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

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 (γ = 0.24, p = 0.001 for physicians and γ = 0.33, p < 0.0001 for nurses). Physician scores moderately correlated with nurses scores (κ = 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.