Measures of Cognitive Function in Patients Awaiting and Undergoing Kidney Transplant

Document Type

Conference Proceeding

Publication Date

8-1-2025

Publication Title

Am J Transplant

Abstract

Purpose: The effect of pre-kidney transplant (KT) cognitive function (CF) on post-KT outcomes is unclear, in part due to the use of variable cognitive assessment measures in the pre-KT setting. As part of a larger systematic review to assess the effects of pre-KT CF on post-KT outcomes, we examined the methodologies employed in assessing pre-KT CF in intended kidney transplant recipients (KTRs) within the existing literature. Methods: We conducted a systematic review to identify studies that measured pre-KT CF and related that to post-KT outcomes. Studies were included if they reported an objective assessment of pre-KT CF and related that to post-KT medical and/or psychosocial outcomes. We screened 1491 studies and 33 were included. Results: Sixty-seven different measures of CF were used across 33 studies. Eight studies assessed CF with one measure only, while 25 studies used more than one measure. Eighteen studies utilized a global cognitive screening measure: Montreal Cognitive Assessment (n=4), Mini Mental Status Exam (n=7), Modified Mini Mental Status Exam (n=6), and Mini-Cog (n=1). The remainder utilized measures focused on specific cognitive domains. The two cognitive domains that were most studied were executive functioning (n=17) and complex attention (n=21), with at least 12 different measures used across studies to assess each domain. Identification of cognitive impairment was inconsistent across studies even when the same assessment measure was used and many studies (n=17) did not include a cut-off score to identify cognitive impairment. Further, not all studies controlled for the effects of variables such as age, education, dialysis time, or biochemical derangements on CF in the pre-KT setting. Conclusions: There were no consistent practices for examining pre-KT CF in terms of assessment tools used or interpretation of results. This variability indicates a lack of a universal, validated approach to assessing CF and identifying cognitive impairment in this population, thus making comparison across studies difficult. Further, variables known to impact cognitive performance (e.g., age, education, dialysis time, and uremia) were not uniformly accounted for. Given these gaps, it is imperative to identify a validated measure of CF in KTRs so that deficits may not only be consistently identified but also intervened on to potentially improve post-KT outcomes. CITATION INFORMATION: Engel K., Yek M., Haver D., Dar W., Jesse M., Workgroup C. Measures of Cognitive Function in Patients Awaiting and Undergoing Kidney Transplant AJT, Volume 25, Issue 8 Supplement 1 DISCLOSURES: K. Engel: None.

Volume

25

Issue

8

First Page

S628

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