Recently I read an article written by a Type 1 Diabetic about the use of a Continuous Glucose Monitor as a central tenant to their diabetic control. In this article, the author used the term “Cognitive Burden” several times. I am not familiar with this terminology due in part to my concentration on STEM courses in college to obtain Engineering degrees. When possible, I try to backfill this void in my education. The following is such an attempt, a modest research effort on what is behind the term “Cognitive Burden” and how, if at all, does it relate to my current situation – being on Dialysis?
Introduction:
Cognitive burden refers to the mental workload or demand imposed on an individual’s cognitive resources, including attention, memory, and decision-making capacity. Patients undergoing dialysis have a high cognitive burden due to the nature of the treatment, which involves long hours of treatment, multiple sessions per week, and strict dietary and fluid restrictions. The aim of this blog is to explore the cognitive burden experienced by dialysis patients and its impact on their quality of life.
Literature Review:
Dialysis is a life-saving treatment for patients with end-stage renal disease (ESRD) who have lost the ability to filter waste and excess fluids from their bodies. However, the treatment imposes a high cognitive burden on patients, which can affect their quality of life. The cognitive burden may be attributed to the following factors:
- Treatment duration and frequency: Dialysis treatment sessions can last for several hours-or every night in my case for PD patients, and patients may require multiple sessions per week. This can lead to fatigue, boredom, and reduced cognitive function.
- Dietary and fluid restrictions: Dialysis patients are often required to follow strict dietary and fluid restrictions to prevent fluid overload and electrolyte imbalances. This can be challenging for patients and requires constant vigilance and self-monitoring, which can add to the cognitive burden.
- Medication management: Dialysis patients often take multiple medications, including those for managing their kidney disease, comorbidities, and side effects of dialysis. Managing these medications can be complex and require careful attention to dosing, timing, and interactions with other medications. Using myself as an example, I am taking 16 different medications, all of which except one – OsteoBiflex, are prescribed. I take some at breakfast, some at night, one MWF, two every two weeks, etc. It gets complicated in a hurry.
Several studies have investigated the impact of a cognitive burden on dialysis patients’ quality of life. One study found that cognitive impairment was associated with poorer health-related quality of life and increased mortality in dialysis patients (Kurella Tamura et al., 2010). Another study found that cognitive function was a significant predictor of adherence to fluid restrictions among dialysis patients (Song et al., 2018). A systematic review also identified cognitive impairment as a common problem among dialysis patients and highlighted the need for further research to explore interventions to improve cognitive function in this population (Kurella Tamura et al., 2016).
Discussion:
The high cognitive burden experienced by dialysis patients can have significant implications for their quality of life and treatment outcomes. Patients may struggle with adhering to dietary and fluid restrictions, managing medications, and coping with the physical and emotional demands of dialysis. These challenges can lead to anxiety, depression, and reduced treatment adherence, which can, in turn, negatively impact their health and well-being.
To mitigate the cognitive burden experienced by dialysis patients, several interventions have been proposed. These include cognitive training programs, educational interventions to improve self-management skills, and technological solutions such as mobile apps and wearable devices to assist with medication management and monitoring of fluid intake. However, further research is needed to determine the efficacy and feasibility of these interventions in improving cognitive function and reducing the cognitive burden of dialysis.
Conclusion:
The cognitive burden is a significant challenge for dialysis patients, affecting their quality of life, treatment adherence, and outcomes. More research is needed to identify effective interventions to mitigate the cognitive burden experienced by dialysis patients and improve their cognitive function and quality of life. Healthcare providers should be aware of the cognitive burden imposed by dialysis treatment and work with patients to develop strategies to manage the cognitive demands of their treatment.
References:
- Kurella Tamura, M., Yaffe, K., Hsu, C. Y., Yang, J., Sozio, S., Fischer, M., … Go, A. S. (2010). Cognitive impairment and poor health literacy are associated with mortality in hemodialysis. Journal of the American Society of Nephrology, 21(11), 1970–1979.
- Song, M. K., Lin, F. C., Gilet, C. A., Arnold, R. M., Bridgman, J. C., Ward, S. E., & Dunbar-Jacob, J. (2018). Symptom clusters in patients with end-stage renal disease prior to starting dialysis. Journal of Pain and Symptom Management, 55(1), 153-160. doi: 10.1016/j.jpainsymman.2017.08.026
- Kurella Tamura, M., Xie, D., Yaffe, K., Cohen, D. L., Teal, V., Kasner, S. E., … Hsu, C. Y. (2016). Vascular risk factors and cognitive impairment in chronic kidney disease: The Chronic Renal Insufficiency Cohort (CRIC) Study. Clinical Journal of the American Society of Nephrology, 11(7), 1144–1153. doi: 10.2215/CJN.11951115
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