Comparison of the montreal cognitive assessment and the mini-mental state examination as screening tests in hemodialysis patients without symptoms

• Published in: Renal failure 2018-11, Vol.40 (1), p.323-330
• Main Authors: Lee, Sun Hwa, Cho, AJin, Min, Yang-Ki, Lee, Young-Ki, Jung, San
• Format: Article
• Language: English
• Subjects: Aged; Aged, 80 and over; Asymptomatic Diseases; chronic kidney disease; Clinical Study; Cognitive ability; Cognitive Dysfunction - diagnosis; Cognitive Dysfunction - etiology; Cognitive impairment; End-stage renal disease; Executive function; Female; Hemodialysis; hemodialysis patients; Humans; Kidney diseases; Kidney Failure, Chronic - complications; Kidney Failure, Chronic - therapy; Male; Memory; Mental Status and Dementia Tests; Middle Aged; MoCA; Renal Dialysis; Renal function; Republic of Korea; ROC Curve; Spatial memory
• ISSN: 0886-022X; 1525-6049
• DOI: 10.1080/0886022X.2018.1455589

Cognitive impairment in end-stage renal disease patients is associated with an increased risk of mortality. We examined the cognitive function in hemodialysis (HD) patients and compared the Korean versions of the Montreal Cognitive Assessment (K-MoCA) and of the Mini-Mental State Examination (K-MMSE) to identify the better cognitive screening instrument in these patients. Thirty patients undergoing hemodialysis and 30 matched reference group of apparently healthy control were included. All subjects underwent the K-MoCA, K-MMSE and a neuropsychological test battery to measure attention, visuospatial function, language, memory and executive function. All cognitive data were converted to z-scores with appropriate age and education level prior to group comparisons. Cognitive performance 1.0 SD below the mean was defined as modest cognitve impairment while 1.5 below the mean was defined as severe cognitive impairment. Modest cognitive impairment in memory plus other cognitive domains was detected in 27 patients (90%) while severe cognitive impairment in memory plus other cognitive domains was detected in 23 (77%) patients. Total scores in the K-MoCA were significantly lower in HD patients than in the reference group. However, no significant group difference was found in the K-MMSE. The K-MMSE ROC AUC (95% confidence interval) was 0.72 (0.59-0.85) and K-MoCA ROC AUC was 0.77 (0.65-0.89). Cognitive impairment is common but under-diagnosed in this population. The K-MoCA seems to be more sensitive than the K-MMSE in HD patients.