Experts recommend Montreal Cognitive Assessment to identify high-risk patients on dialysis
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Experts recommend using the Montreal Cognitive Assessment to identify high-risk patients on dialysis with both high and low frailty, according to data published in Kidney Medicine.
Patients who researchers categorized as extremely frail, but not cognitively impaired, experience high hospital admission rates. However, patients who are cognitively impaired, but not categorized as extremely frail also experience this.
“Frailty and cognitive impairment are both common in people treated by hemodialysis, and both have previously been linked to death and hospitalization. However, little is known about the relationship between frailty and cognitive impairment in hemodialysis recipients,” Benjamin M. Anderson, MB, ChB, from the department of nephrology and transplantation at Queen Elizabeth Hospital and the Institute of Inflammation and Ageing at the University of Birmingham, and colleagues wrote.
In a prospective cohort study, researchers examined 448 patients on maintenance dialysis from the Frailty Intervention Trial in End-Stage Patients on Hemodialysis study (FITNESS) to investigate the association between frailty scores and cognition. Further, researchers sought to identify correlations with hospitalization and mortality.
Patients completed the Montreal Cognitive Assessment (MoCA) at baseline and provided information for the frailty phenotype, frailty index, Edmonton Frailty Scale and clinical frailty scale. Researchers determined cognitive impairment with MoCA scores less than 26 (scores range from zero to 30), dexterity impairment with scores of less than 21 or visual impairment with scores of less than 18. Patients were followed for a median of 685 days.
Using Cox proportional hazard models, researchers identified the primary outcome of mortality in patients. Researchers also performed negative binomial regression for admission rates, censoring for death and the end of follow-up.
Overall, 103 patients died and a total of 1,120 hospital admissions occurred. Researchers identified cognitive impairment in 77.2% of patients and observed a correlation between increasing frailty and poorer cognition.
Multivariable analyses revealed no correlation between cognition and mortality or hospitalization. In fact, hospital admissions were highest when both the MoCA score and frailty scores were high, and when both scores were low.
Because this study observed patients on maintenance dialysis, the findings may not be applicable to those on incident hemodialysis.
“There is an interaction between MoCA scores and frailty upon the association with hospitalization, but MoCA is not independently associated with hospitalization or mortality,” Anderson and colleagues wrote. “The Montreal Cognitive Assessment may therefore offer added discriminative value in identifying higher-risk hemodialysis populations with both high and low degrees of frailty. These results should stimulate further exploration of the interplay between frailty and cognitive impairment, particularly with regard to adverse outcomes.”
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