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Angermann, Susanne; Schier, Johannes; Baumann, Marcus; Steubl, Dominik; Hauser, Christine; Lorenz, Georg; Günthner, Roman; Braunisch, Matthias; Kemmner, Stephan; Satanovskij, Robin; Haller, Bernhard; Heemann, Uwe; Grimmer, Timo; Lehnert, Thomas; Bieber, Richard; Pachmann, Martin; Braun, Jürgen; Scherf, Julia; Schätzle, Gabriele; Fischereder, Michael; Schmaderer, Christoph (2018): Cognitive Impairment is Associated with Mortality in Hemodialysis Patients. In: Journal of Alzheimers Disease
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Abstract

BACKGROUND: The prevalence of cognitive impairment in hemodialysis patients is notably high. In previous studises performed in the general population, cognitive impairment has been associated with increased mortality. OBJECTIVE: We evaluated the relationship between global cognitive function tested by a short screening instrument and mortality in hemodialysis patients. METHODS: Cognitive testing was performed in 242 maintenance hemodialysis patients under standardized conditions at baseline using the Montreal Cognitive Assessment (MoCA).Cognitive impairment was defined as a MoCA test score \textless/=24 points, as published previously. All-cause mortality was monitored during a median follow-up of 3.54 years. Kaplan-Meier plot and Cox regression model adjusted for known risk factors for mortality in hemodialysis patients were used to examine a possible association between global cognitive function and all-cause mortality. RESULTS: A MoCA test score \textless/=24 points resulted in a significant almost 3-fold higher hazard for all-cause mortality (unadjusted hazard ratio HR: 2.812; 95{\%} confidence interval 95{\%} CI: 1.683-4.698; p {\textless} 0.001). After adjustment, this association was attenuated but remained significant (adjusted HR: 1.749; 95{\%} CI: 1.007-3.038; p = 0.047). CONCLUSION: Impairment of global cognitive function measured by a short screening instrument was identified for the first time as an independent predictor of all-cause mortality in hemodialysis patients. Thus, implementing the MoCA test in clinical routine could contribute to a better risk stratification of this patient population.