Cognitive impairment can impair the understanding of instructions and the ability to follow them, ultimately leading to medical nonadherence. Medical nonadherence is fairly common in KT, and is a major cause for rejection and graft loss. The care of a KT recipient is a complex and laborious combination of clinic appointments, laboratory tests, polypharmacy, and medication and dietary adherence. Objective tests should be considered to screen KT recipients for cognitive impairment. Conclusion: Clinical perception is inaccurate at detecting cognitive impairment in KT recipients. 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). Physician scores moderately correlated with nurses scores (κ = 0.44, p < 0.0001). 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). Perceived cognition scores were compared to MoCA scores. Physicians and nurses were blind to MoCA scores. In addition, transplant physicians and nurse coordinators were asked to rate transplant recipients' level of cognition after routine clinical interactions (perceived cognition). Methods: Cognition was assessed in 157 KT recipients using the Montreal Cognitive Assessment (MoCA measured cognition). This study determines whether measured cognition with standard screening tools offers any advantage over perceived cognition in screening transplant patients for cognitive impairment. Failure to identify patients with cognitive impairment can withhold appropriate and timely intervention. Background: Cognitive impairment is common in kidney transplant (KT) recipients and affects quality of life, graft survival, morbidity, and mortality.
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