic resonance imaging as infarcts. White matter disease is represented by hyperintense signals on T2- weighted images in the subcortical white matter. Both are linked to cognitive and physical function decline in the general population, and both are very common in CKD and dialysis patients .
Silent strokes occur in up to 33 percent of the older community population , or 5 times more common than symptomatic strokes . Among CKD patients, the prevalence of silent infarcts is inversely reported to kidney function as measured by cystatin C in the Cardiovascular Health Study among hemodialysis patients in another study, the prevalence was 49 percent, or 5 times more common than in control subjects . Silent strokes are associated with increased risk of subsequent clinically evident stroke, cognitive and physical decline, and incident dementia in both the general and CKD/dialysis populations .
How To Prevent Utis In Seniors
Older adults can help prevent UTIs by drinking plenty of fluids to flush the bacteria from their systems, Forciea says. She recommends older adults drink four to six 8-ounce glasses of water a day. Forciea further notes that drinking cranberry juice or taking cranberry tablets also can make urine less inviting for bacteria.
Use these strategies to help prevent UTIs in elderly women:
- Urinating promptly after the urge arises
- Wiping front to back
- Emptying the bladder shortly after sex
- Taking showers instead of baths
If your loved one has frequent UTIs or other challenges that require help with daily tasks, consider talking to one of our Senior Living Advisors about home care or senior living options that can improve their quality of life.
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What Is Kidney Disease
The kidneys are fist-sized organs located at the bottom of the ribcage, toward the back of the torso. Their primary job is to filter excess fluids and waste out of the blood and dispose of them through urine. Chronic kidney disease is a condition in which the kidneys progressively lose their functionality. It is most commonly caused by diabetes and high blood pressure, and progresses through five stages, characterized by how well the kidneys are doing their job. The final stage is also known as end-stage renal disease . At this point, the kidneys have stopped working completely and the patient receives treatment called dialysis, where a filtration machine cleanses the blood in place of the kidneys.
Does This Patient Have Cognitive Dysfunction In Chronic Kidney Disease
Cognitive impairment increases in prevalence with chronic kidney disease severity, potentially affecting up to 60% of CKD patients. There may also be specific domains of cognition that are impaired for patients with CKD, such as executive cognitive function. Similar to the general population, a dementia diagnosis is more common among the elderly, women, and non-white patients with end-stage renal disease , and less common among patients receiving peritoneal dialysis and transplant recipients, possibly reflecting patient selection and ascertainment bias.
Screening and diagnosis
Cognitive impairment is defined as a new deficit in more than one of the domains of cognitive functioning, which include disturbances in memory, executive functioning, orientation, reasoning, attention, language and cognitive skills necessary for planning and sequencing tasks.Cognitive impairment in the domains of memory, attention, and executive function is common among patients with CKD and dialysis. Studies reveal that working memory and executive function, two key domains of cognitive ability, are potentially important factors in medication compliance.
Mild cognitive impairment is the term given to patients who are not normal because of deficits in more than one cognitive domain but who appear to function independently in daily functioning. Cognitive impairment without dementia is also associated with increased risk for disability, increased health care costs, and progression to dementia.
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Mental Confusion At The End Of Life
Mental confusion or delirium is common at the end of a person’s life. Some people believe that hallucinations at the end of life are part of the dying process. Treatment may not be needed if the hallucinations are not upsetting. For example, people may see family members or friends who have already died. This can be comforting. But if it is unpleasant or scary, treatment can help.
There are several medications available that can make a person with confusion or delirium more comfortable. The doctor may recommend sedation if a person with delirium is very agitated and they do not improve with other treatments. Sedation is medication that puts a person into a deep sleep. The goal of sedation is to make the person feel comfortable, not to speed up death. It may be hard for family and friends when their loved one does not interact as much.
Deciding how to treat mental confusion or delirium depends on the person with cancer and their preferences. If possible, people should talk with their health care team ahead of time about their treatment options and consider putting their health care wishes in writing.
Should Catheters Be Used
Catheters historically have been thought of as a way to respond to problems with incontinence, but their use is not recommended unless absolutely medically necessary. The insertion of a catheter can introduce more bacteria into the urinary system and this increases the risk significantly for UTIs. A UTI that develops in someone using a catheter is called a Cather Associated Urinary Tract Infection , and the medical community has worked hard to reduce these preventable infections.
Catheters are appropriate for some conditions such as urinary retention, where someone is unable to completely empty their bladder, but they are not recommended without a specific medical condition that makes the necessary.
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What Tests To Perform
General screening tests
Given the high prevalence of impairment among patients with CKD and the implications of a diagnosis on decision-making and compliance, screening for cognitive impairment needs to start in the early CKD stage for the reference of baseline functioning. Several screening tests are available with a range of administration times and diagnostic accuracy. Scores on screening instruments are influenced by age, gender, educational level, and language such as English fluency.
The Mini-Mental State Exam has become the most frequently used and studied method for assessing cognitive status in the general population. It assesses orientation, attention, immediate and short-term recall, language, and the ability to follow simple verbal and written commands. The maximum score is 30 and a score less than 24 is consistent with cognitive impairment. Normative scores for age and educational level have been published.
The MMSE lacks sufficient sensitivity for mild cognitive impairment and assessment of executive function, which is a prominent feature of cognitive impairment among patients with ESRD. Another drawback is may be availability since it is under copyright. Newer instruments such as the Modified MMSE , the clock drawing test , and Montreal Cognitive Assessment have been developed, which have improved sensitivity, address executive functioning, and decrease educational bias.
Specific cognitive tests
Figure 1.
Evaluation of cognitive function.
Cognitive Impairment And Dementia
Cognitive impairment is defined as a new deficit in two or more areas of cognitive function. In milder forms, cognitive impairment may not interfere with daily functioning. In contrast, dementia is characterised by persistent cognitive decline and behavioural disturbance that is severe enough to interfere with independence and daily functioning. CKD is an independent risk factor for progressive cognitive impairment and dementia. Dementia presents an important clinical complication as it can result in poor health literacy, medical adherence and is a powerful predictor of mortality in dialysis patients., While cognitive impairment is recognised as a common complication of CKD, it remains poorly identified. The reported prevalence of cognitive impairment in dialysis is estimated at between 30% and 60% while less than 5% of patients have clinically documented histories of cognitive impairment.
Evidence suggests that both the prevalence and progression of cognitive impairment are inversely associated with the level of kidney function. Several large population-based studies have demonstrated an increased risk of cognitive decline in the presence of moderate CKD including an 11% increased prevalence of cognitive impairment per 10mL/min/1.73m2 decrease in eGFR.
Diagnosis and management
Acute manifestations of altered mental status
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Are Utis A Sign Of Dementia
Urinary tract infections can exacerbate dementia symptoms, but a UTI does not necessarily signal dementia or Alzheimers.
As the Alzheimers Society explains, UTIs can cause distressing behavior changes for a person with Alzheimers. These changes, referred to as delirium, can develop in as little as one to two days. Symptoms of delirium can range from agitation and restlessness to hallucinations or delusions.
Further, UTIs can speed up the progression of dementia, making it crucial for caregivers to understand how to recognize and limit risks for UTIs in seniors.
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Support Groups For Caregivers
Ask the dialysis centres social worker, the Kidney Health Information Service or the SANE Helpline, to refer you to a support group of other caregivers who are dealing with the same issues.Many hospitals have support groups and invite educational speakers to talk. You can learn many things about coping with CKD and mental illness which will help.
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