الفهرس 
INTRODUCTIONOnly 14 pages are availabe for public view
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Abstract
Chronic kidney disease (CKD) patients frequently experience cognitive impairment, especially that on dialysis treatment. Although there are a number of potential causes, that include metabolic disturbances linked to kidney failure, recent imaging investigations in dialysis patients and epidemiologic research in people with early stages of CKD support the notion that vascular disease is the main contributing factor. . In particular, cognitive impairment entails a high risk of mortality as well as depression and a lower perceived quality of life.
Unfortunately, there are no effective treatments available yet to slow cognitive deterioration and impairment in HD patients. Intradialytic cognitive training (CT) was evaluated as a means of reducing cognitive impairment in HD patients.
By enhancing the neural networks that mediate executive function, CT delays the age-related decreases in important executive function domains like inhibition, verbal thinking, working memory, and abstraction. Although CT has been found to slow reductions in cognitive performance, including declines in executive function and psychomotor speed, for community-dwelling older persons, these improvements come before improvements in physical function and strength.
Few studies have examined CT in ESRD-affected adults of any age. For these interventions, HD offers a special window of time. They could take the place of routine, inactive pursuits that take place throughout the HD period, such as watching TV and sleep.
We conducted the current study to study whether an intradialytic supervised cognitive training program, administered via smartphone, can stop or delay the loss of cognitive abilities in patients on continuous hemodialysis (MHD). For that we enrolled 60 ESRD patients on low flux MHD 3 sessions weekly for at least 6 months, they were distributed into two groups each included 30 participants, one of them was trained to use (Lumosity) ”Intra- Dialytic Cognitive Training” as smartphone application for 20 – 30 minutes during the first half of the dialysis sessions.
The study included End-stage renal disease patients who received hemodialysis for at least 6 months In good health, free from infection or bleeding, 4-5 hours of hemodialysis 3 times per week, capable of understanding the questionnaire’s questions, and willing to participate in the study. We excluded patients with established dementia, delirium, or major psychiatric illness, recent cerebrovascular accident (within 3 months).Acute inflammatory conditions (infectious or non- infectious), Visual, auditory or motor disabilities that interfere with cognitive training and assessment, Intake of drugs that interfere with mental acuity, as hypnotics, narcotics and tranquilizers.
We assessed cognitive function of participants using Basic version (MoCA-B), Trail making test, parts A and B, and D-symbol substitution test
In trained group under guidance and supervision by the attending physician, brain games provided by a commercially available smartphone application (Lumosity) was practiced by the patients assigned for the (Trained) group for 20 – 30 minutes during the first half of the dialysis sessions. This application has already been widely utilized for cognitive training conducted for research purposes.