- Choose the care setting and, for hemodialysis, when the test was done relative to the session.
- Complete one or more of the three tools. Administer the MoCA and MMSE with their official, licensed forms; this page interprets totals and does not reproduce test items.
- Read the interpretation, the timing check, and the reversible-cause checklist.
All computation runs in your browser; no values are stored or transmitted beyond your own device.
When to Use
Use for case finding in older adults with CKD stage 4–5, before choosing between dialysis and conservative kidney management, when a patient on dialysis misses sessions or medications, and at the yearly geriatric review. A positive screen is a reason for a full assessment, not a diagnosis of dementia.
When NOT to rely on it
Do not screen during acute illness, suspected delirium, severe uremia, hypoglycemia, or marked hyponatremia: treat those first and re-test. Low literacy, a non-native test language, and uncorrected hearing or vision loss lower scores without cognitive disease.
Pearls & Pitfalls
Timing matters on hemodialysis
Global cognition is worst during the session and best shortly before it or on the following day (Murray et al., 2007). Screen just before dialysis or on a non-dialysis day, never in the chair mid-session.
Which tool
The Mini-Cog (three-word recall plus clock drawing) takes about 3 minutes and was not affected by education or language in its original multilingual sample (Borson et al., 2000). The MoCA covers executive function, the domain most affected in hemodialysis; a cut point of 24 or below gave 76.7% sensitivity and 78.6% specificity in hemodialysis patients, while the MMSE discriminated only weakly (Tiffin-Richards et al., 2014).
Pitfalls
(1) Gabapentinoids, sedating antihistamines, benzodiazepines, opioids, and anticholinergics accumulate in CKD and depress scores. (2) Depression mimics cognitive impairment. (3) The MoCA requires training and certification for official use; the MMSE is copyrighted. Use licensed forms.
Cognitive Screen Interpreter
Mini-Cog
MoCA (total from the official form)
MMSE (total from the official form)
Next Steps
- Positive screen: exclude reversible contributors (see checklist in the results), then arrange a comprehensive geriatric or neuropsychological assessment; check B12, thyroid function, glucose, sodium, calcium, and dialysis adequacy.
- Medication safety: simplify the regimen, use pill organizers or blister packs, involve a caregiver, and deprescribe sedating and anticholinergic drugs; dose gabapentinoids for kidney function.
- Decisions and consent: assess capacity for the specific decision; bring family into dialysis versus conservative care discussions early and record values in an advance care plan.
- Prognosis: in CKD-REIN, an MMSE below 24 predicted kidney replacement therapy, death, and major cardiovascular events independent of eGFR; flag the patient for closer follow-up.
- Pair with the Frailty Assessment and read Advance Care Planning in Dialysis.
Evidence
Interpretation used by this tool
| Tool | Score | Interpretation |
|---|---|---|
| Mini-Cog | 0–2 of 5 | Positive screen; full assessment advised. Some programs use below 4 for greater sensitivity. |
| MoCA | ≥ 26 | Normal (general population cut point; +1 if 12 years of education or fewer) |
| MoCA, hemodialysis | ≤ 24 | Cognitive impairment likely (sensitivity 76.7%, specificity 78.6% vs a full neuropsychological battery) |
| MMSE | < 24 / 24–26 / > 26 | CKD-REIN prognostic categories |
CKD-REIN cohort (Levassort et al., 2026)
3004 adults with CKD stage 2–5 (mean eGFR 34 mL/min/1.73 m²); 13% had MMSE below 24 and 23% had 24–26. Adjusted hazard ratios versus MMSE above 26:
| Outcome | MMSE < 24 | MMSE 24–26 |
|---|---|---|
| Kidney replacement therapy | 1.42 (1.12–1.81) | Not significant |
| All-cause death | 1.57 (1.19–2.07) | 1.45 (1.15–1.83) |
| Major adverse cardiovascular events | 1.32 (1.02–1.70) | Not significant |
