# Alzheimer's Supplement to Hemodialysis-based interventions to preserve cognitive function

> **NIH NIH R01** · JOHNS HOPKINS UNIVERSITY · 2021 · $398,618

## Abstract

ABSTRACT: RELEVANCE TO ADRD
Over 640,000 US adults suffer from ESRD, >95% of whom receive hemodialysis (HD) for the rest of their life or
until transplantation. Kidney disease and HD significantly impact cognitive function, especially higher-order
executive function. Only 13% of HD patients have normal cognition; HD patients experience executive function
impairment at a rate 3-fold higher than the general population, leading to hospitalization, disability, death and
dementia. In fact, our preliminary data suggest that HD patients have a 21-25% lifetime risk of receiving a
dementia diagnosis and 4-5% lifetime risk of receiving an Alzheimer's disease and related dementias (ADRD)
diagnosis; they are 19-times and 7-times more likely to be diagnosed with dementia and ADRD, respectively
than older adults without ESRD. Yet, only half of patients who would meet diagnostic criteria for dementia
receive a diagnosis. Among HD patients, dementia and ADRD are major public health challenges. Studies of
older adults suggest that the only effective interventions for preserving executive function and preventing
ADRD are cognitive training (CT) and/or exercise training (ET). However, these modalities have not been
tested in HD patients; even younger HD patients suffer substantial executive function impairment leading to
dementia/ADRD and could benefit from the interventions. HD frequency (3 sessions a week) and duration (4-6
hours/session) makes HD patients a “captive audience” for intradialytic CT and/or ET to mitigate executive
function decline and subsequent ADRD. To test the feasibility of intradialytic interventions, we conducted a
pilot RCT of 20 HD patients, comparing standard of care to CT or ET; even in this pilot, we found that
intradialytic CT and ET preserved executive function. As expected, executive function in patients receiving
standard of care declined substantially by 3 months (difference=47.4 seconds, P=0.006); however, this decline
was not seen among those receiving CT or ET. In just 3 months, CT and ET preserved executive function
compared to a striking decline with standard of care. We have built upon this pilot study and are testing
interventions on a wider breadth of HD patients, for longer durations, and alone versus in combination. Our
ongoing RCT (98/200 participants enrolled) tests the impact of intradialytic CT, ET, and combined CT and ET
on the executive function decline associated with HD. To this study we wish to add the novel endpoint of
dementia/ADRD and ascertained through novel follow-up. We propose the following aims: To 1) add a novel
secondary outcomes of dementia and ADRD to an existing RCT of intradialytic cognitive training (CT) and/or
exercise training (ET); 2) To quantify the effects of intradialytic cognitive training (CT) and/or exercise training
(ET) on dementia and ADRD among high-risk subgroups. Through this RCT, we will learn the impact of two
potential non-pharmacological interventions, cognitive and exercise trai...

## Key facts

- **NIH application ID:** 10286431
- **Project number:** 3R01DK114074-04S1
- **Recipient organization:** JOHNS HOPKINS UNIVERSITY
- **Principal Investigator:** Mara A. McAdams DeMarco
- **Activity code:** R01 (R01, R21, SBIR, etc.)
- **Funding institute:** NIH
- **Fiscal year:** 2021
- **Award amount:** $398,618
- **Award type:** 3
- **Project period:** 2018-01-09 → 2022-12-31

## Primary source

NIH RePORTER: https://reporter.nih.gov/project-details/10286431

## Citation

> US National Institutes of Health, RePORTER application 10286431, Alzheimer's Supplement to Hemodialysis-based interventions to preserve cognitive function (3R01DK114074-04S1). Retrieved via AI Analytics 2026-05-24 from https://api.ai-analytics.org/grant/nih/10286431. Licensed CC0.

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