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MoCA Domain Score Analysis and Relation to Mobility Outcomes in Dysvascular Lower Extremity Amputees

  • Courtney Frengopoulos
    Correspondence
    Corresponding author Courtney Frengopoulos, MSc, c/o Dr Susan W. Hunter, School of Physical Therapy, University of Western Ontario, Elborn College, Room 1588, London, Ontario, Canada N6G 1H1.
    Affiliations
    Faculty of Health & Rehabilitation Sciences, University of Western Ontario, London, Ontario, Canada
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  • Michael W. Payne
    Affiliations
    Department of Physical Medicine and Rehabilitation, Parkwood Institute, London, Ontario, Canada

    Department of Physical Medicine and Rehabilitation, Schulich School of Medicine & Dentistry, University of Western Ontario, London, Ontario, Canada
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  • Ricardo Viana
    Affiliations
    Department of Physical Medicine and Rehabilitation, Parkwood Institute, London, Ontario, Canada

    Department of Physical Medicine and Rehabilitation, Schulich School of Medicine & Dentistry, University of Western Ontario, London, Ontario, Canada
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  • Susan W. Hunter
    Affiliations
    Department of Physical Medicine and Rehabilitation, Schulich School of Medicine & Dentistry, University of Western Ontario, London, Ontario, Canada

    School of Physical Therapy, University of Western Ontario, London, Ontario, Canada
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Published:September 27, 2017DOI:https://doi.org/10.1016/j.apmr.2017.09.003

      Abstract

      Objective

      To investigate the association between cognitive functioning, as measured by the Montreal Cognitive Assessment (MoCA), and functional outcomes upon discharge from prosthetic rehabilitation.

      Design

      Retrospective chart audit.

      Setting

      Rehabilitation hospital.

      Participants

      Consecutive admissions (N=130; mean age, 66.21±11.19y) with lower extremity amputation of dysvascular etiology.

      Interventions

      Not applicable.

      Main Outcome Measures

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

      Results

      In multivariable linear regression analysis, those who scored 2 on the visuospatial/executive functioning (out of 5) and language (out of 3) domains had statistically shorter distances walked on the 2-minute walk test than did those who scored the highest on these MoCA domains. These values were not clinically relevant. Time to complete the L Test for those who scored the lowest on the MoCA domains of visuospatial/executive functioning and delayed recall and 3 on the attention domain (out of 6) was significantly longer than that for those who scored the highest.

      Conclusions

      Individuals with lower extremity amputation have an increased risk of cognitive impairment related to amputation etiology. Lower levels of functioning on MoCA domains of visuospatial/executive functioning, delayed recall, and attention were shown to negatively relate to the rehabilitation outcome of functional mobility, as measured by the L Test.

      Keywords

      List of abbreviations:

      2MWT (2-minute walk test), ABC (Activity-specific Balance Confidence), ANOVA (analysis of variance), LEA (lower extremity amputation), L Test (L Test of Functional Mobility), MoCA (Montreal Cognitive Assessment), PVD (peripheral vascular disease)
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