Disfunção cognitiva em doença renal crônica pré-dialítica: uma revisão sistemática
DOI:
https://doi.org/10.34024/rnc.2021.v29.11431Palavras-chave:
disfunção cognitiva, demência, doença renal, insuficiência renal crônicaResumo
Introdução. No Brasil, a população com mais de 65 anos pode chegar a 25,5%, em 2060. Com o envelhecimento populacional ocorre um aumento da prevalência das doenças degenerativas, dentre as quais o comprometimento cognitivo (CC). Impacto semelhante é observado na doença renal crônica (DRC). Existem fatores fisiopatológicos comuns entre a DRC e o CC. Dentre pacientes com DRC, até 38% apresentam CC. Em relação à fisiopatologia das alterações cognitivas na DRC, os achados são controversos. Objetivo. Avaliar os estudos relacionados à disfunção cognitiva na população com DRC pré-dialítica. Método. Utilizamos as estratégias PRISMA. Selecionamos os unitermos “renal insufficiency, chronic” and “cognitive disfunction”, realizamos a revisão sistemática e não meta-análise dada a disparidade dos estudos. Utilizamos as bases de dados disponíveis de forma gratuita: PubMed, Scielo. A seleção dos artigos foi realizada por dois pesquisadores. Critérios de inclusão: apresentar resumo em língua portuguesa, inglesa, espanhola ou francesa; incluir pacientes em pré-diálise; utilizar avaliações clínicas e/ou laboratoriais e/ou de imagens. Resultados. Encontramos 116 artigos e avaliamos 51. Conclusão. O CC é frequente na DRC e a etiologia permanece em discussão. A maioria dos estudos é derivada de dados secundários de grandes coortes ou estudos transversais. Os instrumentos clínicos mais utilizados são o MEEM e o MoCA e de neuroimagem, a ressonância magnética. Poucos estudos avaliam a inflamação e as toxinas urêmicas. Os mecanismos do CC na DRC são diversos, nem sempre correlacionados, existindo uma grande lacuna no melhor entendimento da associação fisiopatológica destas duas importantes morbidades.
Downloads
Métricas
Referências
Teixeira H. Ciências da aprendizagen – Teorias e conceitos básicos – O que é cognição? [citado em 10 de outubro de 2020] <http://www.helioteixeira.org/ciencias-da-aprendizagem/teorias-e-conceitos-chava-o-que-e-cognicao/>
Rosano A, Botto LD, Botting B, Mastroiacovo P. Infant mortality and congenital anomalies from 1950 to 1994: an international perspective. J Epidemiol Community Health. 2000 Sep;54(9):660-6. doi: 10.1136/jech.54.9.660.
Verity C, Firth H, and French-Constant C. Congenital abnormalities of the central nervous system. J Neurol Neurosurg Psychiatry 2003;74(Suppl I):i3–i8 doi: 10.1136/jnnp.74.suppl_1.i3
Barros ML, Fernandes DA, Melo EV, Porto RLS, Maia MCA, Godinho AS et al. Malformações do sistema nervoso central e malformações associadas diagnosticadas pela ultrassonografia obstétrica. Radiol Bras. 2012 Nov/Dez;45(6):309–314. doi.org/10.1590/S0100-39842012000600005
Gallucci NJ, Tamelini MG, Forlenza OV. Diagnóstico diferencial das demências. Rev. Psiq. Clín. 2005; 32 (3):119-130 doi.org/10.1590/S0101-60832005000300004.
Radanovic M, Stella F. & Forlenza O. Comprometimento cognitivo leve Mild cognitive impairment. Revista de Medicina. 2015;162-8.94(3):162-168. doi.org/10.11606/issn.1679-9836.v94i3p162-168
Diretrizes Sociedade Brasileira de Diabetes 2019/2020[citado em 10 de oututubro de 2020] [citado em 10 de outubro de 2020]<https://www.diabetes.org.br/profissionais/images/DIRETRIZES-COMPLETA-2019-2020.pdf>.
United Nations, Department of Economic and Social Affairs, Population Division (2017). World Population Ageing 2017 - Highlights. [citado em 10 de outubro de 2020] <https://www.un.org/en/development/desa/population/publications/pdf/ageing/WPA2017_Highlights.pdf>
Instituto Brasileiro de Geografia e Estatistica (IBGE). Pesquisa Nacional por Amostra de Domicílios Contínua- Pnad Contínua/maio de 2019. [citado em 10 de outubro de 2020] Disponível em: https://www.ibge.gov.br/estatisticas/sociais/trabalho/17270-pnad-continua.html?=&t=o-que-e
Lopes MA, e Bottino CMC. Prevalência de demência em diversas regiões do mundo- Análise dos estudos epidemiológicos de 1994 a 2000. Arq Neuropsiquiatr 2002;60(1):61-69. doi.org/10.1590/S0004-282X2002000100012.
Scazufca M, Cerqueira ATAR, Menezes PR, Prince M, Vallada HP, Miyazaki MCOS et al. Investigaçöes epidemiológicas sobre demência nos países em desenvolvimento. Rev. saúde pública.2002; 36(6): 773-778.
Caramelli P, Carvalho VA. Doença de Alzheimer. In Teixeira, A L; Caramelli, P. Neurologia Cognitiva e do Comportamento. Rio de Janeiro: Revinter, 2012, p.246 – 259. ISBN: 8537204056/ISBN-13: 9788537204054
Engelhardt E, Moreira DM. Demência Vascular. In Teixeira, A L; Caramelli, P. Neurologia Cognitiva e do Comportamento Rio de Janeiro: Revinter, 2012 p.297- 310. ISBN: 8537204056/ISBN-13: 9788537204054
Bello AK, Levin A, Lunney M, Osman MA, Ye F, Ashuntantang G et al. Global Kidney Health Atlas: A report by the International Society of Nephrology on the Global Burden of End-stage Kidney Disease and Capacity for Kidney Replacement Therapy and Conservative Care across World Countries and Regions. International Society of Nephrology, Brussels Belgium 2019; [citado em 10 de outubro de 2020]Disponível
Vos T, Lim SS, Abbafati C, Abbas KM, Abbasi M, Abbasifard M et al. Global burden of 369 diseases and injuries in 204 countries and territories, 1990–2019: a systematic analysis for the Global Burden of Disease Study 2019. The Lancet 2020;396(10258):1204–1222. doi:10.1016/s0140-6736(20)30925-9
Schmidt MI, Duncan BB, e Silva GA, Menezes AM, Monteiro CA, Barreto SM et al. Chronic non-communicable diseases in Brazil: burden and current challenges. The Lancet2011; 377(9781):1949–1961. doi:10.1016/s01406736(11)60135-9
Kurella TM, Yaffe K, Hsu C, Yang J, Sozio S, Fischer M et al. Cognitive Impairment and Progression of CKD. American Journal of Kidney Diseases, 2016; 68(1); 77–83. doi:10.1053/j.ajkd.2016.01.026
Levin A, Stevens PE, Bilous RW, Coresh J,Francisco ALM, De Jong PE et al. Kidney Disease: Improving Global Outcomes (KDIGO) CKD Work Group. KDIGO 2012 Clinical Practice Guideline for the Evaluation and Management of Chronic Kidney Disease. Kid Int Suppl 2013; 3: 1–150.doi: 10.1038/kisup.2012.73
Etgen T, Chonchol M, Förstl H, Sander D. Chronic Kidney Disease and Cognitive Impairment: A Systematic Review and Meta-Analysis. Am J Nephrol 2012;35:474–482 doi: 10.1159/000338135
Donald M, Kahlon BK, Beanlands H, Straus S, Ronksley P, Herrington G et al. Self-management interventions for adults with chronic kidney disease: a scoping review. BMJ Open 2018; 8:e019814. doi:10.1136/ bmjopen-2017-019814
Blatt B & Tsushima WT. A Psychological Survey of Uremic Patients Being Considered for the Chronic Hemodialysis Program: Intellectual and Emotional Patterns in Uremic Patients. Nephron 1966; 3(4): 206–208. doi:10.1159/000179535
Tyler HR: Neurologic disorders in renal failure. Am J Med 1968; 44:734-746.doi: 10.1016/0002-9343(68)90255-6
Heilman KM, Moyer RS, Melendex F, Schwartz HD and Miller BD. A Memory Defect in Uremic Encephalopathy Journal of the Neurological Sciences, 1975; 26(2):245-249.doi: 10.1016/0022-510x(75)90036-2
Stewart RS & Stewart RM. Neuropsychiatric aspects of chronic renal disease. Psychosomatics 1979; 20(8):524–531. doi:10.1016/s0033-3182(79)70775-4
Brouns R & De Deyn PP. Neurological complications in renal failure: a review, Clinical Neurology and Neurosurgery 2004; 107:1–16. Doi: 10.1016/j.clineuro.2004.07.012
Burn DJ & Bates D. Neurology and the kidney. J Neurol Neurosurg Psychiatry 1998; 65:810–82. Doi: 10.1136/jnnp.65.6.810
Kuriyama N, Mizuno T, Ohshima Y, Yamada K, Ozaki E, Shigeta M et al. Intracranial deep white matter lesions (DWLs) are associated with chronic kidney disease (CKD) and cognitive impairment: A 5-year follow-up magnetic resonance imaging (MRI) study. Archives of Gerontology and Geriatrics 2013; 56(1):55–60. doi:10.1016/j.archger.2011.11.009
Tsuruya K, Yoshida H, Haruyama N, Fujisaki K, Hirakata H, Kitazono T. Clinical Significance of Fronto-Temporal Gray Matter Atrophy in Executive Dysfunction in Patients with Chronic Kidney Disease: The VCOHP Study. PLoS One 2015; 10 (12): e0143706. doi:10.1371/journal.pone.0143706
Tsuruya K & Yoshida H. Brain Atrophy and Cognitive Impairment in Chronic Kidney Disease. Recent Advances in Dialysis Therapy in Japan 2018; 27–36. doi:10.1159/000485694
Shen Z, Ruan Q, Yu Z, Sun Z. Chronic kidney disease-related physical frailty and cognitive impairment: a systemic review. Geriatrics & Gerontology International 2016;17(4): 529–544. doi:10.1111/ggi.12758
Nakagawa T, Hasegawa Y, Uekawa K, Kim-Mitsuyama S. Chronic kidney disease accelerates cognitive impairment in a mouse model of Alzheimer’s disease, through angiotensin II. Experimental Gerontology 2017; 87: 108–112. doi:10.1016/j.exger.2016.11.012
Yao H, Araki Y, Takashima Y, Uchino A, Yuzuriha T, Hashimoto M. Chronic Kidney Disease and Subclinical Brain Infarction Increase the Risk of Vascular Cognitive Impairment: The Sefuri Study. Journal of Stroke and Cerebrovascular Diseases 2017; 26(2): 420–424. doi:10.1016/j.jstrokecerebrovasdis.2016.10.002
Otobe Y, Hiraki K, Hotta C, Nishizawa H, Izawa KP, Taki Y et al. Mild cognitive impairment in older adults with pre-dialysis patients with chronic kidney disease: Prevalence and association with physical function. Nephrology 2019; 24(1):50-55. doi:10.1111/nep.13173
Wang H, Fang C, Cai L, Dong B, Deng J. Chronic kidney disease and cognitive impairment among the very old in China. Aging Clinical and Experimental Research 2015; 28(3): 475–482. doi:10.1007/s40520-015-0433-1
Lv Z, Gao J, Wang L, Chen Z, Yuan H, Ma X et al. Uremia-caused changes of ghrelin system in hippocampus may be associated with impaired cognitive function of hippocampus. International Urology and Nephrology 2016; 48(5): 807–815. doi:10.1007/s11255-016-1228-9
Cheng Z, Lin J, Qian Q. Role of Vitamin D in Cognitive Function in Chronic Kidney Disease. Nutrients 2016; 8(5): 291. doi:10.3390/nu8050291
Pi HC, Xu YF, Xu R, Yang ZK, Qu Z, Chen YQ et al. Cognitive Impairment and Structural Neuroimaging Abnormalities Among Patients with Chronic Kidney Disease. Kidney and Blood Pressure Research 2016; 41(6): 986–996. doi:10.1159/000452603
Bai K, Pan Y, Lu F, Zhao Y, Wang J, Zhang L. Kidney function and cognitive decline in an oldest-old Chinese population. Clinical Interventions in Aging 2017; 12:1049–1054. doi:10.2147/cia.s134205
Wang J, Li XB, Huang P, Huang MY, Gu XJ. Change of Peripheral Blood Treg/Thl7 in Cognitive Impairment with Chronic Renal Failure Patients. Cellular Physiology and Biochemistry 2018; 45(1): 281–290. doi:10.1159/000486
Chen YC, Weng SC, Liu JS, Chuang HL, Hsu CC, Tarng DC. Severe Decline of Estimated Glomerular Filtration Rate Associates with Progressive Cognitive Deterioration in the Elderly: A Community-Based Cohort Study. Scientific Reports 2017; 7(1):42690. doi:10.1038/srep42690
Chang CY, Lin CC, Tsai CF, Yang WC, Wang SJ, Lin FH. et al. Cognitive impairment and hippocampal atrophy in chronic kidney disease. Acta Neurologica Scandinavica 2017; 136(5), 477–485. doi:10.1111/ane.12753
Chen CH, Chen YF, Chiu MJ, Chen TF, Tsai PH, Chen JH et al. Effect of Kidney Dysfunction on Cerebral Cortical Thinning in Elderly Population. Scientific Reports 2017; 7(1):2337. doi:10.1038/s41598-017-02537-y
Chao CT, Lai HJ, Tsai HB, Yang SY, Huang JW. Frail phenotype is associated with distinct quantitative electroencephalographic findings among end-stage renal disease patients: an observational study. BMC Geriatrics 2017; 17(1):277. doi:10.1186/s12877-017-0673-3
Chiu YL, Tsai HH, Lai YJ, Tseng HY, Wu YW, Peng YS et al. Cognitive impairment in patients with end-stage renal disease: Accelerated brain aging? J Formos Med Assoc 2019;118(5):867-875. doi: 10.1016/j.jfma.2019.01.011.
Vinothkumar G , Krishnakumar S, Sureshkumar , Shivashekar G , Sreedhar S, Preethikrishnan et al. Therapeutic impact of rHuEPO on abnormal platelet APP, BACE 1, presenilin 1, ADAM 10 and Aβ expressions in chronic kidney disease patients with cognitive dysfunction like Alzheimer’s disease: A pilot study. Biomedicine & Pharmacotherapy 2018; 104:211–222. doi:10.1016/j.biopha.2018.05.028
Vinothkumar G, Krishnakumar S, Riya, Venkataraman, P. Correlation between abnormal GSK3β, β Amyloid, total Tau, p-Tau 181 levels and neuropsychological assessment total scores in CKD patients with cognitive dysfunction: Impact of rHuEPO therapy. Journal of Clinical Neuroscience 2019.69:38-42. doi:10.1016/j.jocn.2019.08.073
Yeh YC, Huang MF, Hwang SJ, Tsai JC, Liu TL, Hsiao SM et al. Association of homocysteine level and vascular burden and cognitive function in middle-aged and older adults with chronic kidney disease. International Journal of Geriatric Psychiatry 2015; 31(7):723–730. doi:10.1002/gps.4383
Kittiskulnam P, Sheshadri A, Johansen KL. Consequences of CKD on Functioning. Seminars in Nephrology 2016;36(4): 305–318. doi:10.1016/j.semnephrol.2016.05.007
Zammit AR, Katz MJ, Bitzer M, Lipton RB. Cognitive Impairment and Dementia in Older Adults With Chronic Kidney Disease: A Review. Alzheimer disease and associated disorders 2016; 30(4):357–366. doi.org/10.1097/WAD.0000000000000178
Jasinski MJ, Lumley MA, Soman S, Yee J, Ketterer MW. Indicators of Cognitive Impairment From a Medical Record Review: Correlations With Early (30-d) Readmissions Among Hospitalized Patients in a Nephrology Unit. Psychosomatics 2017; 58(2): 173–179. doi:10.1016/j.psym.2016.10.005
Torres RV, Elias MF, Seliger S, Davey A, Robbins MA. Risk for cognitive impairment across 22 measures of cognitive ability in early-stage chronic kidney disease. Nephrology Dialysis Transplantation 2016; 1;32(2):299-306. doi:10.1093/ndt/gfw005
Bronas UG, Puzantian H, Hannan M. Cognitive Impairment in Chronic Kidney Disease: Vascular Milieu and the Potential Therapeutic Role of Exercise. BioMed Research International, 2017; 2726369. doi:10.1155/2017/2726369
Freedman BI, Sink KM, Hugenschmidt CE, Hughes TM, Williamson JD, Whitlow CT et al. Associations of Early Kidney Disease With Brain Magnetic Resonance Imaging and Cognitive Function in African Americans With Type 2 Diabetes Mellitus. American Journal of Kidney Diseases 2017; 70(5): 627–637. doi:10.1053/j.ajkd.2017.05.006
Materson BJ, Garcia-Estrada M, Degraff SB, Preston RA. Prehypertension is real and can be associated with target organ damage. Journal of the American Society of Hypertension 2017; 11(11): 704–708. doi:10.1016/j.jash.2017.09.005
Burns CM, Knopman DS, Tupper DE, Davey CS, Slinin YM, Lakshminarayan K et al. Prevalence and Risk of Severe Cognitive Impairment in Advanced Chronic Kidney Disease. J Gerontol A Biol Sci Med Sci 2018;73(3):393-399. doi: 10.1093/gerona/glx241. PMID: 29244090
Harhay MN, Xie D, Zhang X, Hsu C, Vittinghoff E, Go AS et al. Cognitive Impairment in Non–Dialysis-Dependent CKD and the Transition to Dialysis: Findings From the Chronic Renal Insufficiency Cohort (CRIC) Study. American Journal of Kidney Diseases 2018; 72(4):499-508 doi:10.1053/j.ajkd.2018.02.361
Coppolino G, Bolignano D, Gareri P, Ruberto C, Andreucci M, Ruotolo G et al. Kidney function and cognitive decline in frail elderly: two faces of the same coin? International Urology and Nephrology 2018; 50(8), 1505–1510. doi:10.1007/s11255-018-1900-3
Guenzani D, Buoli M, Carnevali GS, Serati M, Messa P, Vettoretti S. Is there an association between severity of illness and psychiatric symptoms in patients with chronic renal failure? Psychology, Health & Medicine 2018;23(8):970–979. doi:10.1080/13548506.2018.1426868
Lizio R, Babiloni C, Del Percio C, Losurdo A, Vernò L, De Tommaso M et al. Different Abnormalities of Cortical Neural Synchronization Mechanisms in Patients with Mild Cognitive Impairment due to Alzheimer's and Chronic Kidney Diseases: An EEG Study. J Alzheimers Dis 2018;65(3):897-915. doi: 10.3233/JAD-180245.
Kallenberg MH, Kleinveld HA, Dekker FW, van Munster BC, Rabelink TJ, van Buren M, Mooijaart SP. Functional and Cognitive Impairment, Frailty, and Adverse Health Outcomes in Older Patients Reaching ESRD--A Systematic Review. Clinical Journal of the American Society of Nephrology 2016; 11(9):1624–1639. doi:10.2215/cjn.13611215
Berkhout-Byrne N, Kallenberg MH, Gaasbeek A, Rabelink TJ, Hammer S, van Buchem MA et al. The cognitive decline in older patients with end stage renal disease (COPE) study - rationale and design, Current Medical Research and Opinion 2017; 33(11):2057-2064.doi: 10.1080/03007995.2017.1341404
Gronewold J, Todica O, Seidel UK, Volsek M, Kribben A, Bruck H, et al. Cognitive Performance Is Highly Stable over a 2-Year-Follow- Up in Chronic Kidney Disease Patients in a Dedicated Medical Environment. PLoS One 2017; 11(11): e0166530. doi:10.1371/journal.pone.0166530
König M, Gollasch M, Spira D, Buchmann N, Hopfenmüller W, Steinhagen-Thiessen E et al. Mild-to-Moderate Chronic Kidney Disease and Geriatric Outcomes: Analysis of Cross-Sectional Data from the Berlin Aging Study II. Gerontology 2017; 64(2): 118–126. doi:10.1159/000484140
Puy L, Bugnicourt JM, Liabeuf S, Desjardins L, Roussel M, Diouf M et al. Cognitive Impairments and Dysexecutive Behavioral Disorders in Chronic Kidney Disease. The Journal of Neuropsychiatry and Clinical Neurosciences 2018; 30(4):310-317. doi:10.1176/appi.neuropsych.18030047
Karasavvidou D, Kalaitzidis R, Elisaf M. Arterial damage and cognitive impairment in patients with chronic kidney disease. The Journal of Clinical Hypertension 2018; 20(11): 1643–1643. doi:10.1111/jch.13402
Paraizo MA, Almeida ALM, Pires LA, Abrita RSA, Crivellari MHT, Pereira BS et al. Montreal Cognitive Assessment (MoCA) screening mild cognitive impairment in patients with chronic kidney disease (CKD) pre-dialysis. Jornal Brasileiro de Nefrologia 2016; 38(1):31-41. doi:10.5935/0101-2800.20160006
Passos VMA, Ladeira RM, Souza CCV, Santos IS,Barreto SM. First stages chronic kidney disease have mild effects on cognitive performance. Results of a 15,105 brazilian adult baseline cohort. Brazilian Journal of Nephrology 2018; 40(1): 18–25. doi:10.1590/1678-4685-jbn-3889
Franco AO, Starosta RT, Roriz-Cruz M. The specific impact of uremic toxins upon cognitive domains: a review. Brazilian Journal of Nephrology 20189; 41(1):103-111. doi:10.1590/2175-8239-jbn-2018-0033
Amatneeks TM and Hamdan AC. Sensitivity and specificity of the Brazilian version of the Montreal Cognitive Assessment – Basic (MoCA-B) in chronic kidney disease. Trends Psychiatry Psychother 2019; 41( 4 ): 327-333. doi.org/10.1590/2237-6089-2018-0085.
Chaiben VBO, Silveira TB, Guedes MH, Fernandes JPA, Ferreira JHF, Beltrão J et al. Cognition and renal function: findings from a Brazilian population. Brazilian Journal of Nephrology 2019; 41(2):200-207. doi:10.1590/2175-8239-jbn-2018-0067
Foster R, Walker S, Brar R, Hiebert B, Komenda P, Rigatto C et al. Cognitive Impairment in Advanced Chronic Kidney Disease: The Canadian Frailty Observation and Interventions Trial. American Journal of Nephrology 2016; 44(6):473–480. doi:10.1159/000450837
Ben Assayag E, Eldor R, Korczyn AD, Kliper E, Shenhar-Tsarfaty S, Tene O et al. Type 2 Diabetes Mellitus and Impaired Renal Function Are Associated With Brain Alterations and Poststroke Cognitive Decline. Stroke 2017;48(9): 2368–2374. doi:10.1161/strokeaha.117.017709
Szerlip HM, Edwards ML, Williams BJ, Johnson LA, Vintimilla RM, O’Bryant SE. Association Between Cognitive Impairment and Chronic Kidney Disease in Mexican Americans. Journal of the American Geriatrics Society 2015; 63(10): 2023–2028. doi:10.1111/jgs.13665
Folstein MF, Folstein SE , McHugh PR. Mini-Mental State: a practical method for grading the cognitive state for the clinician. J Psychiatr Res 1975, 12: 189-198.doi: 10.1016/0022-3956(75)90026-6.
Bertolucci PHF, Brucki SMD, Campacci AR, Juliano Y. O mini-exame do estado mental em uma população geral -impacto da escolaridade. Arq. Neuropsiquiar 1994; 52 (1).
Teng EL and Chui HC. The Modified Mini-Mental State (3MS) Examination. J. Clin Psychiatry 1987; 48(8):314-8.
Teng EL, Chui HC and Gong A. Comparisons between the Mini-Mental State Exam (MMSE) and its modified version—the 3MS test. In: Hasegawa, K. and Homma, A., Editors, 1990. Psychogeriatrics: biomedical and social advances, Excerpta Medica, 189–192
Nasreddine ZS, Phillips NA, Bedirian V, Charbonneau S, Whitehead V, Collin I et al. The Montreal Cognitive Assessment, MoCA: A Brief Screening Tool For Mild Cognitive Impairment. Journal of the American Geriatrics Society 2005; 53(4): 695–699. doi:10.1111/j.1532-5415.2005.53221.x
European Commission, Directorate General Research and Innovation. Functional Magnetic Resonance Imaging - Understanding the technique and addressing its ethical concerns with a future perspective, 2013. [citado em 10 de outubro de 2020] Disponível < https://www.researchgate.net/publication/303820836_Functional_Magnetic_Resonance_Imaging_Understanding_the_technique_and_addressing_its_ethical_concerns_with_a_future_perspective_httpeceuropaeuresearchparticipantsdatarefh2020otherhiethics-guide-fmri_e/link/5755ec1d08ae10c72b66ec09/download>
Sakamoto SC. Estudo da variabilidade do efeito BOLD em ressonância magnética funcional em sistema de 3 teslas. Tese de doutorado USP – 2016. [citado em 10 de outubro de 2020] doi:10.11606/T.5.2017.tde-03052017-144019
Moodalbail DG, Reiser KA, Detre JA, Schultz RT, Herrington JD, Davatzikos C et al. Systematic Review of Structural and Functional Neuroimaging Findings in Children and Adults with CKD. Clin J Am Soc Nephrol 2013; 8(8): 1429–1448.2013. doi: 10.2215/CJN.11601112
Tryc AB, Alwan G, Bokemeyer M, Goldbecker A, Hecker H, Haubitz M et al. Cerebral metabolic alterations and cognitive dysfunction in chronic kidney disease. Nephrology Dialysis Transplantation 2011; 26(8): 2635–2641. doi:10.1093/ndt/gfq729
Downloads
Publicado
Como Citar
Edição
Seção
Licença
Copyright (c) 2021 Leopoldo Antônio Pires, Rogério Bumgratz de Paula, Danielle Guedes Andrade Ezequiel, Natalia Maria da Silva Fernandes
Este trabalho está licenciado sob uma licença Creative Commons Attribution 4.0 International License.
Aceito: 2021-04-19
Publicado: 2021-07-09
Português
English
Español
