*Purpose: Lung transplantation is a lifesaving therapy in patients with advanced lung disease. Lung transplant recipients must have the ability to manage complex medical regimens post transplant; therefore assessing cognitive status pre transplant is an important assessment when selecting lung transplant candidates. The presence of impaired cognitive status is associated with poorer clinical outcomes post transplant. There is a need to objectively identify cognitive status before transplant and assess potential reversible or modifiable risk factors.

*Methods: We prospectively assessed cognitive status in 44 consecutive lung transplant candidates using the Montreal Cognitive Assessment (MoCA). We determined prevalence and risk factors associated with impaired cognitive status utilizing multivariable logistic regression analysis after adjusting for covariates.

*Results: We evaluated 44 lung transplant candidates. The mean age was 60, 21 of whom were female. Their primary diagnoses were COPD (20%), IPF (18%), Scleroderma (16%) ILD (18%), CPFE (14%) and Other (14%). Of the 44 lung transplant candidates, 16/44 (36%) had MoCA scores indicating cognitive impairment. Decreased MoCA scores was associated with having an education level less than high school (mean score 21.4, P<0.001)

*Conclusions: Cognitive impairment is highly prevalent in lung transplant candidates. Cognitive impairment is associated with having a less than high school education. Further evaluation of risk factors for cognitive impairment and mitigation of these risk factors, such as additional education or required caregiver support, may enhance patient outcomes post lung transplantation. Further evaluation of cognitive status in larger populations is needed to validate these findings.

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