Dementia is a frequent diagnosis in geriatric rehabilitation. Studies in patients with dementia on the development of their cognitive status during rehabilitation and its relation to functional outcomes have been scarce.
Objectives:
To describe the changes in cognitive status in patients with dementia during inpatient rehabilitation and to determine its association with patient characteristics and rehabilitation outcome.
Methods:
Cohort study in a geriatric rehabilitation center with data collection at admission and discharge. Outcome measures were change in global and domain-related cognitive functioning and its association with activities of daily living (ADL) and discharge home.
Results:
154 patients (mean age 83.7 years) diagnosed with mild to moderate dementia were included. Cognitive performance significantly improved from admission to discharge for all cognitive variables tested (p < 0.001 to 0.03). Change in global cognitive functioning, executive functions, and episodic memory were positively associated with ADL recovery. Change in global cognitive functioning predicted ADL improvements (β= 0.32; p = 0.006). Only 7.8% of patients, characterized by worse ADL and motor abilities as well as higher frailty scores at admission, deteriorated in global cognitive scores. In comparison to patients with stable or improved cognition, these patients showed least improvements in ADL-scores (4.1 versus 12.5) and a trend for higher institutionalization (50% versus 26.5%).
Conclusions:
The findings highlight the potential of patients with dementia to recover cognitive functioning during rehabilitation. Cognitive change represents an independent rehabilitation outcome and a prognostic factor for successful rehabilitation suggesting that specific interventions are indicated to maintain and enhance cognitive functioning in these highly vulnerable patients.
ShahDC, EvansM, KingD (2000) Prevalence of mental illness in a rehabilitation unit for older adults. Postgrad Med J76, 153–156.
2.
MeziereA, BlachierM, ThomasS, VernyM, HerbaudS, BouillanneO, HenryO, DavidJP, Le ThuautA, Canoui-PoitrineF, PaillaudE (2013) Neuropsychiatric symptoms in elderly inpatients: A multicenter cross-sectional study. Dement Geriatr Cogn Dis Extra3, 123–130.
3.
Welz-BarthA, StellaS, FüsgenI (2007) Incidence of cognitive dysfunctions in geriatric rehabilitation. Phys Med Rehab Kuror17, 94–97.
4.
ResnickB, BeaupreL, McGiltonKS, GalikE, LiuW, NeumanMD, Gruber-BaldiniAL, OrwigD, MagazinerJ (2016) Rehabilitation interventions for older individuals with cognitive impairment post-hip fracture: A systematic review. J Am Med Dir Assoc17, 200–205.
5.
VassalloM, PoynterL, KwanJ, SharmaJC, AllenSC (2016) A prospective observational study of outcomes from rehabilitation of elderly patients with moderate to severe cognitive impairment. Clin Rehabil30, 901–908.
6.
GoldsteinFC, StrasserDC, WoodardJL, RobertsVJ (1997) Functional outcome of cognitively impaired hip fracture patients on a geriatric rehabilitation unit. J Am Geriatr Soc45, 35–42.
7.
BarnesC, ConnerD, LegaultL, ReznickovaN, Harrison-FelixC (2004) Rehabilitation outcomes in cognitively impaired patients admitted to skilled nursing facilities from the community. Arch Phys Med Rehabil85, 1602–1607.
8.
PoynterL, KwanJ, SayerAA, VassalloM (2011) Does cognitive impairment affect rehabilitation outcome?J Am Geriatr Soc59, 2108–2111.
9.
FuscoD, BochicchioGB, OnderG, BarillaroC, BernabeiR, LandiF, Region S-HSGoB (2009) Predictors of rehabilitation outcome among frail elderly patients living in the community. J Am Med Dir Assoc10, 335–341.
10.
RöslerA, KrauseT, NiehuusC, von Renteln-KruseW (2009) Dementia as a cofactor for geriatric rehabilitation-outcome in patients with osteosynthesis of the proximal femur: A retrospective, matched-pair analysis of 250 patients. Arch Gerontol Geriatr49, e36–e39.
11.
WilsonRS, HebertLE, ScherrPA, DongX, LeurgensSE, EvansDA (2012) Cognitive decline after hospitalization in a community population of older persons. Neurology78, 950–956.
12.
ChenCC, ChiuMJ, ChenSP, ChengCM, HuangGH (2011) Patterns of cognitive change in elderly patients during and 6 months after hospitalisation: A prospective cohort study. Int J Nurs Stud48, 338–346.
13.
EhlenbachWJ, HoughCL, CranePK, HaneuseSJ, CarsonSS, CurtisJR, LarsonEB (2010) Association between acute care and critical illness hospitalization and cognitive function in older adults. JAMA303, 763–770.
14.
ZisbergA, SinoffG, AgmonM, TonkikhO, Gur-YaishN, ShadmiE (2016) Even a small change can make a big difference: The case of in-hospital cognitive decline and new IADL dependency. Age Ageing45, 500–504.
15.
PedoneC, ErcolaniS, CataniM, MaggioD, RuggieroC, QuartesanR, SeninU, MecocciP, CherubiniA, GroupGS (2005) Elderly patients with cognitive impairment have a high risk for functional decline during hospitalization: The GIFA Study. J Gerontol A Biol Sci Med Sci60, 1576–1580.
16.
DewingJ, DijkS (2016) What is the current state of care for older people with dementia in general hospitals? A literature review. Dementia15, 106–124.
17.
MathewsSB, ArnoldSE, EppersonCN (2014) Hospitalization and cognitive decline: Can the nature of the relationship be deciphered?Am J Geriatr Psychiatry22, 465–480.
18.
MuirSW, YohannesAM (2009) The impact of cognitive impairment on rehabilitation outcomes in elderly patients admitted with a femoral neck fracture: A systematic review. J Geriatr Phys Ther32, 24–32.
19.
LandiF, BernabeiR, RussoA, ZuccalaG, OnderG, CarosellaL, CesariM, CocchiA (2002) Predictors ofrehabilitation outcomes in frail patients treated in a geriatric hospital. J Am Geriatr Soc50, 679–684.
20.
HershkovitzA, BrillS (2007) The association between patients’ cognitive status and rehabilitation outcome in a geriatric day hospital. Disabil Rehabil29, 333–337.
21.
McPhailSM, VarghesePN, KuysSS (2014) Patients undergoing subacute physical rehabilitation following an acute hospital admission demonstrated improvement in cognitive functional task independence. ScientificWorldJournal2014, 810418.
22.
PerezLM, InzitariM, RoqueM, DuarteE, VallesE, RodoM, GallofreM (2015) Change in cognitive performance is associated with functional recovery during post-acute stroke rehabilitation: A multi-centric study from intermediate care geriatric rehabilitation units of Catalonia. Neurol Sci36, 1875–1880.
23.
Tomaszewski FariasS, Cahn-WeinerDA, HarveyDJ, ReedBR, MungasD, KramerJH, ChuiH (2009) Longitudinal changes in memory and executive functioning are associated with longitudinal change in instrumental activities of daily living in older adults. Clin Neuropsychol23, 446–461.
24.
PereiraFS, YassudaMS, OliveiraAM, ForlenzaOV (2008) Executive dysfunction correlates with impaired functional status in older adults with varying degrees of cognitive impairment. Int Psychogeriatr20, 1104–1115.
25.
RoyallDR, LauterbachEC, KauferD, MalloyP, CoburnKL, BlackKJ, Committee on Research of the American Neuropsychiatric A (2007) The cognitive correlates of functional status: A review from the Committee on Research of the American Neuropsychiatric Association. J Neuropsychiatry Clin Neurosci19, 249–265.
26.
DutziI, SchwenkM, MicolW, HauerK (2013) [Patients with dementia as a secondary diagnosis. Care in geriatric inpatient rehabilitation]. Z Gerontol Geriatr46, 208–213.
27.
SchwenkM, DutziI, EnglertS, MicolW, NajafiB, MohlerJ, HauerK (2014) An intensive exercise program improves motor performances in patients with dementia: Translational model of geriatric rehabilitation. J Alzheimers Dis39, 487–498.
28.
FolsteinMF, FolsteinSE, McHughPR (1975) Mini-mental state. A practical method for grading the cognitive state of patients for the clinician. J Psychiatr Res12, 189–198.
29.
McKhannGM, KnopmanDS, ChertkowH, HymanBT, JackCRJr, KawasCH, KlunkWE, KoroshetzWJ, ManlyJJ, MayeuxR, MohsRC, MorrisJC, RossorMN, ScheltensP, CarrilloMC, ThiesB, WeintraubS, PhelpsCH (2011) The diagnosis of dementia due to Alzheimer’s disease: Recommendations from the National Institute on Aging-Alzheimer’s Association workgroups on diagnostic guidelines for Alzheimer’s disease. Alzheimers Dement7, 263–269.
30.
RomanGC, TatemichiTK, ErkinjunttiT, CummingsJL, MasdeuJC, GarciaJH, AmaducciL, OrgogozoJM, BrunA, HofmanAet al. (1993) Vascular dementia: Diagnostic criteria for research studies. Report of the NINDS-AIREN International Workshop. Neurology43, 250–260.
31.
MaierW, JessenF, SchneiderF, DeuschlG, SpottkeA, ReichmannH (2010) S3-Leitlinie » Demenzen“ « Langversion (B). In Diagnose- und Behandlungsleitlinie Demenz, Springer Berlin Heidelberg, Heidelberg, pp. 9–72.
RockwoodK, SongX, MacKnightC, BergmanH, HoganDB, McDowellI, MitnitskiA (2005) A global clinicalmeasure of fitness and frailty in elderly people. CMAJ173, 489–495.
34.
DenkingerMD, LindemannU, NicolaiS, IglW, JamourM, NikolausT (2011) Assessing Physical Activity in Inpatient Rehabilitation: Validity, practicality, and sensitivity to change in the physical activity in inpatient rehabilitation assessment. Arch Phys Med Rehabil92, 2012–2017.
35.
MahoneyFI, BarthelDW (1965) Functional evaluation: The Barthel Index. Md State Med J14, 61–65.
36.
LubkeN, MeinckM, VonRenteln-Kruse W (2004) [The Barthel Index in geriatrics. A context analysis for the Hamburg Classification Manual]. Z Gerontol Geriatr37, 316–326.
37.
MorrisJC, MohsRC, RogersH, FillenbaumG, HeymanA (1988) Consortium to establish a registry for Alzheimer’s disease (CERAD) clinical and neuropsychological assessment of Alzheimer’s disease. Psychopharmacol Bull24, 641–652.
38.
OswaldWD, FleischmannUM (1985) Psychometrics in aging and dementia: Advances in geropsychological assessments. Arch Gerontol Geriatr4, 299–309.
39.
ChandlerMJ, LacritzLH, HynanLS, BarnardHD, AllenG, DeschnerM, WeinerMF, CullumCM (2005) A total score for the CERAD neuropsychological battery. Neurology65, 102–106.
40.
EhrenspergerMM, BerresM, TaylorKI, MonschAU (2010) Early detection of Alzheimer’s disease with a total score of the German CERAD. J Int Neuropsychol Soc16, 910–920.
41.
CohenJ (1988) Lawrence. Statistical power analysis for the behavioral sciences, Erlbaum, Hillsdale, NJ.
42.
JacobsonNS, TruaxP (1991) Clinical significance: A statistical approach to defining meaningful change in psychotherapy research. J Consult Clin Psychol59, 12–19.
43.
SongF, Jerosch-HeroldC, HollandR, Drachler MdeL, MaresK, HarveyI (2006) Statistical methods for analysing Barthel scores in trials of poststroke interventions: A review and computer simulations. Clin Rehabil20, 347–356.
44.
InouyeSK, ZhangY, HanL, Leo-SummersL, JonesR, MarcantonioE (2006) Recoverable cognitive dysfunction at hospital admission in older persons during acute illness. J Gen Intern Med21, 1276–1281.
45.
MilosevicDP, KosticS, PoticB, KalasicA, SvorcanP, BojicD, ErcegP, DavidovicM (2007) Is there such thing as “reversible dementia” (RD)?Arch Gerontol Geriatr44 Suppl 1, 271–277.
46.
KulmalaJ, NykanenI, MantyM, HartikainenS (2014) Association between frailty and dementia: A population-based study. Gerontology60, 16–21.
47.
Avila-FunesJA, AmievaH, Barberger-GateauP, Le GoffM, RaouxN, RitchieK, CarriereI, TavernierB, TzourioC, Gutierrez-RobledoLM, DartiguesJF (2009) Cognitive impairment improves the predictive validity of the phenotype of frailty for adverse health outcomes: The three-city study. J Am Geriatr Soc57, 453–461.
48.
FengL, Zin NyuntMS, GaoQ, FengL, YapKB, NgTP (2017) Cognitive frailty and adverse health outcomes: Findings from the Singapore Longitudinal Ageing Studies (SLAS). J Am Med Dir Assoc18, 252–258.
49.
Schmitter-EdgecombeM, ParseyCM (2014) Assessment of functional change and cognitive correlates in the progression from healthy cognitive aging to dementia. Neuropsychology28, 881–893.
50.
de PaulaJJ, DinizBS, BicalhoMA, AlbuquerqueMR, NicolatoR, de MoraesEN, Romano-SilvaMA, Malloy-DinizLF (2015) Specific cognitive functions and depressivesymptoms as predictors of activities of daily living in older adults with heterogeneous cognitive backgrounds. Front Aging Neurosci7, 139.
51.
DuffK, CheluneG, DennettK (2012) Within-session practice effects in patients referred for suspected dementia. Dement Geriatr Cogn Disord33, 245–249.
52.
CooperDB, LacritzLH, WeinerMF, RosenbergRN, CullumCM (2004) Category fluency in mild cognitive impairment: Reduced effect of practice in test-retest conditions. Alzheimer Dis Assoc Disord18, 120–122.
53.
ZehnderAE, BlasiS, BerresM, SpiegelR, MonschAU (2007) Lack of practice effects on neuropsychological tests as early cognitive markers of Alzheimer disease?Am J Alzheimers Dis Other Demen22, 416–426.
54.
MathewsM, AbnerE, Caban-HoltA, KryscioR, SchmittF (2013) CERAD practice effects and attrition bias in a dementia prevention trial. Int Psychogeriatr25, 1115–1123.
55.
DromerickAW, EdwardsDF, DiringerMN (2003) Sensitivity to changes in disability after stroke: A comparison of four scales useful in clinical trials. J Rehabil Res Dev40, 1–8.
