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)To read this article in full you will need to make a payment
Purchase one-time access:
Academic & Personal: 24 hour online accessCorporate R&D Professionals: 24 hour online accessOne-time access price info
- For academic or personal research use, select 'Academic and Personal'
- For corporate R&D use, select 'Corporate R&D Professionals'
Subscribe:
Subscribe to Archives of Physical Medicine and RehabilitationAlready a print subscriber? Claim online access
Already an online subscriber? Sign in
Register: Create an account
Institutional Access: Sign in to ScienceDirect
References
- Report from the National Diabetes Surveillance System: diabetes in Canada, 2009.Centre for Chronic Disease Prevention and Control, Ottawa2009
- Estimating the prevalence of limb loss in the United States: 2005 to 2050.Arch Phys Med Rehabil. 2008; 89: 422-429
- Thinking on your feet: a neuropsychological review of peripheral vascular disease.in: Waldstein S.R. Elias M.F. Neuropsychology of cardiovascular disease. 2nd ed. Psychology Pr, New York2001: 384
- Peripheral arterial disease and cognitive function.Psychosom Med. 2003; 65: 757-763
- Peripheral arterial disease in people with diabetes.Diabetes Care. 2003; 26: 3333-3341
- Diabetes and cognitive dysfunction.Lancet. 2012; 379: 2291-2299
- Risk of dementia among persons with diabetes mellitus: a population-based cohort study.Am J Epidemiol. 1997; 145: 301-308
- Is type II diabetes associated with an increased risk of cognitive dysfunction? A critical review of published studies.Diabetes Care. 1997; 20: 438-445
- Function after lower limb amputation.Acta Orthop Scand. 1986; 57: 154-157
- Elderly patients with lower extremity amputations: three-year study in a rehabilitation setting.Arch Phys Med Rehabil. 1977; 58: 116-123
- Major lower extremity amputation in patients with peripheral arterial insufficiency with special reference to the transgenicular amputation.J Cardiovasc Surg (Torino). 1987; 28: 152-158
- Cognitive functioning in persons with lower limb amputations: a review.Disabil Rehabil. 2012; 34: 1950-1964
- Cognitive aging: a primer.Psychology Pr, New York2000
- Assessment of cognitive and psychomotor function and rehabilitation of elderly people with prostheses.BMJ. 1991; 302: 940
- Memory and executive function predit mobility rehabilitation outcome after lower-limb amputation.Disabil Rehabil. 2009; 31: 1083-1091
- Cognition and mobility rehabilitation following lower limb amputation.in: Gallagher P. Desmond D. MacLachlan M. Psychoprosthetics. Springer-Verlag, London2008: 53-65
- Predicting walking ability following lower limb amputation: a systematic review of the literature.J Rehabil Med. 2009; 41: 593-603
- Relationship between cognition and functional outcomes after dysvascular lower extremity amputation.Am J Phys Med Rehabil. 2015; 94: 707-717
- Association between Montreal Cognitive Assessment scores and measures of functional mobility in lower extremity amputees after inpatient rehabilitation.Arch Phys Med Rehabil. 2017; 98: 450-455
- Lower limb prosthesis utilisation by elderly amputees.Prosthet Orthot Int. 2000; 24: 126-132
- Psychological testing in amputation rehabilitation.Clin Orthop. 1988; 229: 236-240
- Preoperative clinical factors predict postoperative functional outcomes after major lower limb amputation: an analysis of 553 consecutive patients.J Vasc Surg. 2005; 42: 227-235
- The Montreal Cognitive Assessment, MoCA: a brief screening tool for mild cognitive impairment.J Am Geriatr Soc. 2005; 53: 695-699
- 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: 186106
- 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
- Association between Montreal Cognitive Assessment sub-item scores and corresponding cognitive test performance in patients with frontotemporal dementia and related disorders.Dement Geriatr Cogn Disord. 2017; 43: 170-179
- Discriminative power of Montreal Cognitive Assessment.JMED Res. 2014; 14: 1-10
- The Montreal Cognitive Assessment (MoCA) in geriatric rehabilitation: psychometric properties and association with rehabilitation outcomes.Int Psychogeriatr. 2011; 23: 1582-1591
- 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
- Two-, six-, and 12-minute walking tests in respiratory disease.Br Med J (Clin Res Ed). 1982; 284: 1607-1608
- 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
- The Activities-specific Balance Confidence (ABC) Scale.J Gerontol Med Sci. 1995; 50A: M28-M34
- Psychometric properties of the Activities-specific Balance Confidence Scale among individuals with a lower-limb amputation.Arch Phys Med Rehabil. 2003; 84: 656-661
- Validation of the Infectious Diseases Society of America's diabetic foot infection classification system.Clin Infect Dis. 2007; 44: 562-565
- Levels of amputation and limiting factors.Ann R Coll Surg Engl. 1967; 40: 204-216
- Reliability of outcome measures for people with lower-limb amputations: distinguishing true change from statistical error.Phys Ther. 2011; 91: 555-565
- Changes in cognitive function from presurgery to 4 months postsurgery in individuals undergoing dysvascular amputation.Arch Phys Med Rehabil. 2014; 95: 663-669
- Physical, mental, and social predictors of functional outcome in unilateral lower-limb amputees.Arch Phys Med Rehabil. 2003; 84: 803-811
Article Info
Publication History
Published online: September 27, 2017
Footnotes
Disclosures: none.
Identification
Copyright
© 2017 by the American Congress of Rehabilitation Medicine
