PREVALENCE, RECOGNITION, AND IMPLICATIONS OF MENTAL IMPAIRMENT AMONG HEMODIALYSIS-PATIENTS

The increasing age and co-morbidity of dialysis patients may be associ ated with an increase in the prevalence of Alzheimer's disease, stroke , and other causes of mental impairment. We sought to determine the pr evalence, recognition, and implications of mental impairment among chr onic hemodialysis patients. We administered the Mini Mental Status Exa m (MMSE) to 336 randomly selected patients from three dialysis units. To determine recognition of mental impairment by health care providers , we compared MMSE scores with mental status assessments obtained from each patient's dialysis technician and medical record. To determine t he clinical implications of mental impairment, we prospectively obtain ed Kt/V, albumin, protein catabolic rate, blood pressure, and hematocr it values. To determine the resource implications of mental impairment , we assessed staff time required to care for each patient as well as hospitalizations. We found that 22% of subjects had mild mental impair ment (MMSE 18 to 23) and that 8% had moderate-severe mental impairment (MMSE 0 to 17). The sensitivity of technician and medical record ment al status assessments were 57% and 15%, respectively. After adjusting for demographic and medical variables, low MMSE score was independentl y associated with low protein catabolic rate (odds ratio, 1.5; P = 0.0 2), increased technician time caring for patient after dialysis (odds ratio, 1.5; P = 0.005), and increased hospital days (odds ratio, 1.4; P = 0.03). In conclusion, there is a high prevalence of unrecognized m ental impairment among hemodialysis patients that has adverse implicat ions for protein nutritional status, staff time, and hospitalization. We recommend that clinicians routinely screen for mental impairment an d target impaired patients for interventions to improve mental status and associated adverse outcomes. (C) 1997 by the National Kidney Found ation, Inc.