Chan Frederick H F, Sim Pearl, Lim Phoebe X H, Khan Behram A, Choo Jason C J, Griva Konstadina
Lee Kong Chian School of Medicine, Nanyang Technological University, Singapore.
Renal Health Services, Singapore.
BMJ Open. 2025 Mar 25;15(3):e088502. doi: 10.1136/bmjopen-2024-088502.
Cognitive impairments and cognitive complaints are commonly present in dialysis patients and can affect clinical, functional, occupational, and psychosocial well-being. It is important to screen for patients' cognitive status as it offers a gateway to specialty referral, prevention or rehabilitation programmes, and personalisation of clinical care. The Patient's Assessment of Own Functioning Inventory (PAOFI) is a comprehensive questionnaire that assesses patient-reported difficulties in memory, language, motor/sensory-perceptual skills and higher-level cognitive function. In the current study, we adopted network analysis to identify central cognitive complaints in dialysis patients and derived a PAOFI short form (PAOFI-SF) based on these core symptoms to improve screening efficiency in real-world renal settings.
Multicentre, cross-sectional study.
Participants were recruited from 10 community-based dialysis centres in Singapore, from May to November 2022.
A total of 369 eligible haemodialysis patients were invited to join the study, and 268 completed the measures (response rate 72.6%).
Cognitive assessment tools including the PAOFI and the Montreal Cognitive Assessment were administered.
Based on the PAOFI measure, 98 participants (36.6%) endorsed the presence of three or more complaints, indicating clinically significant cognitive complaints. Network analysis identified five central cognitive complaints among dialysis patients: problem-solving difficulty, difficulty following instructions, forgetting how to do tasks, difficulty being understood, and forgetting people known years ago. These core items were combined into a five-item short form of PAOFI, which showed good reliability and validity, and an area under the curve of 83.4% in identifying clinically significant cognitive complaints. The optimal cut-off point of the short form was 11.5 (out of 30), with a specificity of 89.5%, sensitivity of 63.9%, positive predictive value of 77.5% and negative predictive value of 81.4%. This cut-off point also predicted objective cognitive performance even after controlling for sociodemographic and clinical confounders.
Pending future replication and external validation, the PAOFI-SF may be suitable for use in renal care settings as an initial screening tool to identify patients with cognitive complaints and increased risk of objective cognitive impairments.
认知障碍和认知主诉在透析患者中普遍存在，会影响临床、功能、职业和心理社会幸福感。筛查患者的认知状态很重要，因为这为专科转诊、预防或康复计划以及临床护理个性化提供了途径。患者自我功能评估量表（PAOFI）是一份综合问卷，用于评估患者报告的记忆、语言、运动/感觉感知技能和高级认知功能方面的困难。在本研究中，我们采用网络分析来确定透析患者的核心认知主诉，并基于这些核心症状得出PAOFI简表（PAOFI-SF），以提高在实际肾脏治疗环境中的筛查效率。
多中心横断面研究。
2022年5月至11月，从新加坡10个社区透析中心招募参与者。
共邀请369名符合条件的血液透析患者参与研究，268名完成了测量（应答率72.6%）。
采用包括PAOFI和蒙特利尔认知评估在内的认知评估工具。
根据PAOFI测量，98名参与者（36.6%）认可存在三项或更多主诉，表明存在具有临床意义的认知主诉。网络分析确定了透析患者的五项核心认知主诉：解决问题困难、听从指示困难、忘记如何做事、难以被理解以及忘记多年前认识的人。这些核心项目被整合为PAOFI的五项简表，该简表显示出良好的信效度，在识别具有临床意义的认知主诉方面曲线下面积为83.4%。简表的最佳截断点为11.5（满分30分），特异性为89.5%，敏感性为63.9%，阳性预测值为77.5%，阴性预测值为81.4%。即使在控制了社会人口统计学和临床混杂因素后，该截断点仍能预测客观认知表现。
在未来进行重复研究和外部验证之前，PAOFI-SF可能适用于肾脏护理环境，作为一种初步筛查工具，以识别有认知主诉且客观认知障碍风险增加的患者。
