Structural equation modelling of the role of cognition in functional interference and treatment nonadherence among haemodialysis patients
Background and objectives: Cognitive impairment is common in haemodialysis patients and associated with adverse health outcomes. This may be due to cognitive impairments interfering with daily functioning and self-care, but evidence is limited. This cross-sectional study aims to explore the interrel...
| Main Authors: | , , , , , , , , , , |
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| Other Authors: | |
| Format: | Journal Article |
| Language: | English |
| Published: |
2025
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| Subjects: | |
| Online Access: | https://hdl.handle.net/10356/182161 |
| _version_ | 1826114730157146112 |
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| author | Chan, Frederick H. F. Sim, Pearl Lim, Phoebe X. H. Zhu, Xiaoli Lee, Jimmy Haroon, Sabrina Lau, Titus Wai Leong Liu, Allen Yan Lun Khan, Behram A. Choo, Jason C. J. Griva, Konstadina |
| author2 | Lee Kong Chian School of Medicine (LKCMedicine) |
| author_facet | Lee Kong Chian School of Medicine (LKCMedicine) Chan, Frederick H. F. Sim, Pearl Lim, Phoebe X. H. Zhu, Xiaoli Lee, Jimmy Haroon, Sabrina Lau, Titus Wai Leong Liu, Allen Yan Lun Khan, Behram A. Choo, Jason C. J. Griva, Konstadina |
| author_sort | Chan, Frederick H. F. |
| collection | NTU |
| description | Background and objectives: Cognitive impairment is common in haemodialysis patients and associated with adverse health outcomes. This may be due to cognitive impairments interfering with daily functioning and self-care, but evidence is limited. This cross-sectional study aims to explore the interrelationships between cognition and functional outcomes in haemodialysis patients. Methods: Haemodialysis patients completed measures of objective cognitive function (Montreal Cognitive Assessment), everyday problem-solving skills (scenario-based task), and subjective cognitive complaints (self-report). Participants also self-reported sociodemographic information, functional interference, treatment nonadherence, and mood and fatigue symptoms. Patients’ clinical data including comorbidities and lab results were extracted from medical record. Structural equation modelling was performed. Results: A total of 268 haemodialysis patients (mean age = 59.87 years; 42.5% female) participated. The final model showed satisfactory fit: CFI = 0.916, TLI = 0.905, RMSEA = 0.033 (90% confidence interval 0.024 to 0.041), SRMR = 0.066, χ2(493) = 618.573 (p < .001). There was a negative association between objective cognitive function and subjective cognitive complaints. Cognitive complaints were positively associated with both functional interference and treatment nonadherence, whereas objective performance was not. Everyday problem-solving skills emerged as a distinct aspect of cognition not associated with objective performance or subjective complaints, but had additive utility in predicting functional interference. Conclusions: Subjective cognitive complaints and everyday problem-solving skills appear to be stronger predictors of functional variables compared to objective performance based on traditional tests. Routine screening of everyday cognitive difficulties may allow for early identification of dialysis patients at risk of cognitive impairment, functional interference, treatment nonadherence, and poor clinical outcomes. |
| first_indexed | 2025-03-09T11:11:56Z |
| format | Journal Article |
| id | ntu-10356/182161 |
| institution | Nanyang Technological University |
| language | English |
| last_indexed | 2025-03-09T11:11:56Z |
| publishDate | 2025 |
| record_format | dspace |
| spelling | ntu-10356/1821612025-01-19T15:38:46Z Structural equation modelling of the role of cognition in functional interference and treatment nonadherence among haemodialysis patients Chan, Frederick H. F. Sim, Pearl Lim, Phoebe X. H. Zhu, Xiaoli Lee, Jimmy Haroon, Sabrina Lau, Titus Wai Leong Liu, Allen Yan Lun Khan, Behram A. Choo, Jason C. J. Griva, Konstadina Lee Kong Chian School of Medicine (LKCMedicine) National Healthcare Group Polyclinics, Singapore Institute of Mental Health, Singapore Medicine, Health and Life Sciences Cognitive defect Patient compliance Background and objectives: Cognitive impairment is common in haemodialysis patients and associated with adverse health outcomes. This may be due to cognitive impairments interfering with daily functioning and self-care, but evidence is limited. This cross-sectional study aims to explore the interrelationships between cognition and functional outcomes in haemodialysis patients. Methods: Haemodialysis patients completed measures of objective cognitive function (Montreal Cognitive Assessment), everyday problem-solving skills (scenario-based task), and subjective cognitive complaints (self-report). Participants also self-reported sociodemographic information, functional interference, treatment nonadherence, and mood and fatigue symptoms. Patients’ clinical data including comorbidities and lab results were extracted from medical record. Structural equation modelling was performed. Results: A total of 268 haemodialysis patients (mean age = 59.87 years; 42.5% female) participated. The final model showed satisfactory fit: CFI = 0.916, TLI = 0.905, RMSEA = 0.033 (90% confidence interval 0.024 to 0.041), SRMR = 0.066, χ2(493) = 618.573 (p < .001). There was a negative association between objective cognitive function and subjective cognitive complaints. Cognitive complaints were positively associated with both functional interference and treatment nonadherence, whereas objective performance was not. Everyday problem-solving skills emerged as a distinct aspect of cognition not associated with objective performance or subjective complaints, but had additive utility in predicting functional interference. Conclusions: Subjective cognitive complaints and everyday problem-solving skills appear to be stronger predictors of functional variables compared to objective performance based on traditional tests. Routine screening of everyday cognitive difficulties may allow for early identification of dialysis patients at risk of cognitive impairment, functional interference, treatment nonadherence, and poor clinical outcomes. Published version This work was supported by the Venerable Yen Pei-National Kidney Foundation Research Fund, Singapore [grant number NKFRC/ 2021/01/02]. KG received research funding from National Kidney Foundation Singapore. The funding sources had no role in the study design, recruitment of patients, data collection, analysis, interpretation of the results, writing of the manuscript, or decision to submit the manuscript for publication. 2025-01-13T02:28:52Z 2025-01-13T02:28:52Z 2024 Journal Article Chan, F. H. F., Sim, P., Lim, P. X. H., Zhu, X., Lee, J., Haroon, S., Lau, T. W. L., Liu, A. Y. L., Khan, B. A., Choo, J. C. J. & Griva, K. (2024). Structural equation modelling of the role of cognition in functional interference and treatment nonadherence among haemodialysis patients. PloS One, 19(10), e0312039-. https://dx.doi.org/10.1371/journal.pone.0312039 1932-6203 https://hdl.handle.net/10356/182161 10.1371/journal.pone.0312039 39418221 2-s2.0-85206663974 10 19 e0312039 en NKFRC/2021/01/02 PloS One © 2024 Chan et al. This is an open access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited. application/pdf |
| spellingShingle | Medicine, Health and Life Sciences Cognitive defect Patient compliance Chan, Frederick H. F. Sim, Pearl Lim, Phoebe X. H. Zhu, Xiaoli Lee, Jimmy Haroon, Sabrina Lau, Titus Wai Leong Liu, Allen Yan Lun Khan, Behram A. Choo, Jason C. J. Griva, Konstadina Structural equation modelling of the role of cognition in functional interference and treatment nonadherence among haemodialysis patients |
| title | Structural equation modelling of the role of cognition in functional interference and treatment nonadherence among haemodialysis patients |
| title_full | Structural equation modelling of the role of cognition in functional interference and treatment nonadherence among haemodialysis patients |
| title_fullStr | Structural equation modelling of the role of cognition in functional interference and treatment nonadherence among haemodialysis patients |
| title_full_unstemmed | Structural equation modelling of the role of cognition in functional interference and treatment nonadherence among haemodialysis patients |
| title_short | Structural equation modelling of the role of cognition in functional interference and treatment nonadherence among haemodialysis patients |
| title_sort | structural equation modelling of the role of cognition in functional interference and treatment nonadherence among haemodialysis patients |
| topic | Medicine, Health and Life Sciences Cognitive defect Patient compliance |
| url | https://hdl.handle.net/10356/182161 |
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