PREDICTORS OF CHANGE IN QUALITY OF LIFE IN PATIENTS WITH FOCAL NEUROLOGICAL DAMAGE FOLLOWING AN OUTPATIENT COGNITIVE REHABILITATION PROGRAM

Abstract

To evaluate the independent predictors of Quality of Life (QoL) change in patients with Focal Neurological Damage (FND) following an Outpatient Cognitive Rehabilitation (OCR) program. Few studies have analyzed the clinical and cognitive features associated with better outcomes in patients following an OCR program. 90 patients (33 female, age: (mean ± SD) 51.27±19.68 years; education 14.51±3.37 years; Mini-Mental State Examination initial score 26.16±3.44) with cognitive impairment secondary to FND (60 cases with history of stroke, 22 cases of traumatic brain injury, 8 cases of other FND etiologies) were included. The subjects completed cognitive-behavioral, functional and social scales at baseline and treatment end. Efficacy, as measured by changes in the World Health Organization Quality of Life Brief Evaluation Instrument (WHOQOL-BREF), was evaluated by dividing the sample into 3 groups: benefit (difference >5 %), stability (difference between 5% and -5%), and worsening (difference >-5%). Categorical and quantitative predictors at baseline were analyzed prospectively. Based on the changes in the WHOQOL-BREF scale, 29 patients (32.2%) showed benefit, 45 (50%) showed stability, and 16 (17.8%) worsened after the OCR program. The predictors associated with benefit were: small number of sessions (p<0.05), lower score in the analogical visual scale (p<0.01), and poor score in the California Verbal Learning Test (CVLT) (p<0.05) and in direct span (p<0.01). The predictors associated with stability were: a better performance in the CVLT (p<0.01) and in direct span (p<0.01), and higher patient's subjective memory score evaluated by the caregiver (p<0.01). The group that showed a worsening in QoL was associated to a higher Beck depression inventory score at baseline (p<0.01). In patients with FND following an OCR program, the analysis of independent predictors of QoL change may allow for a better prediction of treatment response.