The Montreal Cognitive Assessment (MoCA) In Stable Hemodialysis Patients Without Dementia

Background:Cognitive impairment is common among hemodialysis patients. However, the situation of hemodialysis patients with mild cognitive impairment (MCI) and the changes that occur over time remains unknown.Aims:This study aimed to research the frequency and scores of mild cognitive impairment among hemodialysis patients without dementia and possible correlated factors. And, to assess the validity of two cognitive screening tests, the Mini-Mental State Examination (MMSE) and the Montreal Cognitive Assessment (MoCA), in detecting MCI in hemodialysis patients. Additionally, we assessed MMSE and MoCA scores after 6 months to examine the effects of hemodialysis on MCI.Methods:Data were collected from 64 hemodialysis patients without dementia compared with 54 non-hemodialysis patients all receiving treatment at the Department of Geriatrics of the First Affiliated Hospital of Nanjing Medical University. Mild cognitive impairment were defined using the Mini-Mental State Examination (MMSE) and the Chinese Montreal Cognitive Assessment (C-MoCA) and we used receiver operating characteristic curve (ROC curve) to compare the accuracy, sensitivity and specificity of them. We assessed hemodialysis patients at the beginning of the study (baseline), and again after 6 months of stable hemodialysis (six-months). The data collected before and after 6 months were compared. Monitor index we analyzed included age, sex, education, foundation disease, laboratory examination, blood pressure, and any other factors associated with hemodialysis.Results:There were no statistically significant differences between the hemodialysis (HD) and non-hemodialysis (non-HD) patients for age, sex, education, and foundation disease. Of 64 HD subjects who completed testing,51.9% were classified with mild cognitive impairment, but 29.6% in non-HD patients.The mean C-MoCA scores for HD patients,22.5±5.5, were lower than for the non-HD patients,26.7±3.4. Both groups performed similarly on tasks of attention and memory recall. The optimal MoCA screening cutoff was 26 (93.7% sensitivity,71.9% specificity and area under the curve were 0.905). After 6 months, the visuospatial executive function and abstraction of C-MoCA had significant differences between baseline and six-months group, while the MMSE scores did not change. By the Spearman correlation test, there were associations between age, education, foundation disease, uric acid, albumin, blood pressure, URR, spKt/V HD patients MMSE/MoCA score.Conclusion:Mild cognitive impairment was more common in HD patients without dementia compared with non-HD patients, and this changed with dialysis treatment. The MoCA is superior to the MMSE in detecting MCI in hemodialysis patients.