Publications by authors named "Stephen Harold Scott"

2 Publications

  • Page 1 of 1

Cerebral Perfusion in Hemodialysis Patients: A Feasibility Study.

Can J Kidney Health Dis 2021 6;8:20543581211010654. Epub 2021 May 6.

Centre for Neuroscience Studies, Queen's University, Kingston, ON, Canada.

Background: Patients on hemodialysis (HD) are known to exhibit low values of regional cerebral oxygenation (rSO2) and impaired cognitive functioning. The etiology of both is currently unknown.

Objective: To determine the feasibility of serially monitoring rSO2 in patients initiating HD. In addition, we sought to investigate how rSO2 is related to hemodynamic and dialysis parameters.

Design: Prospective observational study.

Setting: Single-center tertiary academic teaching hospital in Ontario, Canada.

Participants: Six patients initiating HD were enrolled in the study.

Methods: Feasibility was defined as successful study enrollment (>1 patient/month), successful consent rate (>70%), high data capture rates (>90%), and assessment tolerability. Regional cerebral oxygenation monitoring was performed 1 time/wk for the first year of dialysis. A neuropsychological battery was performed 3 times during the study: before dialysis initiation, 3 months, and 1 year after dialysis initiation. The neuropsychological battery included a traditional screening tool: the Repeatable Battery for the Assessment of Neuropsychological Status, and a robot-based assessment: Kinarm.

Results: Our overall consent rate was 33%, and our enrollment rate was 0.4 patients/mo. In total 243 rSO2 sessions were recorded, with a data capture rate of 91.4% (222/243) across the 6 patients. Throughout the study, no adverse interactions were reported. Correlations between rSO2 with hemodynamic and dialysis parameters showed individual patient variability. However, at the individual level, all patients demonstrated positive correlations between mean arterial pressure and rSO2. Patients who had more than 3 liters of fluid showed significant negative correlations with rSO2. Less cognitive impairment was detected after initiating dialysis.

Limitation: This small cohort limits conclusions that can be made between rSO2 and hemodynamic and dialysis parameters.

Conclusions: Prospectively monitoring rSO2 in patients was unfeasible in a single dialysis unit, due to low consent and enrollment rates. However, rSO2 monitoring may provide unique insights into the effects of HD on cerebral oxygenation that should be further investigated.

Trial Registration: Due to the feasibility nature of this study, no trial registration was performed.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1177/20543581211010654DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8114747PMC
May 2021

Robotic technology quantifies novel perceptual-motor impairments in patients with chronic kidney disease.

J Nephrol 2021 Jan 5. Epub 2021 Jan 5.

Centre for Neuroscience Studies, Queen's University, Kingston, ON, Canada.

Background: Neurocognitive impairment is commonly reported in patients with chronic kidney disease (CKD). The precise nature of this impairment is unclear, due to the lack of objective and quantitative assessment tools used. The feasibility of using robotic technology to precisely quantify neurocognitive impairment in patients with CKD is unknown.

Methods: Patients with stage 4 and 5 CKD with no previous history of stroke or neurodegenerative disease were eligible for study enrollment. Feasibility was defined as successful study enrollment, high data capture rates (>‚ÄČ90%), and assessment tolerability. Our assessment included a traditional assessment: The Repeatable Battery for the Assessment of Neuropsychological Status (RBANS), and a robot-based assessment: Kinarm.

Results: Our enrollment rate was 1.6 patients/month. All patients completed the RBANS portion of the assessment, with a 97.8% (range 92-100%) completion rate on Kinarm. Missing data on Kinarm were mainly due to time constraints. Data from 49 CKD patients were analyzed. Kinarm defined more individuals as impaired, compared to RBANS, particularly in the domains of perceptual-motor function (17-49% impairment), complex attention (22-49% impairment), and executive function (29-37.5% impairment). Demographic features (sex and education) predicted performance on some, but not all neurocognitive tasks.

Conclusions: It is feasible to quantify neurocognitive impairments in patients with CKD using robotic technology. Kinarm characterized more patients with CKD as impaired, and importantly identified novel perceptual-motor impairments in these patients, when compared to traditional assessments.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1007/s40620-020-00912-zDOI Listing
January 2021
-->