Background/Aims: We tested the utility of the Mini-Addenbrooke’s Cognitive Examination (M-ACE) in a cohort of older adults with chronic kidney disease (CKD) and diabetes. Method: The M-ACE was administered to 112 CKD and diabetes patients attending a nephrology clinic. Cognitive impairment was based upon patient, informant, and case review, neuropsychological assessment, and application of criteria for mild cognitive impairment (MCI) and the Diagnostic and Statistical Manual of Mental Disorders, fifth edition for dementia. The M-ACE was also compared to the Mini-Mental State Examination (MMSE). Results: Upon assessment, 52 patients had normal cognitive function, 33 had MCI, and 27 had dementia. The area under the receiver operating curve for the M-ACE was 0.96 (95% CI 0.95–1.00). The sensitivity and specificity for a dementia diagnosis were 0.96 and 0.84 at the cut point <25 and 0.70 and 1.00 at the cut point <21. Mean M-ACE scores differed significantly between normal, demented, and MCI groups (p < 0.001), and compared to the MMSE, the M-ACE did not suffer from ceiling effects. Conclusion: The M-ACE is an easily administered test with good sensitivity and specificity to capture and assist in the diagnosis of MCI or dementia in patients with CKD and diabetes.

ObjectiveChronic kidney disease (CKD) affects nearly 9% of global populations and is strongly associated with older age. Neurocognitive disorders (NCDs), which include mild cognitive impairment and dementia, are rising as a result of ageing populations throughout the world. This investigation’s aim is to report the frequency of mild to major NCD in a clinical cohort of adults with mild to moderate CKD and diabetes.SettingGlan Clwyd District general Hospital, North Wales, UK.ParticipantsWe enrolled 178 patients with CKD and diabetes, aged 55 years and over with an estimated glomerular filtration rate <60 >15 mL/min/1.73 m2, attending a specialist renal and diabetic outpatient clinic.Outcome measuresFrequency of mild and major NCD and the association with the stage of CKD was assessed in all patients attending the specialist clinic. The diagnosis of NCD was based on patient and informant interview, case note review, neuropsychological assessment and application of Diagnostic and Statistical Manual of Mental Disorders version 5.ResultsThis investigation found 86/178 (48%) of the cohort with an NCD ranging from mild (n=49) to major symptoms (n=37). No association was found with NCD and the stage of CKD. Mild and major NCD was associated poorer outcomes in several cognitive domains, including, language, executive, memory, fluency and attention function (p<0.05).ConclusionsThis is the first UK investigation to report that cognitive changes occur in a significant number of older adults with CKD and diabetes. The unexpected finding was that prior to cognitive assessment, not any of the cohort had a pre-existing diagnosis of cognitive impairment, suggesting that the current prevalence and incidence rates of NCD in the general population are possibly significantly underestimated. Our findings also suggest that the cognitive function of patients with CKD should be screened and monitored routinely as part of their overall care management.

ObjectivesThe aim of the current investigation is to estimate the incidence and risk for neurocognitive disorders (NCD) in a chronic kidney disease (CKD) cohort with diabetes, compared with an age and sex-matched control cohort.DesignLongitudinal follow-up.SettingDistrict general hospital North Wales, UK.ParticipantsNinety-two patients with CKD and an age and gender-matched sample of 143 controls at baseline and at approximately 36 months.InterventionsCognitive function was assessed in the patients with CKD (mean age 75.8±9.1; 49 men: 43 women) and the control cohort (mean age 74.4±6.2; 71 men: 72) at baseline and at approximately 36 months. An NCD diagnosis was based on patient, informant, case note review, neuropsychological assessment and application of Diagnostic and Statistical Manual of Mental disorders V.5 (DSM-5) for an NCD and Petersen’s criteria for mild cognitive impairment.ResultsFollow-up neuropsychological assessment and application of DSM-5 criteria of the cognitively normal patients and controls revealed, 25/92 (27%) of the CDK and 20/143 (13.9%) in the control cohort developed an NCD. The CKD cohort had a twofold increased risk for the development of an NCD compared with the controls, adjusted for age and sex. The incidence rate for an NCD in the CKD cohort was 10.5 and 5.1 in the controls, respectively. No association was observed with the stage of CKD and cognitive function.ConclusionsThis longitudinal investigation found that patients with CKD have a twofold increased risk for the development of an NCD. The current investigation highlighted the need to recognise that NCD in patients with CKD is a common comorbidity and that they are at a much higher risk for the development of a significant neurodegenerative disorders. In view of these risks, neuropsychological screening and assessment should be incorporated into normal CKD clinical practice and management.