Zusammenfassung
Angesichts ihrer hohen Prävalenz besitzen kognitive Auffälligkeiten bei Patienten mit chronischer Nierenerkrankung unmittelbare praktische Relevanz. Charakterisiert durch kognitive Verlangsamung, Aufmerksamkeitsdefizite, Störungen der Planung, Initiierung und Umsetzung von Handlungen, sowie Sprach- und Gedächtnisstörungen ist die kognitive Beeinträchtigung bei Patienten mit chronischer Niereninsuffizienz meist Folge einer subkortikalen arteriosklerotischen Enzephalopathie. Letzterer liegt in der Regel eine systemische Mikroangiopathie zugrunde, die sich im Gehirn vor allem in der weißen Substanz manifestiert und kernspintomographisch durch Hyperintensitäten in T2-gewichteten Sequenzen nachgewiesen werden kann. Die Therapie umfasst die Behandlung der chronischen Niereninsuffizienz, der gemeinsamen Risikofaktoren von chronischer Nierenerkrankung und subkortikaler arteriosklerotischer Enzephalopathie sowie, bei Vorliegen des Vollbilds einer Demenz, ggf. die Verordnung von Antidementiva.
Abstract
In view of the high prevalence, cognitive abnormalities have a direct relevance in patients with chronic kidney disease. Characterized by cognitive slowing, attention deficits, disturbances in the planning, initiation and implementation of actions as well as language and memory deficits, cognitive impairment in patients with chronic kidney disease is mostly the consequence of subcortical arteriosclerotic encephalopathy. Subcortical arteriosclerotic encephalopathy usually results from systemic microangiopathy, which in the brain is most strongly manifested in the white matter. In magnetic resonance imaging, hyperintensities in T2-weighted images can be detected. Therapeutic approaches involve the treatment of chronic kidney disease, management of joint risk factors of chronic kidney disease and subcortical arteriosclerotic encephalopathy and the prescription of anti-dementia drugs for patients with the clinical symptoms of dementia.
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Hermann, D., Grotz, W. Kognitive Beeinträchtigung bei chronischer Nierenerkrankung. Nephrologe 8, 323–326 (2013). https://doi.org/10.1007/s11560-012-0739-3
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DOI: https://doi.org/10.1007/s11560-012-0739-3
Schlüsselwörter
- Chronische Niereninsuffizienz
- Frontal-exekutive Funktionsstörung
- Subkortikale arteriosklerotische Enzephalopathie
- Vaskuläre Demenz
- Zerebrale Mikroangiopathie