Janet So Ching Li
Objective: To determine the prevalence
and attributes of cognitive impairment in elderly continuous ambulatory peritoneal
dialysis (CAPD) patients.
Methods: The Cantonese version of the Mini-Mental State Examination (CMMSE) was used to assess the cognitive function of 81 elderly CAPD patients and 66 healthy elderly (age more than or equal to 65 years). The maximum score is 30, with a higher score indicating better cognitive performance. Other study variables included demographic data, duration of dialysis, dialysis adequacy (Kt/V), albumin and hemoglobin levels, comorbid medical conditions, days of hospital stay, and episodes of peritonitis and exit site infection.
Results: The CAPD group had lower CMMSE scores than the healthy elderly group (p < 0.001); 32.1% of CAPD patients and 7.6% of the healthy elderly were identified as cognitively impaired according to CMMSE cutoff points (p < 0.001). Logistic regression revealed that increased age (odds ratio, OR, 1.1; 95% confidence interval, 95% CI, 1.02-1.3; p = 0.018) and female gender (OR, 3.3; 95% CI, 1.1-9.9; p < 0.03) were significantly and positively associated with cognitive impairment. Protective factors included years of education (OR, 0.78; 95% CI, 0.65-0.94; p < 0.009). After adjusting for the effects of age, gender and education, CAPD patients were at greater risk for cognitive impairment than the healthy elderly (OR, 7.7; 95% CI, 2.4-24.8; p < 0.001). Education was positively correlated with CMMSE score (r = 0.52; p < 0.001), while days of hospital stay showed an inverse relationship (r = -0.243; p = 0.03). The duration of dialysis, Kt/V, albumin and hemoglobin levels, and the number of comorbid conditions were not correlated with CMMSE score.
Conclusion: There is a high prevalence of cognitive impairment in elderly CAPD patients. It is imperative that a cognitive screening test be incorporated into nursing assessments for early detection of cognitive changes.
Key words: cognitive impairment, Cantonese version of the Mini-Mental State Examination, CMMSE, continuous ambulatory peritoneal dialysis, CAPD
方法：以廣東語簡短智能測試問卷（CMMSE）去評估 81 位 CAPD 長者和 66 位健康長者的認知能力。 其他研究變數包括：個人及生活狀況，透析累積月數，血色數，Kt/V，血液中蛋白質，共存之疾病，住院日數，腹膜炎與導管出口發炎次數。
結果：CAPD 長者的 CMMSE 分數比健康長者為低（p < 0.001）。32.1% CAPD 長者和 7.6% 健康長者被界定為認知能力受損（p < 0.001）。年歲增長及婦女具有危險因素。年歲增長（odds ratio, OR, 1.1；95% confidence interval, 95% CI, 1.02-1.3；p = 0.018）；婦女（OR, 3.3；95% CI, 1.1-9.9；p < 0.03）。求學年數則具有利好因素（OR, 0.78；95% CI, 0.65-0.94；p < 0.009）。經過調較因受年歲增長，性別及求學年數的因素影響後，CAPD 長者比健康長者多七成機會有認知能力受損（OR, 7.7；95% CI, 2.4-24.8, p < 0.001）。CMMSE 分數與求學年數有正面之相關（r = 0.52, p < 0.001） 而與住院曰數則有反面之相關 （r = -0.243, p = 0.03）。透析累積月數，血色數，Kt/V，血液中蛋白質及共存之疾病變數與 CMMSE 分數則沒有相關。
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