Evaluation of Screening Tests for Cognitive Impairment in Patients Receiving Maintenance Hemodialysis (original) (raw)
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Screening of Cognitive Impairment in the Dialysis Population: A Scoping Review
Dementia and Geriatric Cognitive Disorders, 2017
Background: Cognitive impairment in end-stage kidney disease patients on dialysis is increasingly common. This study aimed to review the practice of screening and to evaluate the evidence on cognitive impairment prevalence in this population. Methods: This scoping review of studies summarises the evidence on cognitive impairment in dialysis populations. The search included the Medline, CINAHL, Embase, PsycINFO, PubMed, and Cochrane Library databases for English-language articles published between 2000 and 2015. A total of 46 articles were reviewed. Results: The studies were of prospective observational design, with the majority conducted in the haemodialysis population. The reported prevalence of cognitive impairment ranged from 6.6 to 51%. Three screening tools were consistently used. Conclusion: While cognitive impairment is recognised in the dialysis population, there is paucity of screening data. The design of prospective comparisons ideally includes established screening instruments, particularly the Montreal Cognitive Assessment, to determine the optimal results for this population. Translation of established screening tools to increase the inclusion of people from other cultural and language groups is required. Regular screening can enhance the timing to introduce home-based care support and advance care planning discussions.
IOSR Journal of Dental and Medical Sciences, 2024
Background:cognitive impairment and dementia are frequently seen in the end stage renal disease (ESRD) population who were on maintenance hemodialysis. It negatively affects daily functioning ability, poorly affects health-related quality of life, and non-adherence to hemodialysis therapy. Saint louis university mental status exam (slums) can be a better cognitive impairment detecting tool than the mmse.as per our knowledge, no studies were done using the slums tool for the maintenance hemodialysis (MHD) population to analyze cognitive impairment. Materials and methods: in this cross-sectional study, 160 patients were included who were on MHD. Patients were grouped based on their age, period of hemodialysis, and co-morbid conditions. Then the cognitive status of each patient was analyzed using the slums. Results: we observed that the patients on maintenance hemodialysis (MHD) for 2-4 years (48.8%) have the highest prevalence of cognitive impairment, especially dementia than the patients on MHD less than a year. We observed that the patients doing thrice weekly hemodialysis (HD) are more prevalence to get cognitive impairment than the patients doing twice weekly hd. We also observed that among the elder group >60 years are having higher prevalence of dementia about 58.1% than the other age groups doing hd. Conclusion: patients undergoing hemodialysis experience a transient decline of cognitive function with respect to dialysis vintage, frequency of hd and elder age group had been noted. Slums is a simple and an alternative tool to analyse the cognitive impairment in patients on maintenance hemodialysis.
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...
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.
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.
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.
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.
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.
Prevalence and patterns of cognitive impairment in adults on haemodialysis: the cognitive-Hd study
Nephrology, 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.