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Cognitive Decline in Hemodialysis Patients: A Cross-Sectional Study Using Addenbrooke's Cognitive Examination-III

Siri Chandana1, Jayakumar M1, Sandhya Suresh1

  • 1Department of Nephrology, Sri Ramachandra Institute of Higher Education and Research, Chennai, IND.

Cureus
|October 17, 2025
PubMed

Insights

Cognitive impairment affects nearly half of hemodialysis patients in South India, particularly impacting memory and attention. Early screening using ACE-III is recommended for timely interventions in chronic kidney disease care.

Area of Science:

  • Nephrology
  • Neurology
  • Psychology

Background:

  • Cognitive impairment (CI) is a common, often undiagnosed complication in patients undergoing maintenance hemodialysis (HD).
  • Understanding the prevalence and patterns of CI in diverse populations like South India is crucial for effective management.
  • The Addenbrooke's Cognitive Examination-III (ACE-III) offers a comprehensive tool for assessing cognitive function.

Purpose of the Study:

  • To determine the prevalence and patterns of cognitive dysfunction among South Indian patients on maintenance hemodialysis.
  • To identify clinical and sociodemographic factors associated with cognitive impairment in this population.
  • To evaluate the utility of the ACE-III for screening cognitive impairment in HD patients.

Main Methods:

  • A cross-sectional study involving 175 maintenance hemodialysis patients in Chennai, Tamil Nadu, India.
  • Cognitive function was assessed using the Indian English version of the Addenbrooke's Cognitive Examination-III (ACE-III).
  • Data on age, gender, education, dialysis duration, comorbidities, and hemoglobin levels were collected and analyzed.

Main Results:

  • Cognitive impairment was identified in 46.9% (82 out of 175) of the patients, with ACE-III scores between 60-80.
  • Lower cognitive scores significantly correlated with older age, lower educational attainment, and longer duration of dialysis (p<0.05).
  • Memory and attention domains were most frequently affected by cognitive dysfunction.

Conclusions:

  • Cognitive impairment is highly prevalent in the South Indian hemodialysis population, with significant associations with age, education, and dialysis duration.
  • Routine screening with ACE-III can aid in the early detection of cognitive impairment in hemodialysis patients.
  • Targeted interventions based on early detection can improve outcomes for cognitive dysfunction in chronic kidney disease patients undergoing dialysis.

Keywords:
ace-iiiaddenbrooke's cognitive examination-iii (ace-iii)chronic kidney diseasecognitive impairmenthaemodialysisindianeurocognition

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