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Discrepancies between Perceived and Measured Cognition in Kidney Transplant Recipients: Implications for Clinical Management.

ABSTRACT: BACKGROUND:Cognitive impairment is common in kidney transplant (KT) recipients and affects quality of life, graft survival, morbidity, and mortality. Failure to identify patients with cognitive impairment can withhold appropriate and timely intervention. This study determines whether measured cognition with standard screening tools offers any advantage over perceived cognition in screening transplant patients for cognitive impairment. METHODS:Cognition was assessed in 157 KT recipients using the Montreal Cognitive Assessment (MoCA; measured cognition). In addition, transplant physicians and nurse coordinators were asked to rate transplant recipients' level of cognition after routine clinical interactions (perceived cognition). Physicians and nurses were blind to MoCA scores. Perceived cognition scores were compared to MoCA scores. RESULTS:Perceived cognition scores fairly correlated with MOCA scores (? = 0.24, p = 0.001 for physicians and ? = 0.33, p < 0.0001 for nurses). Physician scores moderately correlated with nurses scores (? = 0.44, p < 0.0001). Clinical perception had a low accuracy for identifying patients with cognitive impairment (sensitivity 66% for physicians, 65% for nurses), and those without cognitive impairment (specificity 67% for physicians, 76% for nurses). CONCLUSION:Clinical perception is inaccurate at detecting cognitive impairment in KT recipients. Objective tests should be considered to screen KT recipients for cognitive impairment.

SUBMITTER: Gupta A

PROVIDER: S-EPMC5828957 | biostudies-literature | 2018

REPOSITORIES: biostudies-literature

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Discrepancies between Perceived and Measured Cognition in Kidney Transplant Recipients: Implications for Clinical Management.

Gupta Aditi A Thomas Tashra S TS Klein Jeffrey A JA Montgomery Robert N RN Mahnken Jonathan D JD Johnson David K DK Drew David A DA Sarnak Mark J MJ Burns Jeffrey M JM

Nephron 20171020 1

<h4>Background</h4>Cognitive impairment is common in kidney transplant (KT) recipients and affects quality of life, graft survival, morbidity, and mortality. Failure to identify patients with cognitive impairment can withhold appropriate and timely intervention. This study determines whether measured cognition with standard screening tools offers any advantage over perceived cognition in screening transplant patients for cognitive impairment.<h4>Methods</h4>Cognition was assessed in 157 KT recip ...[more]

PMID: 29049997

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Project description:Older kidney transplant recipients are susceptible to cognitive impairment, frailty, comorbidities, immunosuppression-related complications, and chronic graft failure, however, there has been limited focus on their concerns and expectations related to transplantation. This study aims to describe the perspectives of older kidney transplant recipients about their experience of kidney transplantation, self-management, and treatment goals to inform strategies and interventions that address their specific needs.Face-to-face semistructured interviews were conducted with 30 kidney transplant recipients aged 65-80 years from five renal units in Australia. Transcripts were analyzed thematically.Six themes were identified: restoring vitality of youth (with subthemes of revived mindset for resilience, embracing enjoyment in life, drive for self-actualization); persisting through prolonged recovery (yielding to aging, accepting functional limitations, pushing the limit, enduring treatment responsibilities); imposing sicknesses (combatting devastating comorbidities, painful restrictions, emerging disillusionment, anxieties about accumulating side effects, consuming treatment burden); prioritizing graft survival (privileged with a miracle, negotiating risks for longevity, enacting a moral duty, preserving the last opportunity); confronting health deterioration (vulnerability and helplessness, narrowing focus to immediate concerns, uncertainty of survival); and value of existence (purpose through autonomy, refusing the burden of futile treatment, staying alive by all means).Older kidney transplant recipients felt able to enjoy life and strived to live at their newly re-established potential and capability, which motivated them to protect their graft. However, some felt constrained by slow recuperation and overwhelmed by unexpected comorbidities, medication-related side effects, and health decline. Our findings suggest the need to prepare and support older recipients for self-management responsibilities, clarify their expectations of post-transplant risks and outcomes, and provide assistance through prolonged recovery after kidney transplantation.

Dataset Information

Discrepancies between Perceived and Measured Cognition in Kidney Transplant Recipients: Implications for Clinical Management.

Publications

Discrepancies between Perceived and Measured Cognition in Kidney Transplant Recipients: Implications for Clinical Management.

Similar Datasets

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