Background/Aims: Cognitive impairment is a common but under-recognised problem in patients with chronic kidney disease, and is likely to become more significant as this patient population ages. Methods: This cross-sectional study focussed on inpatients aged ≥65 years at a tertiary renal unit, and consisted of two parts. Part 1 (n = 25) considered whether cognitively impaired inpatients were being identified and being referred to memory services. In Part 2 (n = 105) two different cognitive function tests were attempted (6-CIT, MMSE). Results: In Part 1, cognitive function tests were attempted in only 4 patients at admission and 1 patient subsequently. No patients were referred to memory services. In Part 2, 6-CIT was abnormal (score ≥8) in 61.4%, and MMSE was abnormal (score <27) in 79.5% (score 21-26: 28.9%, 15-20: 28.9%, 10-14: 13.3%, <10: 8.4%). There was a close correlation between MMSE and 6-CIT (R2 = 0.735). Only 7.2% of those assessed had a documented cognitive deficit prior to admission. Conclusion: This is the first study looking at cognition in elderly inpatients with chronic kidney disease. There appears to be a much higher rate of cognitive impairment than expected and this is largely unidentified. These deficits are likely to have a major impact on both inpatient and outpatient management.

3.
McQuillan R, Jassal SV: Neuropsychiatric complications of chronic kidney disease. Nat Rev Nephrol 2010;6:471-479.
4.
Kurella Tamura M, Yaffe K: Dementia and cognitive impairment in ESRD: diagnostic and therapeutic strategies. Kidney Int 2011;79:14-22.
5.
Etgen T, Chonchol M, Förstl H, Sander D: Chronic kidney disease and cognitive impairment: a systematic review and meta-analysis. Am J Nephrol 2012;35:474-482.
6.
Buchman AS, Tanne D, Boyle PA, et al: Kidney function is associated with the rate of cognitive decline in the elderly. Neurology 2009;73:920-927.
7.
Etgen T, Sander D, Chonchol M, et al: Chronic kidney disease is associated with incident cognitive impairment in the elderly: the INVADE study. Nephrol Dial Transplant 2009;24:3144-3150.
8.
Madero M, Gul A, Sarnak MJ: Cognitive function in chronic kidney disease. Semin Dial 2008;21:29-37.
10.
National Institute for Health and Care Excellence (2011): Alzheimer's disease - donepezil, galantamine, rivastigmine and memantine (TA217). London, National Institute for Health and Care Excellence.
11.
Sampson EL, Blanchard MR, Jones L, et al: Dementia in the acute hospital: prospective cohort study of prevalence and mortality. Br J Psychiatry 2009;195:61-66.
12.
http://www.mocatest.org/default.asp (accessed April 30, 2013).
13.
Cole MG: Persistent delirium in older hospital patients. Curr Opin Psychiatry 2010;23:250-254.
Copyright / Drug Dosage / Disclaimer
Copyright: All rights reserved. No part of this publication may be translated into other languages, reproduced or utilized in any form or by any means, electronic or mechanical, including photocopying, recording, microcopying, or by any information storage and retrieval system, without permission in writing from the publisher.
Drug Dosage: The authors and the publisher have exerted every effort to ensure that drug selection and dosage set forth in this text are in accord with current recommendations and practice at the time of publication. However, in view of ongoing research, changes in government regulations, and the constant flow of information relating to drug therapy and drug reactions, the reader is urged to check the package insert for each drug for any changes in indications and dosage and for added warnings and precautions. This is particularly important when the recommended agent is a new and/or infrequently employed drug.
Disclaimer: The statements, opinions and data contained in this publication are solely those of the individual authors and contributors and not of the publishers and the editor(s). The appearance of advertisements or/and product references in the publication is not a warranty, endorsement, or approval of the products or services advertised or of their effectiveness, quality or safety. The publisher and the editor(s) disclaim responsibility for any injury to persons or property resulting from any ideas, methods, instructions or products referred to in the content or advertisements.
You do not currently have access to this content.