Cognitive impairment is common and underdiagnosed in patients in hemodialysis (HD) can be moderate and severe. About 38% of patients in Dialysis has serious deficits in executive function and this affects patients of all ages.

Based on the case of an 82-year-old patient in a HD program who enters from Nephrology to the Convalescence Unit for miscontrol of pain due to ganglion and liver recidivism after years of cystectomy by bladder neoplasia and having acute confusional syndrome (ACS) subsequently presented after treatmet with morphine MST and Tramadol. We performed an integral geriatric evaluation that showed a deterioration of the executive functions. Through medical literature we analyze this find of atypical pattern and its possible relationship to renal disease.

BI 100/100. No known history of cognitive impairment. Despite optimal pain control with fentanyl patch, pregabalin, paracetamol, metamizol and dexamethasone, without new episodes of ACS, we saw high difficulties in comprehension time schedule, spatial location, bad understanding of medical treatment, etc. Neuropsychological study showed MMSE 24/30; SKT subtest of immediate memory 1/12, null recognition without understanding the task. Memory Imparily Screen 5/8, Test clock 3/7. In summary there were deficits in executive functions such as complex attention, mental control, fluency and reasoning. Fluctuating memory abilities. Mild multiple cognitive impairment executive domain. Atypical Profile.

There is a strong correlation between the decrease in GF and the degree of cognitive impairment. This worsens with the Dialysis due to hemodynamic changes. It is essential to evaluate the cognitive situation in all patients with CKD. Being the most affected cognitive domain, the function executive,it can avoid in these patients the correct assesment of established medications and dietary restrictions that are so important in the control of potassium, phosphorus and liquids that cause greater complications and even more mortality.