Rehabilitation outcome of elderly patients after a first stroke: effect of cognitive status at admission on the functional outcome.
OBJECTIVE
To assess whether, and to what extent, cognitive outcome relates to overall functional outcome among elderly stroke patients.


METHODS
Nonconcurrent prospective study.


METHODS
Geriatric rehabilitation division at a large, urban, academic, freestanding hospital in Israel.


METHODS
Three hundred thirty-six patients aged 60 years and older admitted consecutively for rehabilitation after first acute stroke. Inclusion criteria were met by 315 patients, who were included in the final analysis. Average age was 75.3 years. The stroke was right sided in 44.1%.


METHODS
Not applicable.


METHODS
The motor subscale of the FIM instrument assessed functional status. Absolute functional gain was determined by the FIM motor gain. Relative functional gain was calculated according to the Montebello Rehabilitation Factor Score. Cognitive status was assessed with the Mini-Mental State Examination (MMSE) and the FIM cognitive subscale.


RESULTS
FIM scores increased significantly during rehabilitation, mainly due to improvement in motor functioning. A strong association was found between the cognitive scales (r=.853, P<.001). Better rehabilitation outcomes were observed in patients with higher admission cognitive status, adjusting for the effect of age, sex, onset to admission interval, length of stay, and severity of stroke (odds ratio = 2.0; 95% confidence interval, 1.5-2.5).


CONCLUSIONS
Impaired cognitive status at admission negatively affects the rehabilitation outcome of elderly stroke patients. The utility of routinely using a cognitive test for all patients before admission to rehabilitation, preferably the MMSE, is emphasized. The time, cost, and effort involved in performing such a test are negligible, and the potential benefits are considerable.
Heruti
Raphael J
RJ
Health Service Research Unit, Gertner Institute, Ministry of Health, Ramat-Gan, Israel. heruti@post.tau.ac.il
Lusky
Ayala
A
Dankner
Rachel
R
Ring
Haim
H
Dolgopiat
Mark
M
Barell
Vita
V
Levenkrohn
Shalom
S
Adunsky
Abraham
A
D000203:Activities of Daily Living; D000368:Aged; D003072:Cognition Disorders / Q000150:complications / Q000175:diagnosis*; D005260:Female; D015276:Health Care Rationing; D006801:Humans; D007557:Israel; D008297:Male; D008875:Middle Aged; D009483:Neuropsychological Tests; D010347:Patient Care Planning; D011446:Prospective Studies; D020521:Stroke / Q000150:complications / Q000175:diagnosis* / Q000191:economics; D000071939:Stroke Rehabilitation; D016896:Treatment Outcome