The Clinical Study On Mild Cognitive Impairment In Maintenance Hemodialysis Patients

Objectives:To explore the incidence of mild cognitive impairment(MCI)in maintenance hemodialysis(MHD)patients.Comparing the value of Montreal cognitive assessment(MoCA)and Mini-mental state examination(MMSE)in screening MCI in MHD patients.Analysis of the characteristics of cognitive impairment in patients with MHD.To study the factors influencing cognitive function in patients with MHD.Methods: This study is a cross-sectional study.We selected 200 cases of MHD patients in the nephropathy department of our hospital from September 2016 to June 2017 randomly.According to diagnosis of cognitive impairment by neurologists,moderate or severe cognitive impairment patients were excluded,dividing the remaining patients into mild cognitive impairment group(MCI group)and normal cognitive function group(N-MCI group).Collecting data of gender,age,education level,height,weight,primary disease,dialysis model,dialysis age of patients.And testing blood laboratory indicators,including hemoglobin(Hb),albumin(Alb),blood urea nitrogen(BUN),parathyroid hormone(PTH),calcium(Ca),phosphorus(P),serum ferritin(SF).Evaluation of cognitive function in two groups by MMSE and MoCA scales.According to the sensitivity,specificity and ROC curve of the two scales,the value of the screening of MCI was compared.Then comparing the differences in orientation,attention and calculation,instant memory,delayed memory,language ability,abstract thinking,visual spatial and executive ability of the two groups.Last,the factors influencing cognitive function of MHD patients were found by Logistic regression analysis.Results:1.The positive rate of MCI in 200 patients with MHD was 55%.2.The score of MoCA in MCI group(24 points)was significantly lower than that in N-MCI group(27points).There was no significant difference in the scores of MMSE scale between MCI group and N-MCI group(27 points).The ROC curve showed that the best threshold value for the diagnosis of MCI in MHD patients was 26 points,the sensitivity was 91.7%,the specificity was 80.9%,the area under the curve(AUC)was 0.904.The best limit value of MMSE was 25,the sensitivity was 79.9% and the specificity was36.1%,the AUC was 0.512.3.In the MoCA scale,patients’ attention and calculation,delayed memory,abstract thinking,visual spatial and executive ability scores in MCI group were lower than N-MCI group(P<0.05).There was no significant difference in cognitive subitems between MCI group and N-MCI group in MMSE scale(P>0.05).4.In single factor analysis,there was significant difference between MCI group and N-MCI group in age,education,diabetic nephropathy,dialysis pattern,hemoglobin and serum phosphorus(P<0.05).There was no significant difference in gender,Body Mass Index(BMI),dialysis age,single pool Kt/V(spKt/V),albumin,blood urea nitrogen,parathyroid hormone,calcium and serum ferritin(P>0.05).The multivariate Logistic regression analysis showed that,advanced age(OR=1.201,95%CI:1.124-1.284),low educationlevel(OR=0.806,95%CI:0.601-0.980),low-flux hemodialysis,LFHD)(OR=4.707,95%CI:2.258-9.812),Hb <110g/l(OR=1.421,95%CI: 1.025-1.745),high phosphorus(OR= 1.084,95%CI:1.056-1.604)as independent risk factors for cognitive function in patients with MHD,110g/l ≤ Hb ≤ 130g/l was a protective factor(0.265% 95 CI:0.095-0.745).Conclusions:1.The prevalence of MCI is common in MHD patients.Cognitive impairment occurs in attention and calculation,delayed memory,visual spatial and executive ability.2.MoCA was more accurate than MMSE in screening MCI of MHD patients.3.Advanced age,low education level,long-term LFHD therapy,anemia and hyperphosphatemia made MCI more likely in patients with MHD.