Effectiveness of the Second-Stage Rehabilitation in Stroke Patients With Cognitive Impairment

Eglė Milinavičienė,Daiva Rastenytė,Aleksandras Kriščiūnas

doi:10.3390/medicina47090074

Eglė Milinavičienė, Daiva Rastenytė + Show 1 more

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https://doi.org/10.3390/medicina47090074

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Journal: Medicina	Publication Date: Oct 5, 2011
Citations: 10	License type: CC BY 4.0

Affiliation: Lithuanian University of Health Sciences

Abstract

The aim of this study was to evaluate the recovery of functional status and effectiveness of the second-stage rehabilitation depending on the degree of cognitive impairment in stroke patients. The study sample comprised 226 stroke patients at the Viršužiglis Hospital of rehabilitation, Hospital of Lithuanian University of Health Sciences. Functional status was evaluated with the Functional Independence Measure, cognitive function with the Mini-Mental Status Examination scale, and severity of neurologic condition with the National Institutes of Health Stroke Scale. The patients were divided into 4 study groups based on cognitive impairment: severe, moderate, mild, or no impairment. More than half (53%) of all cases were found to have cognitive impairment, while patients with different degree of cognitive impairment were equally distributed: mild impairment (18%), moderate impairment (17%), and severe impairment (18%). Improvement of functional status was observed in all study groups (P<0.001). In the patients with moderate and severe cognitive impairment, cognitive recovery was significantly more expressed than in other study groups (P<0.001). Insufficient recovery of functional status was significantly associated with hemiplegia (OR, 11.15; P=0.015), urinary incontinence (OR, 14.91; P<0.001), joint diseases (OR, 5.52; P=0.022), heart diseases (OR, 4.10; P=0.041), and severe cognitive impairment (OR, 15.18; P<0.001), while moderate and mild cognitive impairment was not associated with the recovery of functional status. During the second-stage rehabilitation of stroke patients, functional status as well as cognitive and motor skills were improved both in patients with and without cognitive impairment; however, the patients who were diagnosed with severe or moderate cognitive impairment at the beginning of second-stage rehabilitation showed worse neurological and functional status during the whole second-stage rehabilitation than the patients with mild or no cognitive impairment.

Highlights

Majority of stroke patients have motor, cognitive, and behavioral disorders during the subacute stage [1,2,3,4,5]
The aim of our study was to evaluate the recovery of functional status and the effectiveness of the second-stage rehabilitation depending on the degree of cognitive impairment in stroke patients
The impact of cognitive impairment on the improvement of general functional state, motor skills, and cognitive skills in stroke patients as well as factors predicting the recovery during the second-stage rehabilitation have been identified

Summary

Introduction

Majority of stroke patients have motor, cognitive, and behavioral disorders during the subacute stage [1,2,3,4,5]. Cognitive impairment is diagnosed in 21.8% to 65% of stroke patients during the subacute stage [4, 6,7,8,9] and in nearly one-third of stroke patients during the later stages of the disease [10]. The literature shows that cognitive and emotional outcome in stroke patients depends on a combination of 3 factors. The degree of cognitive outcome presumably depends on such factors as patient’s age, gender, premorbid level of functioning, and comorbidities. They are the objects of future research [11]

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