All clinical investigations were conducted in accordance with the principles of the Declaration of Helsinki, sixth revision. The study protocol as well as an amendment specifically covering cognitive testing by both MoCA and CDR were approved by the committees of the Faculty of Medicine of the Technische Universität München and of the medical chamber of Bavaria. ISAR: rISk strAtification in end-stage renal disease MoCA: Montreal Cognitive Assessment CDR: Clinical Dementia Rating scale. Flowchart–data acquisition process within the ISAR study. Fig 1 depicts the data acquisition process throughout this sub study of the ISAR study.įig 1. As a result, a total of 151 patients were tested by both, MoCA and CDR. In order to maximize participation, patients were allowed to decide for themselves, which examinations to undergo. Evaluation of cognitive function was part of a sub study and therefore cognitive testing was performed only in 9 centers of a total of 17 centers taking part in the ISAR study. The complete study protocol in reference to the STROBE guidelines was published in BMC Nephrology in 2016. ISAR is an observational study to evaluate the use of non-invasive markers of autonomic function and micro- and macrocirculation to predict mortality and cardiovascular end points in end stage renal disease (ESRD) patients. This study is part of the ISAR-study, which is registered at (identifier number: NCT01152892, URL: ). Patients, inclusion and exclusion criteria Hence, the aims of our study were to examine the overall degree of dementia in this patient population for the first time using the CDR and to reevaluate cut-off values for the MoCA test to distinguish cognitively normal and impaired hemodialysis patients. Despite its important role in evaluating the degree of cognitive impairment independent from the underlying condition, the CDR has never been applied in hemodialysis patients before. The Clinical Dementia Rating scale (CDR) is an international standard to assess the overall severity of dementia taking both cognitive symptoms and impairment in activities of daily living into account by interviewing the patient and his informant or caregiver. Īccording to the Diagnostic and Statistical Manual of Mental Disorders (DSM)-IV and the International Classification of Diseases (ICD)-10 guidelines the diagnosis of dementia is based on the presence of cognitive impairment and consequently an impairment of daily activities and independence. Only one study validated a short screening instrument, the MoCA, identifying a cut-off of 24 points to be more suitable to detect cognitive impairment compared to the established value of 26 points. In previous studies in hemodialysis patients the Montreal Cognitive Assessment (MoCA) test, the Mini-Mental State Examination (MMSE) or the 3MS have been applied using established cut-offs. In this context, a short screening instrument is the most resource-efficient option, which has to be precise in identifying impaired patients as well as those in need for further evaluation. Thus, periodic screening is needed to identify patients with relevant cognitive impairment in order to improve their clinical care as well as to reduce health care costs. Moreover, dementia is associated with disability, hospitalization and an approximately 2-fold increased risk of both dialysis withdrawal and death. Several studies demonstrated high prevalence of cognitive impairment in hemodialysis patients as well as its potential adverse effects on management and outcome including interference with informed decision making, capacity for self-care and adherence to medical, fluid and dietary instructions.
0 Comments
Leave a Reply. |
AuthorWrite something about yourself. No need to be fancy, just an overview. ArchivesCategories |