Association Between Montreal Cognitive Assessment Scores and Measures of Functional Mobility in Lower Extremity Amputees After Inpatient Rehabilitation



      To determine whether scores on a cognitive measure are associated with walking endurance and functional mobility of individuals with transfemoral or transtibial amputations at discharge from inpatient prosthetic rehabilitation.


      Retrospective cohort study.


      Rehabilitation hospital.


      Consecutive admissions (N=176; mean age ± SD, 64.27±13.23y) with transfemoral or transtibial amputation that had data at admission and discharge from an inpatient prosthetic rehabilitation program.


      Not applicable.

      Main Outcome Measures

      Cognitive status was assessed using the Montreal Cognitive Assessment (MoCA). The L Test and the 2-minute walk test (2MWT) were used to estimate functional mobility and walking endurance.


      The mean ± SD MoCA score was 24.05±4.09 (range, 6–30), and 56.3% of patients had scores <26. MoCA scores had a small positive correlation with the 2MWT (r=.29, P<.01), and a small negative correlation to the L Test (r=−.24, P<.01). In multivariable linear regression, compared with people with the highest MoCA score quartile, there was no difference on the 2MWT, but people in the lowest 2 quartiles took longer to complete the L Test.


      Cognitive impairment was very prevalent. The association between MoCA and functional mobility was statistically significant. These results highlight the potential for differences on complex motor tasks for individuals with cognitive impairment but does not indicate a need to exclude them from rehabilitation on the basis of cognitive impairment alone.


      List of abbreviations:

      ABC (Activities-specific Balance Confidence Scale), LEA (lower extremity amputation), MoCA (Montreal Cognitive Assessment), 2MWT (2-minute walk test)
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        • National Diabetes Surveillance System
        Report from the National Diabetes Surveillance System: diabetes in Canada.
        Public Health Agency of Canada, Ottawa2009
        • American Diabetes Association
        Peripheral arterial disease in people with diabetes.
        Diabetes Care. 2003; 26: 3333-3341
        • Brands A.
        • Biessels G.J.
        • de Hann E.
        • Kappelle J.
        • Kessels R.
        The effects of type 1 diabetes on cognitive performance: a meta-analysis.
        Diabetes Care. 2005; 28: 726-735
        • McCrimmon R.J.
        • Ryan C.M.
        • Frier B.M.
        Diabetes and cognitive dysfunction.
        Lancet. 2012; 379: 2291-2299
        • Ziegler-Graham K.
        • MacKenzie E.J.
        • Ephraim P.L.
        • Travison T.G.
        • Brookmeyer R.
        Estimating the prevalence of limb loss in the United States: 2005 to 2050.
        Arch Phys Med Rehabil. 2008; 89: 422-429
        • Paneni F.
        • Beckman J.A.
        • Creager M.A.
        • Cosentino F.
        Diabetes and vascular disease: pathophysiology, clinical consequences, and medical therapy: part I.
        Eur Heart J. 2013; 34: 2436-2446
        • Ruderman N.B.
        • Gupta S.
        • Sussman I.
        Hyperglycemia, diabetes, and vascular disease: an overview.
        in: Ruderman N. Williamson J. Brownlee M. Hyperglycemia, diabetes and vascular disease. Oxford Univ Pr, New York1992: 3-20
        • Strachan M.W.
        • Deary I.J.
        • Ewing F.M.
        • Frier B.M.
        Is type II diabetes associated with an increased risk of cognitive dysfunction? A critical review of published studies.
        Diabetes Care. 1997; 20: 438-445
        • Leibson C.L.
        • Rocca W.A.
        • Hanson V.A.
        • et al.
        Risk of dementia among persons with diabetes mellitus: a population-based cohort study.
        Am J Epidemiol. 1997; 145: 301-308
        • Verdelho A.
        • Madureira S.
        • Ferro J.M.
        • et al.
        Differential impact of cerebral white matter changes, diabetes, hypertension and stroke on cognitive performance among non-disabled elderly. The LADIS study.
        J Neurol Neurosurg Psychiatry. 2007; 78: 1325-1330
        • Sansam K.
        • Neumann V.
        • O'Connor R.
        • Bhakta B.
        Predicting walking ability following lower limb amputation: a systematic review of the literature.
        J Rehabil Med. 2009; 41: 593-603
        • Coffey L.
        • O'Keeffe F.
        • Gallagher P.
        • Desmond D.
        • Lombard-Vance R.
        Cognitive functioning in persons with lower limb amputations: a review.
        Disabil Rehabil. 2012; 34: 1950-1964
        • O'Neill B.
        Cognition and mobility rehabilitation following lower limb amputation.
        in: Gallagher P. Desmond D. MacLachlan M. Psychoprosthetics. Springer, New York2008: 53-65
        • Nasreddine Z.S.
        • Phillips N.A.
        • Bédirian V.
        • et al.
        The Montreal Cognitive Assessment, MoCA: a brief screening tool for mild cognitive impairment.
        J Am Geriatr Soc. 2005; 53: 695-699
        • Alagiakrishnan K.
        • Zhao N.
        • Mereu L.
        • Senior P.
        • Senthilselvan A.
        Montreal Cognitive Assessment is superior to standardized Mini-Mental Status Exam in detecting mild cognitive impairment in the middle-aged and elderly patients with type 2 diabetes mellitus.
        Biomed Res Int. 2013; 2013: 1-5
        • Montero-Odasso M.
        • Muir S.W.
        Simplifying detection of mild cognitive impairment subtypes.
        J Am Geriatr Soc. 2010; 58: 992-994
        • Pendlebury S.T.
        • Cuthbertson F.C.
        • Welch S.J.
        • Mehta Z.
        • Rothwell P.M.
        Underestimation of cognitive impairment by Mini-Mental State Examination versus the Montreal Cognitive Assessment in patients with transient ischemic attack and stroke: a population-based study.
        Stroke. 2010; 41: 1290-1293
        • Deathe A.B.
        • Miller W.C.
        The L Test of Functional Mobility: measurement properties of a modified version of the Timed “Up & Go” Test designed for people with lower-limb amputations.
        Phys Ther. 2005; 85: 626-635
        • Butland R.J.
        • Pang J.
        • Gross E.R.
        • Woodcock A.A.
        • Geddes D.M.
        Two-, six-, and 12-minute walking tests in respiratory disease.
        Br Med J (Clin Res Ed). 1982; 284: 1607-1608
        • Brooks D.
        • Parsons J.
        • Hunter J.P.
        • Devlin M.
        • Walker J.
        The 2-minute walk test as a measure of functional improvement in persons with lower limb amputation.
        Arch Phys Med Rehabil. 2001; 82: 1478-1483
        • Lavery L.A.
        • Armstrong D.G.
        • Murdoch D.P.
        • Peters E.J.
        • Lipsky B.A.
        Validation of the Infectious Diseases Society of America’s diabetic foot infection classification system.
        Clin Infect Dis. 2007; 44: 562-565
        • Murdoch G.
        Levels of amputation and limiting factors.
        Ann R Coll Surg Engl. 1967; 40: 204-216
        • Resnik L.
        • Borgia M.
        Reliability of outcome measures for people with lower-limb amputations: distinguishing true change from statistical error.
        Phys Ther. 2011; 91: 555-565
        • Lowry K.A.
        • Brach J.S.
        • Nebes R.D.
        • Studenski S.A.
        • VanSwearingen J.M.
        Contributions of cognitive function to straight- and curved-path walking in older adults.
        Arch Phys Med Rehabil. 2012; 93: 802-807
        • Czerniecki J.M.
        • Turner A.P.
        • Williams R.M.
        • Hakimi K.N.
        • Norvell D.C.
        Mobility changes in individuals with dysvascular amputation from the presurgical period to 12 months postamputation.
        Arch Phys Med Rehabil. 2012; 93: 1766-1773
        • Myers A.M.
        • Fletcher P.C.
        • Myers A.H.
        • Sherk W.
        Discriminative and evaluative properties of the Activities-specific Balance Confidence (ABC) Scale.
        J Gerontol A Biol Sci Med Sci. 1998; 53A: M287-M294