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Impaired cognition in hemodialysis patients: The Montreal Cognitive Assessment (MoCA) and important clues for testing
Abstract
BACKGROUND: Cognitive impairment is common among hemodialysis (HD) patients and is associated with poor treatment compliance and mortality. The aim of this study is to evaluate relatively young HD patients with less comorbidities using the Montreal Cognitive Assessment (MoCA) and identify clues for earlier detection of cognitive impairment with the help of cognitive subscale scores. MATERIALS AND METHODS: A total of 103 chronic HD patients (mean age 48.3 years) and 37 stage-3 to 5 chronic kidney disease (CKD) patients with similar demographics were included. Patients with cerebrovascular disease, dementia, depression, malignancy, and infections were excluded. All participants were tested with MoCA. Patients with an MoCA global score < 24/30 were considered cognitively impaired. Groups were compared for MoCA subscales and clinical features. RESULTS: 75 patients (72.8%) in the HD group and 19 in the CKD group (51.3%) had impaired cognition. The number of patients with cognitive impairment was significantly higher in the HD group compared with the CKD group (p = 0.024). The mean total MoCA score was lower in the HD group (p = 0.043). MoCA subscale analysis revealed that the mean score for visuospatial/executive domain was significantly lower in the HD group (p = 0.001). CONCLUSION: In this study, we showed that cognitive impairment was more common in HD patients compared with predialytic CKD patients. This difference was predominantly related to the difference in executive scores. We may think that young HD patients with less comorbidities are also at risk for cognitive impairment. Noticing progressive declines in MoCA cognitive domains, before the development of global cognitive impairment, could be beneficial for HD patients.
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... Although polypharmacy, a geriatric syndrome commonly observed in the elderly with CKD, is defined as taking five or more drugs, recent studies have shown that drug burden, in addition to the number of drugs, is also important [2]. It has been reported that evaluating anticholinergic side effects indicating evaluation of drug burden can decrease the rates of falls, cognitive impairment, hospitalization, and mortality in the elderly [3][4][5]. Polypharmacy with anticholinergic drug burden, combined with metabolic disturbances, puts the elderly CKD patient at greater risk [6]. As a result, biochemical evaluation of anticholinergic drug burden combined with comprehensive geriatric assessment (CGA) could be useful, particularly in elderly CKD patients [2]. ...
... The fact that the mean age of the CKD patient group was lower than that of the control group makes this result even more significant. In a previous study, we observed that frailty rates were high Erken and Erken: Geriatric syndrome and drug burden in CKD even in young CKD patients [5]. We suggest that CKD may be considered as the equivalent of vascular aging and physical frailty. ...
... Various cognitive tests were proposed to evaluate the cognitive functions of patients with CKD. As one of these tests, MoCA is a test that specifically evaluates executive functions and can reveal cognitive impairments related to vascular disease burden [5]. However, the present study revealed no difference between elderly CKD patients and the control group in terms of cognitive capacity scores assessed by MoCA test. ...
Objectives
Chronic kidney disease (CKD) is a condition characterized by atherosclerosis, cognitive impairment, physical limitations, biochemical abnormalities, and vascular aging. The proportion of those with a diagnosis of CKD in the older is increasing. With comprehensive geriatric assessment, it could be possible to detect the disorders that are related to biological aging. The aim is to evaluate geriatric syndromes like frailty, cognitive dysfunction, malnutrition, and polypharmacy in an aged population with pre-dialytic CKD (stages 3a–5), and to investigate possible relations with biochemical features and anticholinergic drug burden (ADB).
Methods
One hundred and fifty-six CKD patients aged 60 and older and 164 healthy controls were included in the study. Geriatric parameters that were used for the evaluation of the groups were, Clinical Frailty Index; Charlson Comorbidity Index; Montreal Cognitive Assessment and Mini Nutritional Assessment-short form. Besides, biochemical parameters and ADB defined with 3 scales Anticholinergic Burden Classification (ABC), Chew’s scale, and Drug Burden Index were recorded.
Results
Despite being younger, CKD patients had higher comorbidity and frailty scores than the controls. Patients and controls had similar nutritional status, and cognitive function test results. Frailty was an important predictor for geriatric parameters and eGFR. ABC score was higher in the CKD group in ADB scale.
Conclusions
Frailty and polypharmacy are more prevalent than expected in older with CKD. In addition, anticholinergic burden and polypharmacy may form causal links with one and other and lead to increased mortality rates especially with frailty. Therefore, geriatric assessment and appropriate ADB evaluation may be recommended in CKD patients.
... End-stage renal disease (ESRD) is the most advanced stage of chronic kidney disease where kidney function is irreversibly lost, necessitating dialysis or transplantation [1,2]. Cognitive impairments (CIs) are common in ESRD patients receiving haemodialysis (HD) treatment, with more than 70% exhibiting at least mild impairments in one or more domains such as attention, memory, and executive function [3][4][5][6]. "Brain fog" has been a common complaint among dialysis patients [7] and a popular topic of discussion in online patient forums [8]. CIs in ESRD are associated with adverse health outcomes including dialysis withdrawal, hospitalisation, and mortality [3, [9][10][11]. ...
Background and objectives
Cognitive impairment is common in haemodialysis patients and associated with adverse health outcomes. This may be due to cognitive impairments interfering with daily functioning and self-care, but evidence is limited. This cross-sectional study aims to explore the interrelationships between cognition and functional outcomes in haemodialysis patients.
Methods
Haemodialysis patients completed measures of objective cognitive function (Montreal Cognitive Assessment), everyday problem-solving skills (scenario-based task), and subjective cognitive complaints (self-report). Participants also self-reported sociodemographic information, functional interference, treatment nonadherence, and mood and fatigue symptoms. Patients’ clinical data including comorbidities and lab results were extracted from medical record. Structural equation modelling was performed.
Results
A total of 268 haemodialysis patients (mean age = 59.87 years; 42.5% female) participated. The final model showed satisfactory fit: CFI = 0.916, TLI = 0.905, RMSEA = 0.033 (90% confidence interval 0.024 to 0.041), SRMR = 0.066, χ²(493) = 618.573 (p < .001). There was a negative association between objective cognitive function and subjective cognitive complaints. Cognitive complaints were positively associated with both functional interference and treatment nonadherence, whereas objective performance was not. Everyday problem-solving skills emerged as a distinct aspect of cognition not associated with objective performance or subjective complaints, but had additive utility in predicting functional interference.
Conclusions
Subjective cognitive complaints and everyday problem-solving skills appear to be stronger predictors of functional variables compared to objective performance based on traditional tests. Routine screening of everyday cognitive difficulties may allow for early identification of dialysis patients at risk of cognitive impairment, functional interference, treatment nonadherence, and poor clinical outcomes.
... In 2018, this difference was significant in the variables handgrip strength (hgs) and It is known that the prevalence of cognitive impairment is high in this population (Chaiben et al., 2019) and that hemodialysis treatment contributes to the worsening of this clinical condition (Erken et al., 2019). Studies indicate that cognitive deficit is (Gesualdo et al., 2017) and that patients with such impairment are at increased risk of poor health outcomes (Kaltsatou et al., 2015). ...
This study aimed to correlate cognitive function with the physical activity level (pal) and physical fitness over three years of patients undergoing hemodialysis and to compare the pal and physical fitness over this period of patients with and without cognitive problems. Therefore, a cohort study was carried out, including patients evaluated between 2018 and 2020, through the Mini-Mental State Exam, functional physical record, Elbow Flexion test, Sit-to-stand test, Handgrip Strength test (hgs), and by the physical activity monitor. Data analysis was performed using the Pearson’s Correlation test and the paired Student’s t-test and its non-parametric equivalent, when necessary, with a significance level of 5%. The results showed that cognitive function assessed in the different years of the research was positively correlated with physical fitness and with pal: in 2018, with hgs (r = 0.313; p = 0.019); in 2019, with cardiorespiratory fitness (r = 0.288; p = 0.038), with hgs (r = 235; p = 0.033) and with pal on hd days (r = 359; p = 0.010) and on days without treatment (r = 314; p = 0.026); and in 2020, with the pal up to date without hd (r = 387; p = 0.014). In addition, patients without probable cognitive deficit had higher pal and physical fitness values in all years of analysis compared to those with the probable cognitive deficit: in 2018, this difference was significant in hgs and pal on a day contrary to hemodialysis; in 2019, in cardiorespiratory fitness and pal on a day contrary to treatment; and in 2020, in cardiorespiratory fitness, hgs and pal on both days. It is concluded that patients with higher pal and better physical fitness had a better cognitive function, suggesting the importance of physical activity practice as an effective alternative in improving physical fitness and, consequently, cognitive function in HD patients.
... Esses dois últimos itens analisados podem ser considerados positivos, tendo em vista uma melhora na cognição e fragilidade. Diversos estudos apontam que pacientes em HD apresentam uma piora nas suas condições de saúde como perda de massa muscular e aumento da fragilidade (Kamijo et al., 2018), dos sintomas depressivos (Khan et al., 2019) e piora da função cognitiva (Erken et al., 2019), contrariando assim alguns achados do presente estudo. ...
The aim of this study was to analyze the health and physical fitness variables of patients with Chronic Renal Failure (CRF) on hemodialysis (HD) after a period of one year. A descriptive and analytical study, with a cohort design, in which 54 patients with CKD who underwent HD participated in the Renal Clinic of Hospital São Vicente de Paulo de Cruz Alta / RS. The evaluation was carried out in 2018 and 2019, and the following instruments were used: Mini Mental State Examination, clinical record, sit and stand test, forearm flexion, dynamometry, flexitest, Lawton-Brody index, Barthel index, Edmonton questionnaire FrailScale, Beck's depression inventory. It was found that over the study period, some variables underwent changes, both negative and positive. Patients worsened their scores in the assessment of body mass index, moving from eutrophic to overweight, increased depressive symptoms and improved rates of cognitive function and frailty. The follow-up of these patients is essential to detect the implications of CRF and HD and to base strategies to improve health conditions, considering biopsychosocial aspects.
... Our data have demonstrated that 19.5% of HD patients have cognitive impairment with MMSE<27, which is similar with the results of previous (8.3-51%) [30][31][32][33]. The different prevalence rates of cognitive impairment in HD patients have been reported in past researches in terms of different population demographics, sample sizes, and measurements for assessment. ...
Introduction:
Cognitive impairment is prevalent in patients undergoing hemodialysis (HD), which is related to the nutritional and inflammatory status of this population. Malnutrition-inflammation score (MIS) has been identified as a useful tool to evaluate nutrition and inflammation status. The aim of this study is to investigate the association between MIS and cognitive impairment in HD patients.
Methods:
This was a multicenter observational cohort study with 1591 patients undergoing HD. Nutritional and inflammatory status was evaluated with MIS, anthropometric measurements, and body composition assessments. Cognitive function was evaluated with the Mini Mental State Examination (MMSE). The associations between MIS and cognitive impairment were analyzed by multivariable logistic regression models.
Results:
Among 1591 HD patients, the mean MIS was 6.0±2.6. Patients with higher MIS had significantly lower MMSE scores. 311 patients had cognitive impairment. After adjusting clinical confounders, higher MIS was independently associated with increased rate of cognitive impairment both as a categorized variable (OR, 1.358; 95%CI, 1.010-1.825; P=0.045) and as a continuous variable (OR, 1.113; 95%CI, 1.053-1.178; P<0.001). Subgroup analysis showed a stronger association between MIS and cognitive impairment in males, the population with age 41-60 years, and 61-80 years, no smoker, living by oneself, HD combined with or without hemoperfusion as dialysis modality. ROC curve analysis of MIS showed 60.1% sensitivity and 52.0% specificity in predicting cognitive impairment (AUC 0.604; 95%CI 0.567-0.640, P<0.001).
Conclusions:
MIS was an independently associated with cognitive impairment in HD patients.
... There are a number of factors that may contribute to CI and dementia in CKD and ESRD including accumulation of uremic toxins, cerebral vascular dysfunction, chronic inflammation, anemia and white matter injury in addition to established risk factors such as advanced age and depression (10)(11)(12)(13). Compared to patients with chronic kidney disease (CKD) or undergoing peritoneal dialysis (PD), CI appears to be more common in HD patients, suggesting unique contributing factors in these patients (14)(15)(16). ...
Background
Abnormalities in cognitive function are almost universal in patients receiving hemodialysis (HD) and are associated with worse quality of life, impaired decision making, increased healthcare utilization and mortality. While cognitive impairment in the HD population is increasingly recognized, it is unclear how quickly it develops after starting HD.
Methods
This was a cross-sectional study of a cohort of low dialysis vintage HD patients (<12 months). We used the validated Cambridge Brain Science (CBS) battery of web-based tests to evaluate cognition compared to age- and sex matched controls across three cognitive domains: verbal processing, reasoning and short-term memory.
Results
Forty-nine HD patients were included in this study; 43 completed the full battery of tests. The average scores for HD patients were consistently below the age and sex-matched controls. Fifty-five percent of HD patients had cognitive impairment in verbal skills, 43% in reasoning and 18% in short-term memory.
Conclusions
There is a high prevalence of CI evident early after starting HD, with the largest deficits seen in reasoning and verbal processing. These deficits may be attributable to the HD treatment itself. Further studies are needed to characterize the natural history of CI in this patient population and to test interventions aimed at preventing or slowing its progression.
... The prevalence of cognitive impairment in our study was similar to other published studies estimated to be between 50% and 80%. [28][29][30] The prevalence of depression in our study was 53% which is similar to Jaber et al 31 but higher than other studies. 22 There is a growing body of evidence that depression is associated with poor outcomes such as post dialysis fatigue, higher mortality, and hospitalizations. ...
Background
The prevalence of frailty is disproportionately increased in patients with chronic kidney disease (CKD) in comparison with non-CKD counterparts and is the highest in patients on hemodialysis (HD). While the cross-sectional measurement of frailty on HD has been associated with adverse clinical events, there is a paucity of data on longitudinal assessment of frailty and its relationship to outcomes.
Objective
The objectives were to (1) evaluate changes in frailty status, level of independence, mood, cognition, and quality of life (QoL) over a 12-month period and (2) explore the relationship between frailty status and level of independence, mood, cognition, and QoL at 2 different time points (at baseline and at 1 year).
Design
This is a prospective cohort study involving 100 prevalent HD patients.
Setting
Regina General Hospital and Wascana Dialysis Unit in Regina, Saskatchewan, Canada, between January 2015 and January 2017.
Patients
One hundred prevalent HD patients underwent frailty assessments using the Fried criteria at baseline and 1 year later.
Measurements
Frailty was assessed using the Fried criteria, which included assessments of unintentional weight loss, weakness (handgrip strength), slowness (walking speed), and questionnaires for physical activity and self-perceived exhaustion. Cognition, mood, and QoL were measured using questionnaires (Montreal Cognitive Assessment [MoCA], Geriatric Depression Scale [GDS], and EuroQol [EQ-5D] utility scores and visual analog scale [VAS], respectively).
Methods
Frailty status was reported as a binary variable: frail vs. nonfrail (prefrail and robust). Differences across baseline and 1-year groups were assessed using McNemar’s test or Wilcoxon signed-rank test, as appropriate. We assessed the differences between frail and nonfrail groups using the Mann–Whitney U test or chi-square test/Fisher’s exact test where appropriate.
Results
Ninety-seven of the 100 patients had complete initial assessments. The median (interquartile range [IQR]) duration of dialysis at baseline was 35.5 (13.75-71.75 months). One year later, 22 had died, 10 refused assessments, and 3 had relocated. In comparison with baseline vs 1 year, the number of frail patients was 68.1% vs. 67.7%; prefrail 26.8% vs. 26.1%; robust 5.1% vs. 6.2%; MoCA ≥24, 69% vs. 64.5%; GDS score ≥ 2, 52.8% vs. 47.7%; median EQ-5D utility score 0.81 vs. 0.77; and median EQ-VAS 60 vs. 50. Similarly, in comparison with baseline vs. 1 year, the number of independent patients was 82% vs. 63%, independent with support 17% vs. 31%, and long-term care home 0% vs. 3.1%. Eighteen of the 22 patients (82%) who died were frail. At 1 year, the median (IQR) MoCA was 24 (19-25) vs. 25 (21-26; P = .039) and median (IQR) GDS was 2 (1-3) vs. 1(0-2; P = .034). Likewise, median (IQR) EQ-5D utility score was 0.78 (0.6-0.82) vs. 0.81 (0.78-0.85; P = .023). There were significant changes in self-care (27% vs. 0%), P = 0.006, and daily activities (68.2% vs. 38.1%), P = 0.021.
Limitations
This is a single-center study, so direct inferences must be interpreted in the context of the demographics of the study population. Patients were undergoing dialysis for a median of 36 months before undergoing initial assessment.
Conclusions
Frailty and prefrailty in our dialysis patients is near-ubiquitous and will need to be proactively addressed to improve subsequent health care outcomes.
... The optimal cut-off of ≤24 points out of a 30-point maximum is lower than the cut-off value of ≤26 described in the original data collected in a population of patients with Alzheimer's disease and mild cognitive impairment [25]. In the present HD cohort, there is a higher prevalence of cognitive impairment (84.6%; 114/136 based on MoCA cut-off ≤ 24 points) than other HD cohorts [26]. This may be related to longer dialysis vintage and higher diabetes mellitus comorbidity in the HD cohort. ...
Patients with end-stage renal disease (ESRD) have an increased risk of both impaired cognitive function and peripheral artery disease (PAD) than the general population. The association between PAD and dementia is recognized, but there are limited studies in patients with ESRD. The aim of this study was to evaluate the relationship between ankle-brachial index (ABI) and brachial-ankle pulse wave velocity (baPWV) and cognitive impairment in patients receiving hemodialysis (HD). We enrolled 136 prevalent HD patients (mean age 59.3±10.5 years, 55.9% male). Cognitive performance was measured using the Montreal Cognitive Assessment (MoCA) and Cognitive Abilities Screening Instrument (CASI) by trained psychiatrists. Associations between the cognitive function and ABI and baPWV were assessed using multiple linear regression analysis. Compared with HD patients with ABI≥0.9 , patients with ABI<0.9 had lower MoCA score ( p=0.027 ) and lower CASI score but did not achieve significant level ( p=0.056 ). In the multivariate stepwise linear regression analysis, ABI (per 0.1) was independently positively associated with the MoCA score ( β coefficient=0.62 , p=0.011 ) and the CASI score ( β coefficient=1.43 , p=0.026 ). There is a negative association between baPWV (per 100 cm/s) and CASI ( β coefficient=−0.70 , p=0.009 ). In conclusion, a low ABI or high baPWV was associated with a lower cognitive function in HD patients.
... O teste cognitivo deve ser realizado antes da sessão de rotina de HD e um ponto de corte adequado deve ser determinado levando em conta a idade e a escolaridade do paciente. 4 A detecção de depressão por um teste prático como o EDG-15 pode servir para eliminar resultados falsos positivos obtidos durante o exame cognitivo dos pacientes. ...
OBJECTIVE: To evaluate the reliability and validate the method used to test for emotional intelligence
(EI) among CKD patients.
METHODOLOGY: This study was conducted in a public hospital for patients with kidney disease. A total
of 30 CKD patients were included in this study using the flat rule of thumb and data collected from June
until July 2023. The Mayer-Salovey-Caruso Emotional Intelligence Test (MSCEIT) question booklet was
used in both English and Malay for this study to evaluate the level of EI in CKD patients. The obtained
data was analyzed using SPSS and AMOS software.
RESULTS: Most respondents were female, n=17 (56.7%) and Male, n=13 (43.3%). The mean results for
MSCEIT indicate that the highest score is for the face component, and the lowest is for sensation. The
branches of EI were measured, and the Goodness Fit Index (GFI) is accepted at 0.917, the RMSEA value
is at 0.024, and TLI is accepted at 0.993. The Cronbach alpha for MSCEIT is 0.807 for 30 patients with
eight categories of items. The Goodness Fit Index is accepted at the value of 0.917, RMSEA 0.024 is
accepted, and TLI is accepted at 0.993.
CONCLUSION: Overall, the results of the present study suggest that MSCEIT can be used for other
medical conditions for bigger-scale research to evaluate the psychological aspect for further treatment.
KEYWORDS: Chronic kidney disease, MSCEIT, nephrology, emotional intelligence
Objective: Cognitive impairment increases the risk of mortality in patients with chronic kidney disease. Progressive cognitive decline can be a serious issue for hemodialysis (HD) patients even if they are young with few comorbid conditions. The aim of this prospective study is to evaluate HD patients using Montreal Cognitive Assessment (MoCA) and search for the signs of cognitive decline using cognitive domain scores. Method: Twenty-nine chronic HD patients were selected. All patients were tested with MoCA at baseline and after the two-years follow-up. Patients with heart failure, dementia, depression, visual disturbance, malignancy, active infections and, those with single-pool Kt/V
The objective was to systematically review the relationship between Chronic Kidney Failure and Hemodialysis with cognitive function. This systematic review followed the parameters proposed by PRISMA. The search for articles was carried out in the PubMed database. A total of 113 articles were found, of which 31 were selected for analysis. Analyzing the studies' samples, it was found that 19.3% of them had a control group, that the most used instrument was the Mini-Mental State Examination (41.9%), and that patients of older age and patients with longer hemodialysis treatment had worse cognitive scores. It is concluded that HD can reduce the cognitive function of people with CKF.
Resumo O objetivo foi revisar sistematicamente a relação da Insuficiência Renal Crônica e da Hemodiálise com a função cognitiva. Esta pesquisa de revisão sistemática seguiu os parâmetros propostos pelo PRISMA. A busca dos artigos foi realizada na base de dados PubMed. Foram encontrados 113 artigos, sendo que destes 31 foram selecionados para análise. Analisando a amostra dos estudos verificou-se que 19,3% dos estudos tiveram grupo controle, que o instrumento mais utilizado foi Mini Exame do Estado Mental (41,9%) e que pacientes com idade mais avançada e os pacientes com mais tempo de tratamento hemodialítico tinham piores escores cognitivos. Conclui-se que a HD pode reduzir a função cognitiva de pessoas com IRC.
Introduction
Cognitive impairment and depression are common mental health problems in chronic kidney disease (CKD) patients with maintenance hemodialysis (MHD). Previous studies have proven that cognitive impairment and depression were risk factors for poor prognosis in MHD patients. However, the related factors of cognitive function and the association between cognitive impairment and depression in MHD patients are still unclear. The purpose of this study is to explore the related factors affecting the cognitive function of MHD patients and evaluate the relationship between cognitive function and depression in MHD patients.
Methods
This single-center, cross-sectional study enrolled 160 MHD patients. Cognitive function and depressive symptoms were measured using Montreal Cognitive Assessment (MoCA) and Patient Health Questionnaire-9 (PHQ-9), respectively.
Results
Cognitive impairment was detected in 58.1% of 160 MHD patients. Multivariate linear regression analysis showed that age, level of education and homocysteine (HCY) were independent influencing factors of MoCA scores and the scores of attention and abstract thinking were independently correlated with PHQ-9 score after adjusting for confounding factors
Conclusions
These findings indicated that age, level of education and HCY were independently associated with cognitive function, and attention and abstract thinking could independently affect depressive symptoms in MHD patients.
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 (> 90%), 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.ResultsOur 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.
Purpose
Frail patients who undergo renal transplantation (RT) have more complications; however, little is known if these patients can sustain the wait to RT. We used the Timed Up and Go Test (TUGT) and Montreal Cognitive Assessment (MoCA) to determine outcomes of RT candidates.
Methods
In this retrospective study, 526 RT candidates underwent TUGT and MoCA (2015‐2019) and were divided into “favorable” (transplanted or remained on the list) or “unfavorable” (not listed, removed from list, or died) outcome. Demographics, education, language, comorbidities, dialysis type, use of a walking device, TUGT, and MoCA were compared by outcome.
Results
Overall, 230 patients (43.7%) passed TUG, 268 (51%) passed MoCA, 133 (25.3%) passed both, and 161 (30.6%) failed both tests. Multivariate analysis demonstrated age ≥ 65 (OR 1.58, CI 1.03–2.43), cardiac disease (OR 3.09, CI 2.02–4.72), ≥36 months on dialysis (OR 1.80, CI 1.24–2.69), EPTS < 20% at time of MoCA (OR 0.26, CI 0.07–0.98), and failing TUGT (OR 2.14, CI 1.43–3.19) were associated with unfavorable outcome. Failing MoCA was not associated with outcome.
Conclusions
MoCA test results were not associated with RT waitlist outcomes; however, passing the TUGT was associated with receiving RT or remaining on the list. Additional studies are needed to validate this and determine outcome after RT.
Background
In international studies, cognitive impairment is a common but underdetected issue in dialysis patients. Chronic Kidney Disease (CKD) shares risk factors with and is an independent risk factor for cognitive impairment. There is a lack of Australian data of cognitive impairment in this at‐risk population. This has implications on service planning because cognitive impairment in CKD is associated with higher mortality, morbidity, and healthcare costs.
Aims
This study examines the prevalence, types, and clinician recognition of cognitive impairment within an Australian dialysis population.
Methods
A cross‐sectional study of haemodialysis and peritoneal dialysis patients in South‐East Sydney screened for cognitive impairment using the Montreal Cognitive Assessment (MoCA). Participant interviews, medical records, physician and carer questionnaires, were used to determine the types of cognitive impairment and rate of recognition.
Results
106 participants were included (median age 66 years, median dialysis duration 2 years) and 58 (54.7%) were cognitively impaired on the MoCA, of whom old age psychiatrists subclassified 21 (36.2%) as having dementia, and 31 (53.4%) with ‘Cognitive Impairment, No Dementia’. 36/58 (62.0%) of the cognitively impaired participants on the MoCA were suspected of having cognitive impairment by nephrologists but only 14/58 (24.1%) had this documented in medical records.
Conclusion
Although cognitive impairment is common in dialysis patients, there are low levels of detection by clinical teams. Cognitive screening of dialysis patients should be incorporated as part of wider assessment and determination of management goals such as individuals’ capacity to self‐care and provide informed consent to treatments.
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Patients with chronic kidney disease (CKD) may undergo cognitive impairment. We aimed to explore the cognition of patients with cognitive impairment (CI) and no cognitive impairment (NCI) respectively and the effect of demographics, estimated glomerular filtration rate (eGFR), number of comorbidities (NCD), and hemoglobin on CI in Chinese patients with CKD at stage 3–5 treated by nondialysis by using the Beijing version of the Montreal Cognitive Assessment (MoCA-BJ). A total of 120 patients with CKD were recruited from the Department of Nephrology at the Affiliated Hospital of Nanjing University of Chinese Medicine at in-patient and out-patient follow up. A logistic regression model was performed to assess the effect of these variables on CI of CKD patients. The results indicated that the CI group was mainly in the decline of visuospatial and executive function, abstraction, and memory, compared with the NCI group. In addition, years of education, eGFR and NCD were found as predictors of CI of CKD patients at stage 3–5. Specifically, lower eGFR, less years of education and more comorbidities were risk predictors of CI.
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