Abstract
Objective
To establish a comprehensive profile of cognitive functioning in people engaged in
lower limb amputation (LLA) rehabilitation.
Design
Cross-sectional study as part of a longitudinal prospective cohort.
Setting
A national tertiary rehabilitation hospital.
Participants
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.
Interventions
Not applicable.
Main Outcome Measures
Demographic and health information and a battery of standardized neuropsychological
assessments.
Results
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.
Conclusions
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.
Keywords
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)To read this article in full you will need to make a payment
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References
- Amputation statistics by cause: limb loss in the United States.(Available at:) (Accessed September 27, 2018)
- Cognitive functioning in persons with lower limb amputations: a review.Disabil Rehabil. 2012; 34: 1950-1964
- Peripheral arterial disease and cognitive function.Vasc Med. 2009; 14: 51-61
- Lower ankle-brachial index is related to worse cognitive performance in old age.Neuropsychology. 2014; 28: 281-289
- Ankle-brachial index as a marker of cognitive impairment and dementia in general population. A systematic review.Atherosclerosis. 2011; 216: 251-257
- The neuropsychological profile of vascular cognitive impairment not demented: a meta-analysis.J Neuropsychol. 2015; 9: 109-136
- Magnitude of cognitive dysfunction in adults with type 2 diabetes: a meta-analysis of six cognitive domains and the most frequently reported neuropsychological tests within domains.J Int Neuropsychol Soc. 2014; 20: 278-291
- The prevalence and incidence of dementia: a systematic review and meta-analysis.Can J Neurol Sci. 2016; 43: S3-S50
- Psychoprosthetics.Springer-Verlag, London2008
- Changes in cognitive function from presurgery to 4 months postsurgery in individuals undergoing dysvascular amputation.Arch Phys Med Rehabil. 2014; 95: 663-669
- Neuropsychological function in peripheral vascular disease amputee patients.Arch Phys Med Rehabil. 1993; 74: 1309-1314
- Psychologic testing in amputation rehabilitation.Clin Orthop Relat Res. 1988; : 236-240
- Influencing factors and ambulation outcome in patients with dual disabilities of hemiplegia and amputation.Arch Phys Med Rehabil. 2000; 81: 14-17
- Rehabilitation of the geriatric vascular amputee patient: a population-based study.Arch Phys Med Rehabil. 2001; 82: 776-779
- 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
- Natural history of the leg amputee.Am J Surg. 1977; 133: 469-473
- Memory functioning in hemiplegics: a neuropsychological analysis of the Wechsler Memory Scale.Arch Phys Med Rehabil. 1975; 56: 517-521
- Health related quality of life, cognitive function, and depression in diabetic patients with foot ulcer or amputation. A preliminary study.Foot Ankle Int. 2005; 26: 128-134
- Scaffolding rehabilitation behaviour using a voice-mediated assistive technology for cognition.Neuropsychol Rehabil. 2010; 20: 509-527
- Self-reported cognitive concerns in people with lower limb loss.Arch Phys Med Rehabil. 2016; 97: 912-918
- Cognitive screening tests versus comprehensive neuropsychological test batteries: a National Academy of Neuropsychology education paper.Arch Clin Neuropsychol. 2017; 32: 491-498
- The hospital anxiety and depression scale.Acta Psychiatr Scand. 1983; 67: 361-370
- Normative data for the HADS from a large non-clinical sample.Br J Clin Psychol. 2001; 40: 429-434
- Quality-of-life and psychosocial outcome following childhood arterial ischaemic stroke.Brain Inj. 2012; 26: 1072-1083
- A compendium of neuropsychological tests: administration, norms, and commentary.3rd ed. Oxford University Press, Oxford, England2006
- The heterogeneity of mild cognitive impairment: a neuropsychological analysis.J Int Neuropsychol Soc. 2010; 16: 84-93
- Cognitive profiles of mild cognitive impairment with and without vascular disease.Neuropsychology. 2007; 21: 706-712
- Prognostic accuracy of mild cognitive impairment subtypes at different cut-off levels.Dement Geriatr Cogn Disord. 2017; 43: 330-341
- Frontal Systems Behavior Scale (FrSBe): professional manual.Psychological Assessment Resources, Lutz2001
- Adjusting for multiple testing when reporting research results: the Bonferroni vs Holm methods.Am J Public Health. 1996; 86: 726-728
- Holm-Bonferroni sequential correction: an EXCEL calculator.(Available at:)www.researchgate.net/publication/236969037_Holm-Bonferroni_Sequential_Correction_An_EXCEL_Calculator(Accessed September 27, 2018)
- Validity of the Montreal Cognitive Assessment (MoCA) as a screening test for mild cognitive impairment (MCI) in a cardiovascular population.J Geriatr Psychiatry Neurol. 2011; 24: 33-38
- Incidence and characteristics of lower limb amputations in people with diabetes.Diabet Med. 2009; 26: 391-396
- The cognitive correlates of functional status: a review from the Committee on Research of the American Neuropsychiatric Association.J Neuropsychiatry Clin Neurosci. 2007; 19: 249-265
- Physical, mental, and social predictors of functional outcome in unilateral lower-limb amputees.Arch Phys Med Rehabil. 2003; 84: 803-811
- Memory and executive function predict mobility rehabilitation outcome after lower-limb amputation.Disabil Rehabil. 2009; 31: 1083-1091
- Lower limb prosthesis utilisation by elderly amputees.Prosthet Orthot Int. 2000; 24: 126-132
- Do psychological measures predict the ability of lower limb amputees to learn to use a prosthesis?.Clin Rehabil. 2003; 17: 493-498
- Relationship between cognition and functional outcomes after dysvascular lower extremity amputation.Am J Phys Med Rehabil. 2015; 94: 707-717
- The relationship between cognitive impairment and diabetes self-management in a population-based community sample of older adults with type 2 diabetes.J Behav Med. 2012; 35: 190-199
- Predicting compliance with treatment following stroke: a new model of adherence following rehabilitation.Brain Impair. 2008; 122: 122-139
- Limb amputation.Oxford University Press, Oxford, England2012
- The Hopkins Rehabilitation Engagement Rating Scale: development and psychometric properties.Arch Phys Med Rehabil. 2007; 88: 877-884
- Neurobehavioral dysfunction in patients with subcortical vascular mild cognitive impairment and subcortical vascular dementia.Clin Neuropsychol. 2012; 26: 224-228
- A time to think: circadian rhythms in human cognition.Cogn Neuropsychol. 2007; 24: 755-789
- Backwards digit recall: a measure of short-term memory or working memory?.Eur J Cogn Psychol. 2010; 22: 286-296
- Neuropsychological assessment.5th ed. Oxford University Press, Oxford, England2012
Article info
Publication history
Published online: August 30, 2018
Footnotes
Disclosures: Supported by an Irish Research Council Postgraduate Research Scholarship and a Dublin City University Daniel O’Hare Postgraduate Studentship provided to Richard Lombard-Vance, PhD. The other authors have nothing to disclose.
Identification
Copyright
© 2018 by the American Congress of Rehabilitation Medicine
