Aim: Examine how perceived cognitive performance compares with measured cognitive performance in renal transplant recipients.

Background: Cognitive abilities affect patients' complex post-transplant care. An accurate assessment of cognitive abilities is imperative for appropriate patient education. It is unclear whether the transplant team accurately estimates a patient's cognitive ability.

Methods: Renal transplant patients underwent evaluation of cognitive function using the Montreal cognitive Assessment (MoCA), a validated clinic-based test to assess cognition. After the patients' clinic visit, the medical provider (transplant nephrologist or nurse practitioner) and the transplant nurse coordinator separately evaluated patients' cognition using a visual analogue scale (1=poor, 10=excellent), in a blinded manner. These scores were based on the interactions with the patient during the current clinic visit and the past experiences with the patient. To compare the MoCA scores and the provider and coordinators' perceived scores, we used the gamma statistic, as the two scales were different. We used kappa, weighted kappa, and Wilcoxon signed-rank test to assess the agreement between the providers' and coordinators' perceived scores.

Results: 240 renal transplant recipients: age 54.7 ± 12.6 years, 54.6% male, 70.4% Caucasians, and 28.7% with at least some college education completed the assessments. The mean MoCA score was 26±3.1. The mean provider and coordinator scores were 8.6±1.4 and 8.7±1.3 respectively. The MoCA scores correlated weakly with the provider's perceived scores (gamma: 0.29, 95% CI: 0.17-0.41) as well as the coordinators' perceived scores (gamma: 0.37, 95% CI: 0.27-0.47). The agreement between the providers and coordinators score was poor (kappa 0.18, 95% CI: 0.10-0.26; weighted kappa 0.34, 95% CI: 0.26-0.42). The providers performed better than the coordinators at identifying patients with lower MOCA scores (p=0.05).

Conclusions: Transplant providers and coordinators poorly adjudicate patients' true cognitive abilities. Further studies are needed to assess whether the knowledge of true cognitive ability of patients will help the transplant team in providing better patient education and improving transplant outcomes.

CITATION INFORMATION: Gupta A, Mahanken J, Klein J, Johnson D, Burns J. Discrepancies in Perceived and Measured Cognitive Abilities in Transplant Recipients. Am J Transplant. 2017;17 (suppl 3).

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