Gupta Aditi, Thomas Tashra S, Klein Jeffrey A, Montgomery Robert N, Mahnken Jonathan D, Johnson David K, Drew David A, Sarnak Mark J, Burns Jeffrey M
Division of Nephrology and The Kidney Institute, University of Kansas Medical Center, Kansas City, KS, USA.
Nephron. 2018;138(1):22-28. doi: 10.1159/000481182. Epub 2017 Oct 20.
Cognitive impairment is common in kidney transplant (KT) recipients and affects quality of life, graft survival, morbidity, and mortality. Failure to identify patients with cognitive impairment can withhold appropriate and timely intervention. This study determines whether measured cognition with standard screening tools offers any advantage over perceived cognition in screening transplant patients for cognitive impairment.
Cognition was assessed in 157 KT recipients using the Montreal Cognitive Assessment (MoCA; measured cognition). In addition, transplant physicians and nurse coordinators were asked to rate transplant recipients' level of cognition after routine clinical interactions (perceived cognition). Physicians and nurses were blind to MoCA scores. Perceived cognition scores were compared to MoCA scores.
Perceived cognition scores fairly correlated with MOCA scores (γ = 0.24, p = 0.001 for physicians and γ = 0.33, p < 0.0001 for nurses). Physician scores moderately correlated with nurses scores (κ = 0.44, p < 0.0001). Clinical perception had a low accuracy for identifying patients with cognitive impairment (sensitivity 66% for physicians, 65% for nurses), and those without cognitive impairment (specificity 67% for physicians, 76% for nurses).
Clinical perception is inaccurate at detecting cognitive impairment in KT recipients. Objective tests should be considered to screen KT recipients for cognitive impairment.
认知障碍在肾移植（KT）受者中很常见，会影响生活质量、移植物存活、发病率和死亡率。未能识别出有认知障碍的患者可能会延误适当且及时的干预。本研究旨在确定使用标准筛查工具测量的认知在筛查移植患者认知障碍方面是否比感知认知具有任何优势。
使用蒙特利尔认知评估量表（MoCA；测量认知）对157名KT受者的认知情况进行评估。此外，还要求移植医生和护士协调员在常规临床互动后对移植受者的认知水平进行评分（感知认知）。医生和护士对MoCA评分不知情。将感知认知评分与MoCA评分进行比较。
感知认知评分与MoCA评分呈中等程度相关（医生的γ = 0.24，p = 0.001；护士的γ = 0.33，p < 0.0001）。医生的评分与护士的评分呈中度相关（κ = 0.44，p < 0.0001）。临床感知在识别有认知障碍的患者（医生的敏感性为66%，护士为65%）和无认知障碍的患者（医生的特异性为67%，护士为76%）方面准确性较低。
临床感知在检测KT受者的认知障碍方面不准确。应考虑采用客观测试来筛查KT受者的认知障碍。
