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Abstract
Objective
Cognitive dysfunction is an important factor on functional recovery after stroke. This study investigated the relationship between functional outcome and cognitive status during rehabilitation after stroke.
Method
This retrospective study included 80 patients with rehabilitation program after first-ever stroke. The independent variables were mini-mental status examination (MMSE) and computerized neurocognitive function test (CNT). The dependent variables were modified Barthel index (MBI), Berg balance scale (BBS), National Institute of Health Stroke Scale (NIHSS) and discharge destination. The correlation analysis was applied.
Results
Mean interval from onset to rehabilitation program was 29.5 days and duration of inpatient rehabilitation program was 31.1 days. Mean score of initial MMSE was 20.5 and CNT showed abnormal performance in at least one of the domain specific tests in all patients. The scores of MMSE, MBI, NIHSS and BBS were improved after rehabilitation program (p<0.05). Cognitive improvement contributing to the functional recovery were significant in the early participants in rehabilitation and in older patients (p<0.05). The home-discharge group demonstrated higher scores in executive function tests (p<0.001). Visual attention, visual working memory and reasoning revealed significant correlation with the MBI score at discharge.
Figures and Tables
Fig. 1
Correlation between cognitive tests and functional outcome after rehabilitation program. There are significant correlation between cognitive function and primary functional outcome only in the tests for visual attention and memory (VSB) and auditory vigilance. The results of tests for general cognition (K-MMSE) and emotion (BDI) do not showed any correlation-ship with primary functional outcomes. (*p<0.05, †p<0.01, MBI: Modified Barthel index, ΔMBI: changes in MBI (total score) between beginning of rehabilitation program and discharge, K-MMSEi: Korean version mini-mental status examination at beginning of rehabilitation program, ΔK-MMSE: changes in K-MMSE between beginning of rehabilitation program and discharge, BDI: Beck depression inventory, VSB: visual span backward test, ACPT: auditory continuous performance test, NIHSSdc: National Institute of Health Stroke Scale at discharge, ΔNIHSS: changes in NIHSS between beginning of rehabilitation program and discharge, BBSdc: Berg balance scale at discharge, ΔBBS: changes in BBS between beginning of rehabilitation program and discharge.
Table 3
Correlation between K-MMSE Scores and Functional Outcome Measures
K-MMSEi: Korean version mini-mental status examination at beginning of rehabilitation program, ΔK-MMSE: changes in K-MMSE between beginning of rehabilitation program and discharge, BDI: Beck depression inventory, MBIdc: Modified Barthel index at discharge, S-care: self-care, ΔMBI: changes in MBI total scores between beginning of rehabilitation program and discharge, NIHSSdc: National Institute of Health Stroke Scale at discharge, ΔNIHSS: changes in NIHSS between beginning of rehabilitation program and discharge, BBSdc: Berg balance scale at discharge, ΔBBS: changes in BBS between beginning of rehabilitation program and discharge. *p<0.05, †p<0.01.
Table 4
Correlation between K-MMSE Scores and Functional Outcome Measures according to the Subgroups
K-MMSEi: Korean version mini-mental status examination at beginning of rehabilitation program, ΔK-MMSE: changes in K-MMSE between beginning of rehabilitation program and discharge, MBI: Modified Barthel index at discharge, ΔMBI: changes in MBI total scores between beginning of rehabilitation program and discharge, NIHSS: National Institute of Health Stroke Scale at discharge, ΔNIHSS: changes in NIHSS between beginning of rehabilitation program and discharge, BBS: Berg balance scale at discharge, ΔBBS: changes in BBS between beginning of rehabilitation program and discharge. *p<0.05, †p<0.01.
Table 5
Correlation between Detailed Cognitive Tests and Functional Outcome after Rehabilitation Program
MBI: Modified Barthel index, ΔMBI: changes in MBI total scores between beginning of rehabilitation program and discharge, NIHSS: National Institute of Health Stroke Scale, ΔNIHSS: changes in NIHSS between beginning of rehabilitation program and discharge, BBS: Berg balance scale, ΔBBS: changes in BBS between beginning of rehabilitation program and discharge, ACPT: auditory continuous performance test, VCPT: visual continuous performance test, (A1): first step test, (A5): fifth step test, (D): delayed phase, CPM: colored progressive matrices. *p<0.05, †p<0.01.
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