title: Do co-morbidities and cognition impact functional change and discharge needs in Parkinson disease?
abstract: OBJECTIVE
  The aim of this study was to assess the impact of cognition, baseline motor function, and co-morbid medical conditions on functional change, discharge destination, and discharge needs in patients admitted to acute rehabilitation for Parkinson-related impairments.
  
  
  METHODS
  This retrospective chart review study evaluated the records of patients admitted to acute rehabilitation over a 5-yr period with a primary impairment category of parkinsonism. Functional status was measured at admission and discharge; 3-mo follow-up function was also collected in a sample of discharged patients.
  
  
  RESULTS
  Eighty-nine patients (mean age, 74.26 yrs) were admitted over the 5-yr time frame. A more complicated Medicare tier diagnosis (tier 2) was associated with lower total and motor score Functional Independence Measure gains compared with tier 3 (P = 0.009 and P = 0.016, respectively). Cognitive scores at admission were not related to need for caregivers upon discharge. Overall Functional Independence Measure gain (adjusted R(2) = 0.073, P = 0.006) and Functional Independence Measure gain efficiency (adjusted R(2) = 0.142, P < 0.001) inversely correlated with age. At the 3-mo follow-up, a random sample (38%) of patients contacted postdischarge demonstrated continued improvements.
  
  
  CONCLUSIONS
  Significant improvement may be seen after acute rehabilitation in patients with Parkinson disease, irrespective of cognitive impairment. More complicated medical tier diagnoses result in less Functional Independence Measure gain, and older individuals with Parkinson disease are more likely to show less functional change. However, functional improvements are still statistically significant.
authors.affiliation: Northwestern University, Rehabilitation Institute of Chicago, Illinois, USA.
authors.forename: Christina M
authors.initials: CM
authors.lastname: Marciniak
authors.forename: Clara M
authors.initials: CM
authors.lastname: Choo
authors.forename: Santiago D
authors.initials: SD
authors.lastname: Toledo
authors.forename: Patrick E
authors.initials: PE
authors.lastname: Semik
authors.forename: Andrea L
authors.initials: AL
authors.lastname: Aegesen
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D003071:Cognition / Q000502:physiology*; D005260:Female; D006801:Humans; D007902:Length of Stay; D008297:Male; D008875:Middle Aged; D009043:Motor Activity / Q000502:physiology*; D010300:Parkinson Disease / Q000503:physiopathology* / Q000523:psychology* / Q000534:rehabilitation; D010351:Patient Discharge; D026741:Physical Therapy Modalities; D020127:Recovery of Function / Q000502:physiology*; D012189:Retrospective Studies; D016896:Treatment Outcome