Abstract: FR-PO424
Evaluation of Screening Tests for Severe Cognitive Impairment in Maintenance Hemodialysis Patients
Session Information
- Hemodialysis and Frequent Dialysis - III
November 08, 2019 | Location: Exhibit Hall, Walter E. Washington Convention Center
Abstract Time: 10:00 AM - 12:00 PM
Category: Dialysis
- 701 Dialysis: Hemodialysis and Frequent Dialysis
Authors
- Drew, David A., Tufts Medical Center, Boston, Massachusetts, United States
- Tighiouart, Hocine, Tufts Medical Center, Boston, Massachusetts, United States
- Rollins, Jasmine S., Tufts Medical Center, Boston, Massachusetts, United States
- Duncan, Sarah, Icahn School of Medicine at Mount Sinai, New York, New York, United States
- Babroudi, Seda, Tufts Medical Center, Boston, Massachusetts, United States
- Weiner, Daniel E., Tufts Medical Center, Boston, Massachusetts, United States
- Sarnak, Mark J., Tufts Medical Center, Boston, Massachusetts, United States
Background
Detailed neurocognitive testing shows that cognitive impairment is common among patients requiring maintenance hemodialysis. Identification of a well performing and easy to administer test for cognitive impairment could facilitate broader screening in dialysis units.
Methods
In 150 hemodialysis patients, we performed a comprehensive battery of neurocognitive tests (considered the "gold standard" for this study). Participants were classified as having normal cognitive function versus mild, moderate, or severe cognitive impairment by comparing scores in multiple cognitive domains to normative data. We examined the predictive screening ability of the Mini-Mental State Examination (MMSE), the Modified Mini-Mental State Examination (3MS), the Montreal Cognitive Assessment (MoCA), Mini-Cog, Clock Drawing test, Trails Making B (Trails B), and Digit Symbol Substitution tests to identify participants with severe cognitive impairment using area under the curve analysis.
Results
Mean age was 64 years; 61% were men, 39% were black and 94% had at least a high school education. Of the 150 participants, 21% had normal cognitive function, 17% mild cognitive impairment, 33% moderate impairment, and 29% severe impairment. The MoCA had the best predictive ability for severe cognitive impairment (AUC = 0.81 [0.73, 0.89]). A score on the MoCA of less than 21, which maximized the sum of sensitivity and specificity, displayed a sensitivity of 86% and specificity of 55% for severe impairment. The Trails B and Digit Symbol tests also performed reasonably well with AUC of 0.73 [0.59, 0.87] and 0.78 [0.68, 0.88], respectively. The MMSE, 3MS, Mini-Cog, and Clock Drawing tests had the lowest predictive performance.
Conclusion
Nearly one third of participants had severe cognitive impairment. The MoCA, a widely available, brief assessment that requires relatively simple training to administer, showed high sensitivity and moderate specificity in detecting severe cognitive impairment in prevalent hemodialysis patients.
Funding
- NIDDK Support