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@ARTICLE{Surez:1027034,
      author       = {Suárez, Victor and Picotin, Rosanne and Fassbender, Ronja
                      and Gramespacher, Hannes and Haneder, Stefan and Persigehl,
                      Thorsten and Todorova, Polina and Hackl, Matthias Johannes
                      and Onur, Oezguer A. and Richter, Nils and Burst, Volker},
      title        = {{C}hronic {H}yponatremia and {B}rain {S}tructure and
                      {F}unction {B}efore and {A}fter {T}reatment},
      journal      = {American journal of kidney diseases},
      volume       = {84},
      number       = {1},
      issn         = {0272-6386},
      address      = {Philadelphia, Pa.},
      publisher    = {Elsevier Saunders},
      reportid     = {FZJ-2024-03600},
      pages        = {S0272638624000015},
      year         = {2024},
      abstract     = {Rationale $\&$ objective: Hyponatremia is the most common
                      electrolyte disorder and is associated with significant
                      morbidity and mortality. This study investigated
                      neurocognitive impairment, brain volume, and alterations in
                      magnetic resonance imaging (MRI)-based measures of cerebral
                      function in patients before and after treatment for
                      hyponatremia.Study design: Prospective cohort study.Setting
                      $\&$ participants: Patients with presumed chronic
                      hyponatremia without signs of hypo- or hypervolemia treated
                      in the emergency department of a German tertiary-care
                      hospital.Exposure: Hyponatremia (ie, plasma sodium
                      concentration [Na+]<125mmol/L) before and after treatment
                      leading to [Na+]>130mmol/L.Outcomes: Standardized
                      neuropsychological testing (Mini-Mental State Examination,
                      DemTect, Trail Making Test A/B, Beck Depression Inventory,
                      Timed Up and Go) and resting-state MRI were performed before
                      and after treatment of hyponatremia to assess total brain
                      and white and gray matter volumes as well as neuronal
                      activity and its synchronization.Analytical approach:
                      Changes in outcomes after treatment for hyponatremia
                      assessed using bootstrapped confidence intervals and Cohen d
                      statistic. Associations between parameters were assessed
                      using correlation analyses.Results: During a 3.7-year
                      period, 26 patients were enrolled. Complete data were
                      available for 21 patients. Mean [Na+]s were 118.4mmol/L
                      before treatment and 135.5mmol/L after treatment. Most
                      measures of cognition improved significantly. Comparison of
                      MRI studies showed a decrease in brain tissue volumes,
                      neuronal activity, and synchronization across all gray
                      matter after normalization of [Na+]. Volume effects were
                      particularly prominent in the hippocampus. During
                      hyponatremia, synchronization of neuronal activity was
                      negatively correlated with [Na+] (r=-0.836; $95\%$ CI,
                      -0.979 to-0.446) and cognitive function (Mini-Mental State
                      Examination, r=-0.523; $95\%$ CI, -0.805 to-0.069; DemTect,
                      r=-0.744; $95\%$ CI, -0.951 to-0.385; and Trail Making Test
                      A, r=0.692; $95\%$ CI, 0.255-0.922).Limitations: Small
                      sample size, insufficient quality of several MRI scans as a
                      result of motion artifact.Conclusions: Resolution of
                      hyponatremia was associated with improved cognition and
                      reductions in brain volumes and neuronal activity. Impaired
                      cognition during hyponatremia is closely linked to increased
                      neuronal activity rather than to tissue volumes.
                      Furthermore, the hippocampus appears to be particularly
                      susceptible to hyponatremia, exhibiting pronounced changes
                      in tissue volume.Plain-language summary: Hyponatremia is a
                      common clinical problem, and patients often present with
                      neurologic symptoms that are at least partially reversible.
                      This study used neuropsychological testing and magnetic
                      resonance imaging to examine patients during and after
                      correction of hyponatremia. Treatment led to an improvement
                      in patients' cognition as well as a decrease in their brain
                      volumes, spontaneous neuronal activity, and synchronized
                      neuronal activity between remote brain regions. Volume
                      effects were particularly prominent in the hippocampus, an
                      area of the brain that is important for the modulation of
                      memory. During hyponatremia, patients with the lowest sodium
                      concentrations had the highest levels of synchronized
                      neuronal activity and the poorest cognitive test
                      results.Keywords: Hyponatremia; cerebral edema; functional
                      MRI; neuropsychological assessment.},
      cin          = {INM-3},
      ddc          = {610},
      cid          = {I:(DE-Juel1)INM-3-20090406},
      pnm          = {5251 - Multilevel Brain Organization and Variability
                      (POF4-525)},
      pid          = {G:(DE-HGF)POF4-5251},
      typ          = {PUB:(DE-HGF)16},
      pubmed       = {38184092},
      UT           = {WOS:001260318200001},
      doi          = {10.1053/j.ajkd.2023.11.007},
      url          = {https://juser.fz-juelich.de/record/1027034},
}