{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,23]],"date-time":"2026-10-23T23:56:07Z","timestamp":1792799767608,"version":"4.5.0"},"reference-count":46,"publisher":"BMJ","issue":"3","license":[{"start":{"date-parts":[[2025,3,25]],"date-time":"2025-03-25T00:00:00Z","timestamp":1742860800000},"content-version":"unspecified","delay-in-days":24,"URL":"http:\/\/creativecommons.org\/licenses\/by-nc\/4.0\/"}],"funder":[{"name":"Venerable Yen Pei-National Kidney Foundation Research Fund","award":["NKFRC\/2021\/01\/02"],"award-info":[{"award-number":["NKFRC\/2021\/01\/02"]}]}],"content-domain":{"domain":["bmj.com"],"crossmark-restriction":true},"short-container-title":["BMJ Open"],"accepted":{"date-parts":[[2025,2,24]]},"published-print":{"date-parts":[[2025,3]]},"abstract":"<jats:sec>\n                    <jats:title>Objectives<\/jats:title>\n                    <jats:p>Cognitive impairments and cognitive complaints are commonly present in dialysis patients and can affect clinical, functional, occupational, and psychosocial well-being. It is important to screen for patients\u2019 cognitive status as it offers a gateway to specialty referral, prevention or rehabilitation programmes, and personalisation of clinical care. The Patient\u2019s Assessment of Own Functioning Inventory (PAOFI) is a comprehensive questionnaire that assesses patient-reported difficulties in memory, language, motor\/sensory-perceptual skills and higher-level cognitive function. In the current study, we adopted network analysis to identify central cognitive complaints in dialysis patients and derived a PAOFI short form (PAOFI-SF) based on these core symptoms to improve screening efficiency in real-world renal settings.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Design<\/jats:title>\n                    <jats:p>Multicentre, cross-sectional study.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Setting<\/jats:title>\n                    <jats:p>Participants were recruited from 10 community-based dialysis centres in Singapore, from May to November 2022.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Participants<\/jats:title>\n                    <jats:p>A total of 369 eligible haemodialysis patients were invited to join the study, and 268 completed the measures (response rate 72.6%).<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Outcome measures<\/jats:title>\n                    <jats:p>Cognitive assessment tools including the PAOFI and the Montreal Cognitive Assessment were administered.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>Based on the PAOFI measure, 98 participants (36.6%) endorsed the presence of three or more complaints, indicating clinically significant cognitive complaints. Network analysis identified five central cognitive complaints among dialysis patients: problem-solving difficulty, difficulty following instructions, forgetting how to do tasks, difficulty being understood, and forgetting people known years ago. These core items were combined into a five-item short form of PAOFI, which showed good reliability and validity, and an area under the curve of 83.4% in identifying clinically significant cognitive complaints. The optimal cut-off point of the short form was 11.5 (out of 30), with a specificity of 89.5%, sensitivity of 63.9%, positive predictive value of 77.5% and negative predictive value of 81.4%. This cut-off point also predicted objective cognitive performance even after controlling for sociodemographic and clinical confounders.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusions<\/jats:title>\n                    <jats:p>Pending future replication and external validation, the PAOFI-SF may be suitable for use in renal care settings as an initial screening tool to identify patients with cognitive complaints and increased risk of objective cognitive impairments.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1136\/bmjopen-2024-088502","type":"journal-article","created":{"date-parts":[[2025,3,25]],"date-time":"2025-03-25T19:48:44Z","timestamp":1742932124000},"page":"e088502","update-policy":"https:\/\/doi.org\/10.1136\/crossmarkpolicy","source":"Crossref","is-referenced-by-count":1,"title":["Development of a rapid screener through network analysis to identify central cognitive complaints in haemodialysis 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Singapore"},{"name":"Duke\u2013NUS Medical School, Singapore"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jason C J","family":"Choo","sequence":"additional","affiliation":[{"name":"National Kidney Foundation Singapore, Singapore"},{"name":"Department of Renal Medicine, Singapore General Hospital, Singapore"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-8173-5663","authenticated-orcid":false,"given":"Konstadina","family":"Griva","sequence":"additional","affiliation":[{"name":"Lee Kong Chian School of Medicine, Nanyang Technological University, Singapore"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"239","published-online":{"date-parts":[[2025,3,25]]},"reference":[{"key":"2025121401411210000_15.3.e088502.1","doi-asserted-by":"crossref","first-page":"452","DOI":"10.1038\/s41581-020-0266-9","article-title":"Mechanisms of cognitive dysfunction in 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