Assessment Of Cognitive Impairment In Maintenance Hemodialysis Patients Using Saint Louis University Mental Status Exam (original) (raw)
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Dementia & neuropsychologia
Cognitive impairment and dementia commonly occur in individuals with chronic kidney disease, especially in advanced stages, but are still poorly diagnosed. To evaluate the cognitive ability of patients with chronic kidney disease on hemodialysis and its relationship with sociodemographic and clinical characteristics. A cross-sectional study was carried out in a Renal Replacement Therapy Unit in the interior of the State of São Paulo involving 99 patients. The data were collected through an individual interview, using the Sociodemographic and Clinical Characterization questionnaires and the Addenbrooke's Cognitive Examination - Revised (ACE-R) questionnaire. Participants were predominantly male, with a mean age of 54.68 years. The mean ACE-R score was 64.26 points, and 76.76% of patients had lower-than-expected scores, suggesting the presence of cognitive impairment. A moderate, negative correlation was found between total score on the ACE-R and age (r= -0.38, p≤0.001), a moderat...
Caspian Journal of Neurological Sciences, 2017
Background: Hemodialysis is a treatment for end-stage renal disease (ESRD) that is an underlying factor of cognitive impairment in patients. Objectives: This study was conducted to evaluate the prevalence of cognitive impairment and its associated factors in patients undergoing hemodialysis using Montreal Cognitive Assessment (MoCA). Materials and Methods: This cross-sectional study was carried out in 2016 in the dialysis unit of an academic hospital in the north of Iran. A total of two hundreds and twenty-four patients with chronic renal failure and ESRD presenting to for hemodialysis were included. All the patients were evaluated by the MoCA and the cutoff point was set at ≤25 for confirming cognitive impairment. The data obtained were analyzed in SPSS-18 using the Chi-square test, Mann-Whitney's U-test, Fisher's exact test, the independent t-test and the binomial logistic regression. Results: From the total of 224 patients examined, 93 (41.52%) had developed cognitive impairment. The variables of age, stroke, education and diabetes were entered into the logistic regression model to analyze the associated risk factors, but only age and a history of stroke showed a significant relationship with this impairment; that is, the possibility of cognitive impairment increases with increasing age and a history of stroke can increase its risk six-fold. Conclusion: Cognitive impairment was a relatively frequent complication of hemodialysis in this study which was performed in the north of Iran. Aging and a history of stroke are risk factors of cognitive impairment in patients with chronic kidney failure undergoing hemodialysis treatment.
Assessment of cognitive impairment and related risk factors in hemodialysis patients
2021
Cognitive impairment in hemodialysis patients has been acknowledged over the last years and has been reported in up to 80% of patients. Older age, high prevalence of cardiovascular risk factors, such as stroke and transient ischemic attack, uremia, and multiple metabolic disturbances represent the most common factors for cognitive impairment in hemodialysis patients. We conducted a prospective cohort study on 408 patients from 10 hemodialysis centers in the regional government district of Middle Hesse (Germany). Patients underwent a neuropsychological test battery consisting of five tests, in addition to a phonemic fluency test, to assess cognitive profile. The patients were classified into no cognitive impairment mildly-, moderately- or severely-impaired cognitive function, depending on the degree of impairment and number of domains where the deficit was determined. We analyzed the cognitive profile and the change in performance over time in hemodialysis patients based on their cog...
A study on cognitive status in chronic kidney patients on dialysis
IP innovative publication pvt. ltd, 2019
Introduction: Cogitive impairment is common in uremia and diabetes mellitus. Cognitive impairment affects the activities of daily living in most of chronic kidney disease patients. As per literature, cognitive impairment is less common in non-diabetic than diabetic of chronic kidney disease. There is sparse data regarding incidence and pattern of cognitive impairment in chronic kidney disease patients with regard to mode of dialysis either hemodialysis or peritoneal dialysis. Aim and Objectives: Aim : To estimate the pattern and prevalence of cognitive impairment in chronic kidney patients on dialysis. Objectives: 1) To compare the pattern of cognitive impairment between hemodialysis and peritoneal dialysis patients. 2) T o study the impact of glycemic status on cognitive impairment in chronic kidney disease patients. Material and Methods: A prospective cross-sectional observational study conducted at MGM hospital/Kakatiya medical college during May 2016 through December 2017 on chronic dialysis patients who fulfilled the inclusion and exclusion criteria. All the cases were subjected to Cognitive assessment by applying ACE- R adapted to Telugu speaking people. Results: 1) In our study the prevalence of dementia and mild cognitive impairment (MCI) were 47% & 21% respectively. 2) Among 47 dementia patients 31(66%) were diabetic, 25(53%) were undergoing hemodialysis and 22(46%) were undergoing peritoneal dialysis. 3) The pattern of cognitive decline was memory (89%), language (78%), visuospatial (68%), attention (57%), and fluency (57%). Conclusions: Present study highlighted not only the burden of cognitive decline in the dialysis patients where hemodialysis and presence of diabetic were significantly associated with dementia.
iranian journal of nursing and midwifery research, 2023
Background: Cognitive disorders are one of the most common disorders in elderly people with chronic renal failure. This study aimed to investigate the correlation and agreement of Montreal Cognitive Assessment (MoCA), Abbreviated Mental Test Score (AMTS), and Mini-Mental State Examination (MMSE) tests in assessing the cognitive status of elderly patients undergoing hemodialysis at Guilan University of Medical Sciences in north of Iran. Materials and Methods: This cross-sectional study was conducted on 84 elderly people undergoing hemodialysis. Inclusion criteria was having an age of 60 years old and older, hemodialysis treatment for at least 6 months, and having reading and writing skills. The Pearson correlation test, Intraclass Correlation Coefficient (ICC) test, and Bland-Altman plot were used for data analysis. Results: The majority of samples were in the age group of 60-65 years (28.57%) and the majority of them were male (66.66%). The results showed a significant positive correlation between MoCA and MMSE (r = 0.69, p = 0.001), between MMSE and AMTS (r = 0.64, p = 0.001), and between MoCA and AMTS tests (r = 0.62, p = 0.001). The results also showed a weak agreement between MoCA and MMSE tests (ICC = −0.11, p = 0.633), between MMSE and AMTS tests (ICC = −0.007, p = 0.369), and between MoCA and AMTS tests (ICC = −0.001, p = 0.780). Conclusions: Based on the results, these tools seem to complement each other. The inconsistency between cognitive tests indicates a serious need to develop appropriate instruments for detecting cognitive disorders in elderly.
Cognitive Impairment and its Correlates in Chronic Kidney Disease Patients Undergoing Haemodialysis
Journal of Evolution of Medical and Dental Sciences, 2019
BACKGROUND Cognitive Impairment (CI) has been found to be quite common amongst patients with Chronic Kidney Disease (CKD) undergoing haemodialysis (HD). The presence of these deficits could affect patient's adherence to diet regimens, treatment and also reduce their Quality of Life. The presence of depression in such patients can further lead to CI. We wanted to assess the prevalence of CI in CKD patients undergoing haemodialysis, socio-demographic and patient related variables affecting CI, and also the relationship between depression and cognition. METHODS Fifty patients undergoing haemodialysis from two dialysis units were assessed. The Montreal Cognitive Assessment (MoCA) scale and Patient Health Questionnaire-9 (PHQ-9) were administered to patients. Descriptive analysis was done for the sociodemographic and clinical variables. Chi square test was used to find the association between the categorical data. Kruskal-Wallis test was used to determine the association between categorical and quantitative variables. RESULTS Mean age of patient was 50.32 (±12.4) years. Mean duration of dialysis was 18.8 (±15.11) months. The prevalence of depression in the patients was 42%. Cognitive impairment was present in 44% of the patients. There was a significant relationship between education level and recall (χ²=31.7, df=12, p=.002) as well as orientation (χ²=29.78, df=8, p=.000) domains of cognition. Also, there was a significant relationship between socioeconomic status and global cognition score (χ²=81.13, df=48, p=.002). There was a negative correlation between duration of dialysis and cognition. Significant relationships were found between depression and various cognitive domains. CONCLUSIONS The prevalence of CI in haemodialysis patients is high. It is also affected by factors such as education level, socioeconomic status, duration of dialysis and presence of depression. Insight into CI is essential for its early identification during the course of illness, so that patient precise treatment decisions can be made.
Prevalence and Correlates of Cognitive Impairment in Hemodialysis Patients
Clinical Journal of the American Society of Nephrology, 2010
Background and objectives: Cognitive impairment is common among persons with ESRD, but the underlying mechanisms are unknown. This study evaluated the prevalence of cognitive impairment and association with modifiable ESRD-and dialysis-associated factors in a large group of hemodialysis patients. Design, setting, participants, & measurements: Cross-sectional analyses were conducted on baseline data collected from 383 subjects participating in the Frequent Hemodialysis Network trials. Global cognitive impairment was defined as a score <80 on the Modified Mini-Mental State Exam, and impaired executive function was defined as a score >300 seconds on the Trailmaking B test. Five main categories of explanatory variables were examined: urea clearance, nutritional markers, hemodynamic measures, anemia, and central nervous system (CNS)-active medications. Results: Subjects had a mean age of 51.6 ؎ 13.3 years and a median ESRD vintage of 2.6 years. Sixty-one subjects (16%) had global cognitive impairment, and 110 subjects (29%) had impaired executive function. In addition to several nonmodifiable factors, the use of H1-receptor antagonists and opioids were associated with impaired executive function. No strong association was found between several other potentially modifiable factors associated with ESRD and dialysis therapy, such as urea clearance, proxies of dietary protein intake and other nutritional markers, hemodynamic measures, and anemia with global cognition and executive function after adjustment for case-mix factors. Conclusions: Cognitive impairment, especially impaired executive function, is common among hemodialysis patients, but with the exception of CNS-active medications, is not strongly associated with several ESRD-and dialysis-associated factors.
Journal of the American Society of Nephrology, 2020
Significance Statement Cognitive impairment is common among individuals receiving maintenance hemodialysis, but few data exist regarding how well screening tests for cognitive function perform in this population. The authors assessed the ability of the Mini Mental State Examination, the Modified Mini Mental State Examination, the Montreal Cognitive Assessment, the Trail Making Test Part B, the Mini-Cog test, and the Digit Symbol Substitution Test to predict severe cognitive impairment in a cohort of 150 patients on dialysis whose cognitive status had been first defined with a battery of neurocognitive tests. The Montreal Cognitive Assessment was the best-performing overall screening test, and the authors recommend it as the preferred test to screen for severe cognitive impairment in patients receiving maintenance hemodialysis. Identification of such impairment may then facilitate optimal medical management and discussion of relevant issues with patients and family members. Backgroun...
Nephrology Dialysis Transplantation, 2017
Background. Mounting evidence indicates an increased risk of cognitive impairment in adults with end-stage kidney disease on dialysis, but the extent and pattern of deficits across the spectrum of cognitive domains are uncertain. Methods. We conducted a cross-sectional study of 676 adult hemodialysis patients from 20 centers in Italy, aiming to evaluate the prevalence and patterns of cognitive impairment across five domains of learning and memory, complex attention, executive function, language and perceptual-motor function. We assessed cognitive function using a neuropsychological battery of 10 tests and calculated test and domain z-scores using population norms (age or age/education). We defined cognitive impairment as a z-score À1.5. Results. Participants' median age was 70.9 years (range 21.6-94.1) and 262 (38.8%) were women. Proportions of impairment on each domain were as follows: perceptual-motor function 31.5% (150/476), language 41.2% (273/662), executive function 41.7% (281/674), learning and memory 42.2% (269/638), complex attention 48.8% (329/674). Among 474 participants with data for all domains, only 28.9% (n ¼ 137) were not impaired on any domain, with 25.9% impaired on a single domain (n ¼ 123), 17.3% on two (n ¼ 82), 13.9% on three (n ¼ 66), 9.1% on four (n ¼ 43) and 4.9% (n ¼ 23) on all five. Across patients, patterns of impairment combinations were diverse. Conclusions. In conclusion, cognitive impairment is extremely common in hemodialysis patients, across numerous domains, and patients often experience multiple deficits simultaneously. Clinical care should be tailored to meet the needs of patients with different types of cognitive impairment and future research should focus on identifying risk factors for cognitive decline.
Relationship between dialysis adequacy and cognitive function in hemodialysis patients
Ukrainian Journal of Nephrology and Dialysis
The prevalence of cognitive impairment is extremely high in dialysis patients, and it has been hypothesized that low urea clearance has an impact on cognitive impairment. However, several other studies conducted in the era of high-flux dialysis have not shown an association between lower Kt/V and poorer cognitive function. Therefore, studies that directly examine the relationship between dialysis adequacy and cognitive function in hemodialysis patients are essential. The present study aimed to investigate the cognitive functions of hemodialysis patients and their relationship with dialysis adequacy. Methods. This cross-sectional observational study included 100 patients and 100 healthy volunteers. Dialysis adequacy was assessed by the Kt/V ratio in the previous month. The Mini-Mental State Examination (MMSE), the Montreal Cognitive Assessment Test (MoCA), and the Clock Drawing Test (CDT) were used to assess cognitive function. Multiple regression analysis was used to determine the s...