Cognitive Decline in Hemodialysis Patients: A Cross-Sectional Study Using Addenbrooke's Cognitive Examination-III (ACE-III)

TL;DR

This study finds that nearly half of hemodialysis patients in South India show cognitive impairment, with memory and attention most affected.

Contribution

The study reports the prevalence of cognitive impairment in a South Indian hemodialysis population using the ACE-III test.

Findings

46.9% of hemodialysis patients showed cognitive impairment based on ACE-III scores.

Lower cognitive scores were significantly linked to older age, lower education, and longer dialysis duration.

Memory and attention were the most affected cognitive domains in these patients.

Abstract

Background

Among patients with chronic kidney disease (CKD) undergoing maintenance hemodialysis (HD), cognitive impairment (CI) is a significant yet often unknown side effect. This study used Addenbrooke's Cognitive Examination-III (ACE-III) to assess the prevalence and pattern of cognitive dysfunction in a South Indian HD population. It also aimed to determine the correlations with clinical and sociodemographic factors.

Methods

A cross-sectional study was conducted in a tertiary care facility in Chennai, Tamil Nadu, India, involving 175 patients undergoing maintenance HD for more than three months. The Indian English version of the ACE-III was used to evaluate cognitive function. Clinical and demographic data, including age, gender, education, duration of dialysis, comorbidities, and hemoglobin levels, were collected and analyzed. A p-value of <0.05 was considered statistically significant.

Results

Almost half of the patients, that is, 82 (46.9%), were classified as having CI with ACE-III scores of 60-80. Lower cognitive scores were significantly associated with greater age, lower educational levels, and longer time spent on dialysis (p<0.05).

Conclusion

In South India, CI is prevalent among HD patients, with memory and attention being the areas that are most affected. Age, level of education, and dialysis duration are contributing factors. In dialysis care, routine ACE-III screening can facilitate early detection and targeted interventions.