@ggibson, my own experience has been mild to moderate short-term memory loss and slowed problem-solving/decision-making shortly after I went into End Stage. This contiinued the first 2-3 weeks of dialysis then slowly began to improve, especially after post-dialysis power naps. At age 75 as a retiree and natural-born hermit, I tend to lose track of what day of the week it is anyway and occasionally can't remember someone's name or the name of an object but this was happening before dialysis and I can't tell that it's worse after 4 months of hemodialysis. Am currently a week off dialysis due to almost normal labs and slightly (temporary, I believe) increased renal function and feel no ill effects 3 days post last dialysis, including good cognition. Hope this helps but every situation and every person is different. With my nursing background, I can confirm your observation about your wife's confusion prior to dialysis - without dialysis, cognition and other symptoms become much worse unless there's some resumption of kidney function. So loving of you to be patient and kind with your wife!