David A Drew1, Hocine Tighiouart2,3, Jasmine Rollins4, Sarah Duncan4, Seda Babroudi4, Tammy Scott5, Daniel E Weiner4, Mark J Sarnak4. 1. Division of Nephrology, Department of Medicine, and ddrew@tuftsmedicalcenter.org. 2. The Institute for Clinical Research and Health Policy Studies, Tufts Medical Center, Boston, Massachusetts. 3. Tufts Clinical and Translational Science Institute, and. 4. Division of Nephrology, Department of Medicine, and. 5. Jean Mayer United States Department of Agriculture Human Nutrition Research Center on Aging, Tufts University, Boston, Massachusetts.
Abstract
BACKGROUND: Neurocognitive testing shows that cognitive impairment is common among patients receiving maintenance hemodialysis. Identification of a well performing screening test for cognitive impairment might allow for broader assessment in dialysis facilities and thus optimal delivery of education and medical management. METHODS: From 2015 to 2018, in a cohort of 150 patients on hemodialysis, we performed a set of comprehensive neurocognitive tests that included the cognitive domains of memory, attention, and executive function to classify whether participants had normal cognitive function versus mild, moderate, or severe cognitive impairment. Using area-under-the-curve (AUC) analysis, we then examined the predictive ability of the Mini Mental State Examination, the Modified Mini Mental State Examination, the Montreal Cognitive Assessment, the Trail Making Test Part B, the Mini-Cog test, and the Digit Symbol Substitution Test, determining each test's performance for identifying severe cognitive impairment. 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% had mild cognitive impairment, 33% had moderate impairment, and 29% had severe impairment. The Montreal Cognitive Assessment had the highest overall predictive ability for severe cognitive impairment (AUC, 0.81); a score of ≤21 had a sensitivity of 86% and specificity of 55% for severe impairment, with a negative predictive value of 91%. The Trails B and Digit Symbol tests also performed reasonably well (AUCs, 0.73 and 0.78, respectively). The other tests had lower predictive performances. CONCLUSIONS: The Montreal Cognitive Assessment, a widely available and brief cognitive screening tool, showed high sensitivity and moderate specificity in detecting severe cognitive impairment in patients on maintenance hemodialysis.
BACKGROUND: Neurocognitive testing shows that cognitive impairment is common among patients receiving maintenance hemodialysis. Identification of a well performing screening test for cognitive impairment might allow for broader assessment in dialysis facilities and thus optimal delivery of education and medical management. METHODS: From 2015 to 2018, in a cohort of 150 patients on hemodialysis, we performed a set of comprehensive neurocognitive tests that included the cognitive domains of memory, attention, and executive function to classify whether participants had normal cognitive function versus mild, moderate, or severe cognitive impairment. Using area-under-the-curve (AUC) analysis, we then examined the predictive ability of the Mini Mental State Examination, the Modified Mini Mental State Examination, the Montreal Cognitive Assessment, the Trail Making Test Part B, the Mini-Cog test, and the Digit Symbol Substitution Test, determining each test's performance for identifying severe cognitive impairment. 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% had mild cognitive impairment, 33% had moderate impairment, and 29% had severe impairment. The Montreal Cognitive Assessment had the highest overall predictive ability for severe cognitive impairment (AUC, 0.81); a score of ≤21 had a sensitivity of 86% and specificity of 55% for severe impairment, with a negative predictive value of 91%. The Trails B and Digit Symbol tests also performed reasonably well (AUCs, 0.73 and 0.78, respectively). The other tests had lower predictive performances. CONCLUSIONS: The Montreal Cognitive Assessment, a widely available and brief cognitive screening tool, showed high sensitivity and moderate specificity in detecting severe cognitive impairment in patients on maintenance hemodialysis.
Authors: Mark J Sarnak; Hocine Tighiouart; Tammy M Scott; Kristina V Lou; Eric P Sorensen; Lena M Giang; David A Drew; Kamran Shaffi; James A Strom; Ajay K Singh; Daniel E Weiner Journal: Neurology Date: 2013-01-09 Impact factor: 9.910
Authors: A M Murray; D E Tupper; D S Knopman; D T Gilbertson; S L Pederson; S Li; G E Smith; A K Hochhalter; A J Collins; R L Kane Journal: Neurology Date: 2006-07-25 Impact factor: 9.910
Authors: David A Drew; Rafeeque Bhadelia; Hocine Tighiouart; Vera Novak; Tammy M Scott; Kristina V Lou; Kamran Shaffi; Daniel E Weiner; Mark J Sarnak Journal: Am J Kidney Dis Date: 2012-10-03 Impact factor: 8.860
Authors: David A Drew; Daniel E Weiner; Hocine Tighiouart; Tammy Scott; Kristina Lou; Amy Kantor; Li Fan; James A Strom; Ajay K Singh; Mark J Sarnak Journal: Am J Kidney Dis Date: 2014-09-17 Impact factor: 8.860
Authors: Frances E Tiffin-Richards; Ana S Costa; Bernhard Holschbach; Rolf D Frank; Athina Vassiliadou; Thilo Krüger; Karl Kuckuck; Theresa Gross; Frank Eitner; Jürgen Floege; Jörg B Schulz; Kathrin Reetz Journal: PLoS One Date: 2014-10-27 Impact factor: 3.240
Authors: Benjamin Lidgard; Nisha Bansal; Leila R Zelnick; Andrew Hoofnagle; Jing Chen; Derek Colaizzo; Mirela Dobre; Katherine T Mills; Anna C Porter; Sylvia E Rosas; Mark J Sarnak; Stephen Seliger; James Sondheimer; Manjula Kurella Tamura; Kristine Yaffe; Bryan Kestenbaum Journal: J Am Soc Nephrol Date: 2022-04-20 Impact factor: 14.978
Authors: M Kyla Shea; Jifan Wang; Kathryn Barger; Daniel E Weiner; Sarah L Booth; Stephen L Seliger; Amanda H Anderson; Rajat Deo; Harold I Feldman; Alan S Go; Jiang He; Ana C Ricardo; Manjula Kurella Tamura Journal: Curr Dev Nutr Date: 2022-06-24