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Impaired cognition in hemodialysis patients: The Montreal Cognitive Assessment (MoCA) and important clues for

Ertugrul Erken, Orcun Altunoren, Mahmut Egemen Senel

    Clinical Nephrology
    |January 29, 2019
    PubMed

    Insights

    Cognitive impairment is prevalent in hemodialysis (HD) patients, particularly affecting executive function. Early detection using Montreal Cognitive Assessment (MoCA) subscales may benefit younger HD patients with fewer comorbidities.

    Area of Science:

    • Nephrology
    • Neurology
    • Gerontology

    Background:

    • Cognitive impairment is a significant issue in hemodialysis (HD) patients, linked to poor outcomes.
    • This study focuses on younger HD patients with fewer comorbidities to understand cognitive decline.
    • Early detection of cognitive impairment is crucial for improving treatment compliance and mortality rates.

    Purpose of the Study:

    • To evaluate cognitive function in relatively young hemodialysis patients using the Montreal Cognitive Assessment (MoCA).
    • To identify early indicators of cognitive impairment by analyzing MoCA subscale scores.
    • To compare cognitive function between chronic HD patients and predialytic chronic kidney disease (CKD) patients.

    Main Methods:

    • 103 chronic HD patients and 37 stage 3-5 CKD patients were assessed using the MoCA.
    • Exclusion criteria included cerebrovascular disease, dementia, depression, malignancy, and infections.
    • Cognitive impairment was defined as a MoCA global score < 24/30.

    Main Results:

    • A higher prevalence of cognitive impairment was observed in the HD group (72.8%) compared to the CKD group (51.3%).
    • The HD group exhibited significantly lower mean total MoCA scores.
    • The visuospatial/executive domain scores were significantly lower in the HD group, indicating a primary deficit in this area.

    Conclusions:

    • Cognitive impairment is more common in HD patients than in predialytic CKD patients, primarily due to executive function deficits.
    • Younger HD patients, even with fewer comorbidities, are at risk for cognitive impairment.
    • Monitoring MoCA cognitive subdomains for progressive decline can aid in early detection and intervention for HD patients.
    Abstract

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