Montreal Cognitive Assessment for cognitive assessment in chronic kidney disease: a systematic review

Abstract Introduction: There is evidence in the literature that cognitive impairment is more prevalent in individuals with chronic kidney disease (CKD) than in the general population. The Montreal Cognitive Assessment (MoCA) is an instrument with a good application profile for cognitive evaluation of patients with CKD-like impairments. The objective of this study is to perform a systematic review of MoCA use in the context of CKD. Method: The keywords "Montreal Cognitive Assessment", "Kidney Disease" and "Chronic Kidney Disease" were used to search the databases. The inclusion criteria were: a) empirical articles; b) approach to cognitive impairment in CKD; c) papers in Portuguese and English. Results: The studies were mostly cross-sectional, published in medical journals, with research carried out mostly in Europe. About 45% of the studies had samples of less than 150 participants and variations in the prevalence of cognitive impairment were found ranging from 28.9% to 74.6%. The cutoff point for the identification of the impairment presented variation between the studies. Discussion: The results' analysis demonstrates the need for more complete studies on MoCA scoring and adaptation in its different versions. We recommend to the health professionals who will use the results in the clinical setting that the interpretation of the results be made in the light of studies more related to the context lived by the patients. Conclusions: The instrument is efficient to be used in several stages and treatment modalities of the disease. We point to the need to adapt a cut-off point for the instrument in the different translations of the instrument.

引言：现有文献证据表明，慢性肾脏病（Chronic Kidney Disease, CKD）患者的认知障碍患病率高于普通人群。蒙特利尔认知评估量表（Montreal Cognitive Assessment, MoCA）是一款应用表现优异的工具，适用于伴类似认知损害的慢性肾脏病患者的认知评估。本研究旨在针对慢性肾脏病场景下蒙特利尔认知评估量表的应用情况开展系统综述。
研究方法：以“蒙特利尔认知评估量表”“肾脏病”及“慢性肾脏病”为关键词检索数据库。纳入标准如下：① 实证研究类文章；② 聚焦慢性肾脏病患者认知障碍的研究；③ 葡萄牙语或英语发表的文献。
研究结果：纳入的研究多为横断面研究，发表于医学期刊，且研究开展区域以欧洲为主。约45%的研究样本量不足150例；认知障碍患病率的报道范围跨度较大，为28.9%至74.6%。不同研究中用于识别认知障碍的临界值（cutoff point）存在差异。
讨论：对研究结果的分析显示，当前仍需开展更为全面的研究，以完善蒙特利尔认知评估量表的计分体系及其不同版本的适配性。本研究建议，拟在临床场景中应用该量表结果的医护人员，需结合与患者所处医疗场景更贴合的相关研究来解读量表结果。
结论：蒙特利尔认知评估量表可有效应用于慢性肾脏病的多个疾病阶段及多种治疗模式中。本研究指出，需针对该量表的不同译制版，适配对应的认知障碍识别临界值。