Patient‐reported cognitive functioning and daily functioning in chronic dialysis patients

Song, Mi‐Kyung; Ward, Sandra E.; Bair, Eric; Weiner, Lia J.; Bridgman, Jessica C.; Hladik, Gerald A.; Gilet, Constance A.

doi:10.1111/hdi.12202

Cited by 25 publications

(16 citation statements)

References 58 publications

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“…Whereas we used a common cut-off value for poor outcome on the mRS (>2) [ 21 – 23 ], there is no such commonly used cut-off value for the iADL. However, loss of independence on any iADL task is usually regarded as an impaired iADL [ 3 , 24 ]. Therefore we have chosen a cut-off value of <8 to indicate poor functional outcome.…”

Section: Patientsmentioning

confidence: 99%

Women have a poorer very long-term functional outcome after stroke among adults aged 18–50 years: the FUTURE study

et al. 2016

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Due to their young age young stroke survivors have to cope with a dramatic impact on their life for the decades to come. We investigated the sex-specific very long-term functional outcome after transient ischemic attack (TIA) and ischemic stroke (IS) in adults aged 18–50 years. This study is part of a cohort study among 619 first-ever young ischemic stroke patients, admitted to our department between January 1, 1980 and November 1, 2010. Functional outcome was assessed during follow-up in 2009–2011 and in 2014–2015 with the modified Rankin Scale (mRS) and instrumental Activities of Daily Living scale (iADL). Risk factors for a poor functional outcome (mRS > 2 and iADL < 8) were calculated by logistic regression analysis. After a mean follow-up of 13.9 (SD 8.2) years, 24.5 % of TIA patients and 44.7 % of IS patients had a poor functional outcome (mRS > 2). When assessing the survivors, 15.2 % of TIA patients and 22.9 % of IS patients had a poor outcome as assessed by iADL. The strongest baseline predictors of poor outcome were female sex (OR 2.7, 95 % CI 1.5–5.0) and baseline NIHSS (OR 1.1, 95 % CI 1.1–1.2 per point increase). In conclusion, 14 years after an ischemic cerebrovascular event in young adults, one out of five IS survivors and one out of ten TIA survivors is still dependent in daily life, with a two to threefold higher risk of a poor outcome in women. This includes a period of life, during which important decisions regarding work and family life have to be made.

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Section: Patientsmentioning

confidence: 99%

Women have a poorer very long-term functional outcome after stroke among adults aged 18–50 years: the FUTURE study

et al. 2016

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“…The association between frailty and cognitive impairment has been studied in older populations 11 , 12 and patients on hemodialysis (HD) 13 – 15 , but has not been clearly established in patients on PD. Both frailty and cognitive impairment are barriers to rehabilitation of patients on PD.…”

Section: Introductionmentioning

confidence: 99%

Prevalence and Prognosis of Coexisting Frailty and Cognitive Impairment in Patients on Continuous Ambulatory Peritoneal Dialysis

Chen

Lin

Cao

et al. 2018

Sci Rep

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The aim of this study was to investigate the prevalence of coexisting frailty and cognitive impairment and its association with clinical outcomes in patients on continuous ambulatory peritoneal dialysis (CAPD). Patients on CAPD started to enroll from 2014 to 2016 and ended follow-up by 2017. Frailty was assessed by clinical frailty scale (CFS), and cognitive function was assessed by Montreal Cognitive Assessment (MoCA). Totally 784 CAPD patients were recruited, with median duration of PD 30.7 (8.9~54.3) months. The mean age was 48.8 ± 14.6 years, 320 (40.8%) patients were female and 130 (16.6%) had diabetic nephropathy. Patients with cognitive impairment were more than those with frailty (55.5% vs. 27.6%). Coexisting frailty and cognitive impairment was present in 23.9% patients. Pathway analysis showed that CFS score was negatively associated with MoCA score (β = −0.69, P < 0.001). Coexisting frailty and cognitive impairment was associated with decreased patient survival rate (Log-rank = 84.33, P < 0.001) and increased peritonitis rate (0.22 vs. 0.11, 0.15 and 0.12 episodes per patient year, respectively; all P < 0.001). It was concluded that there was a relatively high prevalence of coexisting frailty and cognitive impairment among patients on CAPD. Frailty was positively associated with cognitive impairment. Coexisting frailty and cognitive impairment increased the risk of adverse outcomes.

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“…39 Our study does show a statistically significant association of the metaconcentration scores with tests of executive function (TMT B), consistent with another study in the dialysis population. 15 This is not surprising, and it raises the possibility of the metaconcentration measurement as an effective proxy/complement to objective tests of executive brain function. This remains to be validated, and so does the metacognition questionnaire in the population with renal disease.…”

Section: Discussionmentioning

confidence: 99%

“…Few studies have been published to date, in regard to patients with kidney disease, that specifically seek to examine the association between subjective and objective cognition assessments. 15 , 16 The Kidney Disease Quality of Life (KDQOL)−Cognitive Function subscale with 3 questions was shown to be a limited instrument for accurately assessing subjective cognitive function 16 and bore no relationship to the executive function test, which is commonly abnormal in chronic kidney disease. 17 , 18 , 19 More recently, a study found modest correlation between subjective and objective assessments; however, the former was a predictor of the patient’s self-reported measure of activities of daily living, although both subjective reports may well be influenced by negative affectivity.…”

mentioning

confidence: 99%

“… 17 , 18 , 19 More recently, a study found modest correlation between subjective and objective assessments; however, the former was a predictor of the patient’s self-reported measure of activities of daily living, although both subjective reports may well be influenced by negative affectivity. 15 , 20 In other population groups, subjective assessment of impaired cognition has been associated with poorer health-related quality-of-life, reduced daily functioning, 21 and increased risk of hospital attendance, 22 , 23 and is also predictive of future cognitive decline. 24 , 25 , 26 In addition, the identification of cognitive impairment is important in order to assist patients in making well-informed treatment decisions, in ensuring treatment compliance, and in helping to prevent functional decline.…”

mentioning

confidence: 99%

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The Burden of Cognitive Impairment in Patients With End-Stage Renal Disease and Impact on Dialysis Modality Choice

Jayanti

Foden

Brenchley

et al. 2016

Kidney International Reports

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IntroductionKidney disease is associated with significant cognitive dysfunction. Subjective reports of cognitive ability have not been studied extensively in chronic kidney disease. We investigated the association between objective and subjective cognitive functions in predialysis patients and their association with self-care dialysis modality choice.MethodsCross-sectional data from the Barriers to Successful Implementation of Care in Home Haemodialysis study were used for the study of cognition in 220 predialysis patients. The data were used to ascertain the demographics, clinical, laboratory, and neuropsychometric variables. The latter includes Trail Making Tests (TMT) parts A and B, Modified Mini Mental State Examination, and metacognition questionnaire for subjective assessment of one’s cognitive ability. The outcome variable was fully assisted and self-care dialysis modality choice.ResultsWithin the study cohort, 90 patients chose fully assisted hemodialysis and 114 patients chose self-care dialysis. The median Modified Mini Mental State Examination, TMT part A, and TMT part B scores were greater for the assisted versus the self-care group. Metamemory was not significantly different between groups, but the metaconcentration score was significantly worse in the group choosing assisted dialysis. Higher (i.e., better) metaconcentration scores were significantly associated with the self-care modality choice in the univariate and hierarchical regression analyses. Adjusted and unadjusted analyses showed a significant association between perceived concentration and TMT part B scores (P < 0.01). With every 1.6-minute increase in TMT part B score, there was a 1-unit reduction in metaconcentration score, and the latter was associated with 20% lower odds of choosing self-care dialysis over a fully assisted dialysis modality.DiscussionPatients’ self-perception of cognitive ability is a significant predictor of self-care dialysis modality choice. Subjective report of “metaconcentration” is also strongly associated with poorer outcome on the TMT part B.

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Patient‐reported cognitive functioning and daily functioning in chronic dialysis patients

Cited by 25 publications

References 58 publications

Women have a poorer very long-term functional outcome after stroke among adults aged 18–50 years: the FUTURE study

Women have a poorer very long-term functional outcome after stroke among adults aged 18–50 years: the FUTURE study

Prevalence and Prognosis of Coexisting Frailty and Cognitive Impairment in Patients on Continuous Ambulatory Peritoneal Dialysis

The Burden of Cognitive Impairment in Patients With End-Stage Renal Disease and Impact on Dialysis Modality Choice

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