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

Erken, Ertuğrul; Altunören, Orçun; Şenel, Mahmut Egemen; Tunçel, Deniz; Yılmaz, Tuğba; Ganidagli, Safa Ersen; Demircioğlu, Didem; Güngör, Özkan

doi:10.5414/cn109506

Cited by 13 publications

(11 citation statements)

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“…The optimal cut-off of ≤24 points out of a 30-point maximum is lower than the cut-off value of ≤26 described in the original data collected in a population of patients with Alzheimer's disease and mild cognitive impairment [25]. In the present HD cohort, there is a higher prevalence of cognitive impairment (84.6%; 114/136 based on MoCA cut‐off ≤ 24 points) than other HD cohorts [26]. This may be related to longer dialysis vintage and higher diabetes mellitus comorbidity in the HD cohort.…”

Section: Discussionmentioning

confidence: 83%

A Low Ankle-Brachial Index and High Brachial-Ankle Pulse Wave Velocity Are Associated with Poor Cognitive Function in Patients Undergoing Hemodialysis

Lin

et al. 2019

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Patients with end-stage renal disease (ESRD) have an increased risk of both impaired cognitive function and peripheral artery disease (PAD) than the general population. The association between PAD and dementia is recognized, but there are limited studies in patients with ESRD. The aim of this study was to evaluate the relationship between ankle-brachial index (ABI) and brachial-ankle pulse wave velocity (baPWV) and cognitive impairment in patients receiving hemodialysis (HD). We enrolled 136 prevalent HD patients (mean age 59.3±10.5 years, 55.9% male). Cognitive performance was measured using the Montreal Cognitive Assessment (MoCA) and Cognitive Abilities Screening Instrument (CASI) by trained psychiatrists. Associations between the cognitive function and ABI and baPWV were assessed using multiple linear regression analysis. Compared with HD patients with ABI≥0.9, patients with ABI<0.9 had lower MoCA score (p=0.027) and lower CASI score but did not achieve significant level (p=0.056). In the multivariate stepwise linear regression analysis, ABI (per 0.1) was independently positively associated with the MoCA score (β coefficient=0.62, p=0.011) and the CASI score (β coefficient=1.43, p=0.026). There is a negative association between baPWV (per 100 cm/s) and CASI (β coefficient=−0.70, p=0.009). In conclusion, a low ABI or high baPWV was associated with a lower cognitive function in HD patients.

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Section: Discussionmentioning

confidence: 83%

A Low Ankle-Brachial Index and High Brachial-Ankle Pulse Wave Velocity Are Associated with Poor Cognitive Function in Patients Undergoing Hemodialysis

Lin

et al. 2019

Disease Markers

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“…Moreover, cognitive impairment may persist after RT compared with the general population, but improve compared with patients receiving HD 18,19 . The Montreal Cognitive Assessment (MoCA) is a validated and sensitive screening tool for cognitive impairment in patients with CKD on HD 20‐22 . Despite this, there are no studies evaluating the prognostic value of MoCA, specifically, on the outcomes of patients on the kidney transplant list.…”

Section: Introductionmentioning

confidence: 99%

Can the Timed Up & Go Test and Montreal Cognitive Assessment predict outcomes in patients waitlisted for renal transplant?

Bozhilov

2020

Clinical Transplantation

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Purpose Frail patients who undergo renal transplantation (RT) have more complications; however, little is known if these patients can sustain the wait to RT. We used the Timed Up and Go Test (TUGT) and Montreal Cognitive Assessment (MoCA) to determine outcomes of RT candidates. Methods In this retrospective study, 526 RT candidates underwent TUGT and MoCA (2015‐2019) and were divided into “favorable” (transplanted or remained on the list) or “unfavorable” (not listed, removed from list, or died) outcome. Demographics, education, language, comorbidities, dialysis type, use of a walking device, TUGT, and MoCA were compared by outcome. Results Overall, 230 patients (43.7%) passed TUG, 268 (51%) passed MoCA, 133 (25.3%) passed both, and 161 (30.6%) failed both tests. Multivariate analysis demonstrated age ≥ 65 (OR 1.58, CI 1.03–2.43), cardiac disease (OR 3.09, CI 2.02–4.72), ≥36 months on dialysis (OR 1.80, CI 1.24–2.69), EPTS < 20% at time of MoCA (OR 0.26, CI 0.07–0.98), and failing TUGT (OR 2.14, CI 1.43–3.19) were associated with unfavorable outcome. Failing MoCA was not associated with outcome. Conclusions MoCA test results were not associated with RT waitlist outcomes; however, passing the TUGT was associated with receiving RT or remaining on the list. Additional studies are needed to validate this and determine outcome after RT.

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“…Indeed, using MMSE only may lead to underestimation of cognitive impairment in HD patients who predominantly exhibit cognitive deficits in executive, attention, and memory cognitive domains. Therefore, we should combine MMSE with other cognitive tests like Viana et al did, or choose a single practical cognitive test that could be more suitable for patients with advanced CKD such as the Montreal Cognitive Assessment (MoCA) (4,5) 4 , 5. After all, testing elderly HD patients for cognitive functions necessitates the selection of a tool that includes evaluation of executive functions.…”

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confidence: 99%

“…After all, testing elderly HD patients for cognitive functions necessitates the selection of a tool that includes evaluation of executive functions. Cognitive testing should be performed before a routine HD session and a suitable cut-off point should be determined by taking into consideration the age and educational status of the subject 4. Detection of depressive mood with a practical test like GDS-15 might be a way to eliminate false positivity during cognitive testing in these patients.…”

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confidence: 99%

“…CFI is also a numerical scale that is useful in grading the severity of frailty 6. Comorbidity burden can be assessed with tools like the Cumulative Illness Rating Scale (CIRS) or the Charlson Comorbidity Index (CCI) 4 , 7. It would be wise to reevaluate any HD patient for preventive measures and multidisciplinary treatment strategies when frailty or severe comorbidity burden is detected.…”

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confidence: 99%

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Geriatric assessment in elderly hemodialysis patients

Erken

2019

J. Bras. Nefrol.

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

Cited by 13 publications

References 0 publications

A Low Ankle-Brachial Index and High Brachial-Ankle Pulse Wave Velocity Are Associated with Poor Cognitive Function in Patients Undergoing Hemodialysis

A Low Ankle-Brachial Index and High Brachial-Ankle Pulse Wave Velocity Are Associated with Poor Cognitive Function in Patients Undergoing Hemodialysis

Can the Timed Up & Go Test and Montreal Cognitive Assessment predict outcomes in patients waitlisted for renal transplant?

Geriatric assessment in elderly hemodialysis patients

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