a Department of Neurology , Hallym University Medical Center Kangnam Sacred Heart Hospital , Seoul , Korea.
b Department of Neurology , Hallym University Medical Center Dongtan Sacred Heart Hospital , Seoul , Korea.
Ren Fail. 2018 Nov;40(1):323-330. doi: 10.1080/0886022X.2018.1455589.
Cognitive impairment in end-stage renal disease patients is associated with an increased risk of mortality. We examined the cognitive function in hemodialysis (HD) patients and compared the Korean versions of the Montreal Cognitive Assessment (K-MoCA) and of the Mini-Mental State Examination (K-MMSE) to identify the better cognitive screening instrument in these patients. Thirty patients undergoing hemodialysis and 30 matched reference group of apparently healthy control were included. All subjects underwent the K-MoCA, K-MMSE and a neuropsychological test battery to measure attention, visuospatial function, language, memory and executive function. All cognitive data were converted to z-scores with appropriate age and education level prior to group comparisons. Cognitive performance 1.0 SD below the mean was defined as modest cognitve impairment while 1.5 below the mean was defined as severe cognitive impairment. Modest cognitive impairment in memory plus other cognitive domains was detected in 27 patients (90%) while severe cognitive impairment in memory plus other cognitive domains was detected in 23 (77%) patients. Total scores in the K-MoCA were significantly lower in HD patients than in the reference group. However, no significant group difference was found in the K-MMSE. The K-MMSE ROC AUC (95% confidence interval) was 0.72 (0.59-0.85) and K-MoCA ROC AUC was 0.77 (0.65-0.89). Cognitive impairment is common but under-diagnosed in this population. The K-MoCA seems to be more sensitive than the K-MMSE in HD patients.
终末期肾病患者的认知障碍与死亡率增加有关。我们检查了血液透析（HD）患者的认知功能，并比较了蒙特利尔认知评估（K-MoCA）和简易精神状态检查（K-MMSE）的韩文版本，以确定哪种认知筛查工具更适合这些患者。纳入 30 名正在接受血液透析的患者和 30 名匹配的健康对照组。所有受试者均接受 K-MoCA、K-MMSE 和神经心理测试套件，以测量注意力、视空间功能、语言、记忆和执行功能。在进行组间比较之前，所有认知数据均转换为适当年龄和教育水平的 z 分数。认知表现低于平均值 1.0 SD 被定义为轻度认知障碍，而低于平均值 1.5 SD 被定义为严重认知障碍。27 名患者（90%）存在记忆及其他认知领域的轻度认知障碍，23 名患者（77%）存在记忆及其他认知领域的严重认知障碍。HD 患者的 K-MoCA 总分明显低于对照组。然而，K-MMSE 组间无显著差异。K-MMSE 的 ROC AUC（95%置信区间）为 0.72（0.59-0.85），K-MoCA 的 ROC AUC 为 0.77（0.65-0.89）。该人群的认知障碍很常见，但诊断不足。K-MoCA 在 HD 患者中的敏感性似乎高于 K-MMSE。
