Original research| Volume 100, ISSUE 2, P278-288.e2, February 2019

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Comprehensive Neuropsychological Assessment of Cognitive Functioning of Adults With Lower Limb Amputation in Rehabilitation

Published:August 30, 2018DOI:



      To establish a comprehensive profile of cognitive functioning in people engaged in lower limb amputation (LLA) rehabilitation.


      Cross-sectional study as part of a longitudinal prospective cohort.


      A national tertiary rehabilitation hospital.


      Adult volunteer participants (N=87) referred for comprehensive rehabilitation for major LLA were sampled from 207 consecutive admissions. Participants with both vascular (n=69) and nonvascular (n=18) LLA etiologies were included.


      Not applicable.

      Main Outcome Measures

      Demographic and health information and a battery of standardized neuropsychological assessments.


      Compared to normative data, impairment was evident in overall cognitive functioning (P≤.003). Impairment was also evident in particular areas, including reasoning, psychomotor function, information processing, attention, memory, language/naming, visuospatial functions, and executive functions (all P≤.003 Holm-corrected). There were also higher frequencies of impaired functions across most aspects of functioning in this group compared with expected frequencies in normative data (P≤.003 Holm-corrected). There were no significant differences in cognitive functioning between participants of vascular and nonvascular LLA etiology.


      Findings support the need for cognitive screening at rehabilitation admission regardless of etiology. Administration of comprehensive neuropsychological assessment with a battery sensitive to vascular cognitive impairment is recommended in some cases to generate an accurate and precise understanding of relative strengths and weaknesses in cognitive functioning. Cognitive functioning is a potential intervention point for improvement of rehabilitation outcomes for those with LLA, and further research is warranted in this area.


      List of abbreviations:

      BADS (Behavioral Assessment of the Dysexecutive Syndrome), CVLT-II SF (California Verbal Learning Test II Short Form), D-KEFS (Delis-Kaplan Executive Function System), FrSBe (Frontal Systems Behavior Scale (self-rated)), LLA (lower limb amputation), MCI (mild cognitive impairment), MoCA (Montreal Cognitive Assessment), PVD (peripheral vascular disease), RBANS (Repeatable Battery for the Assessment of Neuropsychological Status), TEA (Test of Everyday Attention), VCI (vascular cognitive impairment), VOSP (Visual Object and Space Perception Battery), WAIS-IV (Wechsler Adult Intelligence Scale-Fourth Edition), WMS-IV (Wechsler Memory Scale-Fourth Edition)
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