Cognitive Impairment and Associated Factors Among Chronic Kidney Disease Patients: A Comparative Cross-Sectional Study.

BACKGROUND: Cognitive impairment is one of the public health problems affecting 50 million people in the world. Chronic kidney disease (CKD) patients are at high risk to develop cognitive impairment which leads to poor quality of life, difficulty in adhering to medications, increased risk of mortality, and health resource utilization. However, there is no study done on the prevalence of cognitive impairment and associated factors among chronic kidney disease patients in Ethiopia. OBJECTIVE: This study aimed to assess the prevalence of cognitive impairment and associated factors among chronic kidney disease patients at the University of Gondar Comprehensive Specialized and Felege Hiwot Referral Hospitals in 2020, Northwest Ethiopia, 2020. METHODS: An institution-based comparative cross-sectional study was conducted at the University of Gondar Comprehensive Specialized and Felege Hiwot Referral Hospitals in 2020. A systematic random sampling technique was used to select the study participants. Data were collected using standard tools. Data were checked for its completeness and entered into Epi data version 3.0 then exported into STATA 14. Multi-variable logistic regression analysis was employed to identify associated factors of cognitive impairment among CKD patients, and variables having a p-value of ≤0.05 were declared as significant. RESULTS: In this study, 116 CKD patients and 116 age, sex, and educational level matched controls were included with a response rate of 100%. The prevalence of cognitive impairment was 49.1% [95% CI (40%, 58.3%)] among CKD patients and 28.4% [95% CI (20.9%, 37.5%)] among controls. Independent predictors of cognitive impairment among CKD patients were estimated glomerular filtration (eGFR) <60mL/min/m2 [AOR=3.9, 95% CI (1.1-14.74)], proteinuria [AOR=6.0, 95% CI (1.83-20.3)], age greater than 65 years [AOR=4.0, 95% CI (1.12-14.64)], and educational level of grade 8 and less [AOR= 4.7, 95% CI (1.22 -18.47)]. CONCLUSION: The prevalence of cognitive impairment among CKD patients was higher than healthy controls. Cognitive impairment was higher among CKD patients with eGFR <60mL/min/m2, proteinuria, educational level of grade 8 and less, and age greater than 65 years. Therefore, there is a need to have a regular evaluation and follow-up of CKD patients for cognitive impairment.

Cognitive Impairment and Associated Factors Among Adult Hypothyroid Patients in Referral Hospitals, Amhara Region, Ethiopia: Multicenter Cross-Sectional Study.

BACKGROUND: Cognitive impairment is a common complication of hypothyroidism that affects the patient's quality of life in different aspects. In Ethiopia, though the prevalence of hypothyroidism is high the magnitude of cognitive impairment among these patients is not known. Therefore, the current study is aimed at determining the prevalence of cognitive impairment and associated factors among adult hypothyroid patients. METHODS: An institution-based cross-sectional study was employed from February 24 to May 22, 2020, to assess the prevalence of cognitive impairment and associated factors among adult hypothyroid patients. Data was collected by a pretested interviewer-administered structured questionnaire and standardized Mini-mental state examination (SMMSE) tool. A cluster sampling technique was used. Data was entered into Epidata version 4.6 and exported into a statistical package for social science (SPSS) version 25 for further analysis. Both bivariable and multivariable logistic regression analyses were done. A 95% confidence interval and P-value <0.05 were used to declare statistical significance. RESULTS: A total of 216 adult hypothyroid patients were included with a response rate of 98.6%. The mean age was 42.5 (± 11) years. The prevalence of cognitive impairment was 27.3% (95% CI (21.7, 33.8)) and it was significantly associated with increased age (AOR = 1.23, 95% CI (1.11, 1.34)), increased duration of illness (AOR = 1.48, 95% CI (1.14, 1.90)) and high thyroid-stimulating hormone (TSH) level (AOR = 1.3, 95% CI (1.1, 1.6)). CONCLUSION: The prevalence of cognitive impairment among hypothyroid patients was high. Increased age, increased duration of illness and high TSH levels were significantly associated with cognitive impairment. Hence, early screening of cognitive impairment among hypothyroid patients with increased age, increased duration of illness and high TSH level should be given due emphasis to increase patients quality of life.

Comparison of the Greek Version of the Quick Mild Cognitive Impairment Screen and Standardised Mini-Mental State Examination.

INTRODUCTION: Short cognitive screening instruments (CSIs) are widely used to stratify patients presenting with cognitive symptoms. The Quick Mild Cognitive Impairment (Qmci) screen is a new, brief (<5mins) CSI designed to identify mild cognitive impairment (MCI), which can be used across the spectrum of cognitive decline. Here we present the translation of the Qmci into Greek (Qmci-Gr) and its validation against the widely-used Standardised Mini-Mental State Examination (SMMSE). METHODS: Consecutive patients aged ≥55 years presenting with cognitive complaints were recruited from two outpatient clinics in Greece. All patients completed the Qmci-Gr and SMMSE and underwent an independent detailed neuropsychological assessment to determine a diagnostic classification. RESULTS: In total, 140 patients, median age 75 years, were included; 30 with mild dementia (median SMMSE 23/30), 76 with MCI and 34 with subjective memory complaints (SMC) but normal cognition. The Qmci-Gr had similar accuracy in differentiating SMC from cognitive impairment (MCI & mild dementia) compared with SMMSE, area under the curve (AUC) of 0.84 versus 0.79, respectively; while accuracy was higher for the Qmci-Gr, this finding was not significantly different, (p = .19). Similarly, the Qmci-Gr had similar accuracy in separating SMC from MCI, AUC of 0.79 versus 0.73 (p = .23). CONCLUSIONS: The Qmci-Gr compared favorably with the SMMSE. Further research with larger samples and comparison with other instruments such as the Montreal Cognitive Assessment is needed to confirm these findings but given its established brevity, it may be a better choice in busy clinical practice in Greece.

Investigating the safety and efficacy of nabilone for the treatment of agitation in patients with moderate-to-severe Alzheimer's disease: Study protocol for a cross-over randomized controlled trial.

Agitation is a prevalent and difficult-to-treat symptom in patients with moderate-to-severe Alzheimer's disease (AD). Though there are nonpharmacological and pharmacological interventions recommended for the treatment of agitation, the efficacy of these are modest and not always consistent. Furthermore, the safety profiles of currently prescribed medications are questionable. Nabilone, a synthetic cannabinoid, has a distinct pharmacological profile that may provide a safer and more effective treatment for agitation, while potentially having benefits for weight and pain. Additionally, emerging evidence suggests nabilone may have neuroprotective effects. We describe a clinical trial investigating the safety and efficacy of nabilone for the treatment of agitation in patients with moderate-to-severe AD. This will be a double-blind, randomized cross-over study comparing 6 weeks of nabilone (0.5-2 mg) and placebo, with a 1-week washout preceding each phase. Study outcomes will be measured at baseline and end of treatment for each treatment phase. The primary outcome measure will be agitation as assessed by the Cohen-Mansfield Agitation Inventory. The secondary outcomes include safety, behaviour (Neuropsychiatric Inventory), cognition (standardized Mini Mental Status Exam and either Severe Impairment Battery or Alzheimer's disease Assessment Scale-Cognitive subscale) and global impression (Clinician's Global Impression of Change). Exploratory outcomes include pain (Pain Assessment in Advanced AD), nutritional status (Mini-Nutritional Assessment-Short Form), caregiver distress (NPI caregiver distress), and blood-based biomarkers. A safe and efficacious pharmacological intervention for agitation, with effects on pain and weight loss in patients with moderate-to-severe AD could increase quality-of-life, reduce caregiver stress and avoid unnecessary institutionalization and related increases in health care costs. CLINICAL TRIALS NUMBER: NCT02351882.