Multiple studies have shown that individuals on maintenance hemodialysis

have a high risk of developing cognitive impairment. Cognitive impairment

is linked to an increased prevalence of depression, anxiety, and decreased
quality of life in general. According to reports from the United States and
Italy, the prevalence of cognitive impairment in hemodialysis patients has
varied from 70 to 80 percent in the last ten years, which is much greater than
that of those with normal kidney function.

According to a study conducted between September 2009 and January

2010. In 154 patients (88 males and 66 females) undergoing HD at
Oyokyo Kidney Research Institute in Japan, the prevalence of
cognitive impairment based on the MMSE score was 18.8% among
HD patients and 6.0 percent among controls.
A previous study of 80 HD
patients (mean age, 61.2 ± 14.3 years) found severe
levels of impairment in executive function (38%), as
,measured by the Trail Making Test B, Part B (Trails B)
and severe memory impairment (33%) based on the
short form of the California Verbal Learning Trial
CVLT,A French study showed that the
prevalence of cognitive impairment based on the MiniMental State
Examination (MMSE) was 47% of 51 HD
outpatients (at least 70 years old).

A cross-sectional observational study of 76 outpatients (50 with recurrent

outpatient HD and 26 with normal kidney function, matched for age and
comorbidities) was conducted in New York in 2011. HD patients were
dialyzed properly and had normal hemoglobin levels. The researchers
utilized a battery of eight neuropsychological tests. Assessment scores of
neurocognitive tests, as well as the frequency and subtype of CI, were
among the outcomes. HD patients showed substantially lower composite
scores for each cognitive domain assessed when compared to controls.
Except for memory, the percentage of participants with impairment was
substantially higher in HD subjects than in controls in every area. There
were no differences between the groups regardless of vascular or dementia
risk factors. In comparison to 50% of controls, 82 percent of HD individuals
achieved CI criteria. In both groups, the non-amnestic subtype of CI was
more common.

In 2017, in the El Ghassani hemodialysis center in Fez, Morocco, an

observational, cross-sectional study of 116 patients on hemodialysis was
performed. Before the hemodialysis session, they took the Montreal
cognitive assessment exam; a Moca of 24/30 indicates the existence of
cognitive impairment. In 70% of our patients, the Moca was abnormal. The
average score for women was lower. The domains of attention and short-
term memory were the most affected. They discovered a substantial link
between the decline in the Moca score and the aging process (p0.001).
Hypertension was linked to a Moca score of 20.54 (p0.006) in the
hypertensive population. The association between cardiac disease and Moca
was shown to be substantial, with an average score of 19 (p0.01) among
individuals with heart disease.

An Egyptian cross-sectional research was done in June 2014 to evaluate the

cognitive functioning of older participants on HD. A total of 94 people aged
60 and up were involved in the study. According to the findings, 26 patients
(27.7%) had normal cognitive function, 32 (43%) had mild cognitive
impairment, 21 (23%) had mild dementia, 8 (8.5%) had moderate dementia,
and 7 (7.4%) had severe dementia. Older age, lower education level, and
longer dialysis history were all shown to be associated with cognitive
impairment [P: 0.001, 0.002, and 0.012, respectively]. They came to the
conclusion that CI is common among Egyptian elderly persons on HD, and
that it was more common and severe in those who were older, had less
education, had lower blood sodium levels, had a longer dialysis history, and
had a greater dry weight.

Another cross-sectional research in Egypt assessed cognitive performance in

50 patients with chronic renal disease who had been on hemodialysis for at
least a year and an age-matched control group in Beni Suef Hospital.
Memory, executive function, and language were the three areas in which
cognitive performance was assessed. MMSE scores were abnormal in 66
percent of patients (scoring 24).