Evaluation of Screening Tests for Cognitive Impairment in Patients Receiving Maintenance Hemodialysis
Evaluation of Screening Tests for Cognitive Impairment in Patients Receiving Maintenance Hemodialysis
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DOI：
10.1681/asn.2019100988
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发表时间：
2020-04-01
影响因子：
13.6
通讯作者：
Sarnak, Mark J.
中科院分区：
文献类型：
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作者：
Drew, David A.;Tighiouart, Hocine;Sarnak, Mark J.
背景：神经认知测试显示，认知障碍在接受维持性血液透析的患者中很常见。识别一个良好的认知功能障碍筛查测试可能会允许更广泛的评估透析设施，从而优化教育和医疗管理。方法从2015年到2018年，在150名血液透析患者的队列中，我们进行了一组全面的神经认知测试，包括记忆，注意力，和执行功能，以区分参与者是否具有正常的认知功能与轻度、中度或重度认知障碍。采用曲线下面积（AUC）分析，检测简易精神状态检查、改良简易精神状态检查、蒙特利尔认知评估、连线测验B部分、Mini-Cog测验和数字符号替代测验的预测能力，确定每种测验对识别严重认知障碍的性能。61%是男性，39%是黑人，94%至少受过高中教育。在150名参与者中，21%的认知功能正常，17%有轻度认知障碍，33%有中度障碍，29%有重度障碍。蒙特利尔认知评估对严重认知障碍的总体预测能力最高（AUC，0.81）;
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