Mild cognitive impairment (MCI) seems to affect 30% of the general population above 65 and its presence has a wide range of significance. This is a prospective single centre study to look at MCI in adult urological patients above 18 years of age and to identify external factors affecting it. The Montreal Cognitive Assessment (MoCA) screening test is the tool used with scores of 26-30 being normal being <26 is deemed MCI. The MoCA evaluates MCI with 90% sensitivity and 87% specificity. It takes 10 minutes to complete the test. Exclusion criteria were non-English speaking patients and / or patients with profound visual or hearing defects, and / or those with notations of dementia at the time of enrolment. One hundred and ninety-seven patients were studied; 30%, 47% and 68% of 18-40, 41-64, 65+ year olds had MCI respectively. No significant associated factors were seen for 18-40 year olds, but current opioid use is associated with MCI in 41-64 year olds. Stone disease patients are less likely to have MCI and in the 65+ group, age, cancer, depression and education. By definition, MCI patients usually do not have significant impairment in their activities of daily living (ADLs), but there may actually be a spectrum that does compromise ADLs. About 19% of patients with MCI have difficulty performing at least one instrumental ADL, such as taking medication, shopping, and travelling. There are a lot of limitations of the study but this is the first study using MoCA and looks at cognitive barriers which are important for patients to understand and carry out urological tasks at home. One has to understand there is no fully validated standard for MCI at present and all cognitive impairment in the absence of dementia is considered MCI by MoCA. All this sets up new areas and scopes for future studies.
Urology patient assessment – importance of holistic approach – new paradigm
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