Progression of cognitive impairment in hemodialysis patients

Abstract

Objective: Cognitive impairment increases the risk of mortality in patients with chronic kidney disease. Progressive cognitive decline can be a serious issue for hemodialysis (HD) patients even if they are young with few comorbid conditions. The aim of this prospective study is to evaluate HD patients using Montreal Cognitive Assessment (MoCA) and search for the signs of cognitive decline using cognitive domain scores. Method: Twenty-nine chronic HD patients were selected. All patients were tested with MoCA at baseline and after the two-years follow-up. Patients with heart failure, dementia, depression, visual disturbance, malignancy, active infections and, those with single-pool Kt/V<1.4 at baseline or during follow-up were excluded. Patients with MoCA global score <24/30 are considered to be cognitively impaired. MoCA and MoCA subscale scores were compared for differences in time. Results: The number of patients with cognitive impairment at baseline increased from 18 (62%) to 22 (75.8%) after 2 years follow-up period. The mean total MoCA score after follow-up was significantly lower than that of the baseline (20.57±4.64<22.17±3.87; p=0.001). Analysis for MoCA subscale scores revealed that the mean scores for the attention and language cognitive domains were significantly lower in the follow-up measures compared to the baseline measures in HD patients (p=0.013 & p<0.001). Conclusion: This study demonstrated that global cognitive scores in HD patients decrease over time. This cognitive decline was predominantly related to the differences in attention and language scores. Routine comprehensive evaluation of HD patients with cognitive batteries may be helpful to detect the progression of cognitive function.

Keywords

• Cognitive impairment
• End stage renal disease
• Hemodialysis
• Attention
• Language

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