Patients with severe kidney failure often suffer from some degree of cognitive impairment. The causes of the impairment are not well understood and most of the times are complex. This cognitive impairment affects patients and carers slightly different than the conventional Alzheimer's dementia or other types of well studied dementia entities. These patients progress in a non-conventional fashion and to date there is a need to further identify the cognitive deficits at an early stage, not only to address the potential causes and slow the progression but also to be able to give advice so patients and carers can make further decisions regarding their will to engage in renal replacement therapy, which although will increase the longevity, not necessarily in some circumstances will improve their quality of life.
I had the privilege to organise the first symposium on this important topic in Newcastle with a selected group of Kidney health care practitioners along with Prof. Peter Schofield and Dr.Peter Saul.
Prof. Schofield is a world leader in Neuropsychiatry and his lecture in "Recognized Limitations of the Current Cognitive Assessment Practice" enlightened us. He also demonstrated a novel and practical method of cognitive assessment which we decided to trial in our cohort of renal patients.
Dr. Peter Saul is a world expert in medical ethics and we were honoured with his presence on that night, the fact that he was jet lagged upon his return from Germany where he had just attended a World Conference in Medical Ethics and End of Life Decision Issues. It was a delight to hear his eloquent talk. He put in perspective the magnitude of dementia as a health problem and more importantly the alarming figures expected in 2 or 3 decades to come. His talk also emphasised the difficulties that medical practitioners face while trying to advise patients and carers of a change in medical strategies when patients are deemed to be no longer compus mentus. His talk motivated a fantastic debate among us: Chronic Care Physicians, Transplant and Dialysis Physicians, Transplant Surgeons, Transplant and Dialysis Nurses as well as Clinical Psychologists and Occupational Therapists who attended the symposium. Issues regarding different aspects of health and life preservation as well as quality of life compromise were touched on and we ended the session fully motivated to continue our work to improve our delivery of care to the renal patients and carers.
I humbly accepted the next task: to coordinate efforts to validate in our cohort of Renal Patients, the ARCS cognitive scale that Professor Schofield has developed.
We look forward to attend following symposiums in this important topic in future.