Abstract
BackgroundChronic kidney disease (CKD) patients undergoing hemodialysis (HD) therapy have an increased risk of developing cognitive impairment and dementia, which are known relevant factors in disease prognosis and therapeutic success, but still lack adequate screening in clinical routine. We evaluated the Montreal Cognitive Assessment (MoCA) for suitability in assessing cognitive performance in HD patients in comparison to the commonly used Mini-Mental State Examination (MMSE) and a detailed neuropsychological test battery, used as gold standard.Methods43 HD patients and 42 healthy controls with an average age of 58 years, were assessed with the MoCA, the MMSE and a detailed neuropsychological test battery, covering the domains of memory, attention, language, visuospatial and executive functions. Composite scores were created for comparison of cognitive domains and test results were analyzed using Spearman's correlation and linear regression. Cognitive dysfunction was defined using z-score values and predictive values were calculated. Sensitivity and specificity of the MoCA were determined using receiver operating characteristic (ROC) analysis.ResultsHD patients performed worse in all cognitive domains, especially in memory recall and executive functions. The MoCA correlated well with the detailed test battery and identified patients with cognitive impairment with a sensitivity of 76.7% and specificity of 78.6% for a cut-off value of ≤24 out of 30 points. In the detailed assessment executive functions accounted significantly for performance in the MoCA. The MMSE only discriminated weakly between groups.ConclusionsThe MoCA represents a suitable cognitive screening tool for hemodialysis patients, demonstrating good sensitivity and specificity levels, and covering executive functions, which appear to play an important role in cognitive performance of HD patients.
Highlights
The association of cognitive impairment and a higher incidence of dementia in patients with chronic kidney disease (CKD) has been increasingly acknowledged over the last few years [1,2,3] and represents an important issue in an already vulnerable population
The funders had no role in study design, data collection and analysis, decision to publish, or preparation of the manuscript
Patients had been on dialysis treatment for 50 months and spent four hours on dialysis, three times per week, with an average ultrafiltration volume of 1.2 liters
Summary
The association of cognitive impairment and a higher incidence of dementia in patients with chronic kidney disease (CKD) has been increasingly acknowledged over the last few years [1,2,3] and represents an important issue in an already vulnerable population. It is generally considered superior to the well-established Mini-Mental State Examination (MMSE) screening test [12,13], since the MoCA assesses executive functioning, which may be important in the CKD population [14,15], and presents a higher sensitivity for mild cognitive impairment. The ability to distinguish between HD patients with and without cognitive impairment, the sensitivity, specificity and predictive values of the MoCA were assessed Psychometric criteria such as concurrent and criterion validity of performance on the MoCA, a comprehensive neuropsychological test battery and the standard brief cognitive screening test MMSE were evaluated. Chronic kidney disease (CKD) patients undergoing hemodialysis (HD) therapy have an increased risk of developing cognitive impairment and dementia, which are known relevant factors in disease prognosis and therapeutic success, but still lack adequate screening in clinical routine. We evaluated the Montreal Cognitive Assessment (MoCA) for suitability in assessing cognitive performance in HD patients in comparison to the commonly used Mini-Mental State Examination (MMSE) and a detailed neuropsychological test battery, used as gold standard
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