Development of a rapid screener through network analysis to identify central cognitive complaints in haemodialysis...

Cognitive impairments and cognitive complaints are commonly present in dialysis patients and can affect clinical, functional, occupational, and psychosocial well-being. It is important to screen for patients' cognitive status as it offers a gateway to specialty referral, prevention or rehabilitation programmes, and personalisation of clinical care. The Patient's Assessment of Own Functioning Inventory (PAOFI) is a comprehensive questionnaire that assesses patient-reported difficulties in memory, language, motor/sensory-perceptual skills and higher-level cognitive function. In the current study, we adopted network analysis to identify central cognitive complaints in dialysis patients and derived a PAOFI short form (PAOFI-SF) based on these core symptoms to improve screening efficiency in real-world renal settings.

Multicentre, cross-sectional study.

Participants were recruited from 10 community-based dialysis centres in Singapore, from May to November 2022.

A total of 369 eligible haemodialysis patients were invited to join the study, and 268 completed the measures (response rate 72.6%).

Cognitive assessment tools including the PAOFI and the Montreal Cognitive Assessment were administered.

Based on the PAOFI measure, 98 participants (36.6%) endorsed the presence of three or more complaints, indicating clinically significant cognitive complaints. Network analysis identified five central cognitive complaints among dialysis patients: problem-solving difficulty, difficulty following instructions, forgetting how to do tasks, difficulty being understood, and forgetting people known years ago. These core items were combined into a five-item short form of PAOFI, which showed good reliability and validity, and an area under the curve of 83.4% in identifying clinically significant cognitive complaints. The optimal cut-off point of the short form was 11.5 (out of 30), with a specificity of 89.5%, sensitivity of 63.9%, positive predictive value of 77.5% and negative predictive value of 81.4%. This cut-off point also predicted objective cognitive performance even after controlling for sociodemographic and clinical confounders.

Pending future replication and external validation, the PAOFI-SF may be suitable for use in renal care settings as an initial screening tool to identify patients with cognitive complaints and increased risk of objective cognitive impairments.