| [ Summary ] |
Cognitive dysfunction is prevalent among dialysis population. Cognitive dysfunction may be treated either non-pharmacologically or pharmacologically. The aims of such therapies include slowing cognitive decline and managing behavioral and psychological symptoms of dementia (BPSD). Two classes of drugs can be used for slowing cognitive decline. One class is choline esterase inhibitors and the other is the N-methyl-D-aspartate (NMDA) receptor blocker. Acetylcholine is known to be depleted in the brain of patients with Alzheimer disease, while glutamate levels increase. Choline esterase inhibitors increase the activity of cholinergic neurons. The NMDA receptor blocker modulate the function of NMDS receptors and protects neurons from cell death. The adverse effects of choline esterase inhibitors include gastrointestinal symptoms, which may be a dose-limiting symptom. Bradycardia is an uncommon but important adverse event to be monitored in patients taking choline esterase inhibitors. Although non-pharmacological therapy is preferred for management of BPSD, atypical antipsychotics, antidepressants, and Yoku-Kan-San are usually used for pharmacological management. The risks and benefits of drug therapy must, however, be balanced, because all of these drugs may potentially have adverse effects and may negatively affect the clinical outcomes. Several drugs, such as anticholinergic drugs or benzodiazepines, cause cognitive dysfunction. These drugs must be avoided in older dialysis patients. |