title: Relationship between cognition and functional outcomes after dysvascular lower extremity amputation: a prospective study.
abstract: OBJECTIVE
  The aim of this study was to examine associations between a cognitive screen and four neuropsychologic tests administered at both 6 wks and 4 mos after amputation and five functional outcomes measured 12 mos after lower extremity amputation.
  
  
  METHODS
  This study includes a prospective cohort from four medical centers. Participants were primarily male Veterans experiencing their first lower extremity amputation as a result of complications of diabetes mellitus or peripheral arterial disease. Of those eligible, 87 (64%) enrolled; 75 (86%) were retained at 12 mos. Measures included demographic/health information, four neuropsychologic measures, the Locomotor Capability Index-5, the Gronigen Activity Restriction Scale, prosthetic use, community participation, and social integration.
  
  
  RESULTS
  Better performance on the Short Portable Mental Status Questionnaire at 4 mos was associated with greater 12-mo mobility and social integration. Better attention and working memory abilities 6 wks after amputation were associated with increased 12-mo prosthetic wear; and at 4 mos after amputation, with greater 12-mo mobility. Better verbal memory at 6 wks was associated with greater 12-mo social integration and community participation as well as increased prosthetic wear.
  
  
  CONCLUSIONS
  These findings highlight the potential value in including a brief, formal cognitive assessment in addition to a general mental status screen. Specific domains of cognitive function are differentially associated with functional outcomes and may inform amputation rehabilitation decisions.
authors.affiliation: From the VA Puget Sound Health Care System (RMW, APT, MG, AWH, KNH, JMC); Department of Rehabilitation Medicine, University of Washington, Seattle (RMW, APT, KNH, JMC); Spectrum Research, Inc, Tacoma, Washington (DCN); VA Eastern Colorado Health Care System (DJB); and University of Colorado, Denver (DJB).
authors.forename: Rhonda M
authors.initials: RM
authors.lastname: Williams
authors.forename: Aaron P
authors.initials: AP
authors.lastname: Turner
authors.forename: Monica
authors.initials: M
authors.lastname: Green
authors.forename: Daniel C
authors.initials: DC
authors.lastname: Norvell
authors.forename: Alison W
authors.initials: AW
authors.lastname: Henderson
authors.forename: Kevin N
authors.initials: KN
authors.lastname: Hakimi
authors.forename: Donna Jo
authors.initials: DJ
authors.lastname: Blake
authors.forename: Joseph M
authors.initials: JM
authors.lastname: Czerniecki
mesh_terms: D000203:Activities of Daily Living; D000222:Adaptation, Physiological / Q000502:physiology; D000223:Adaptation, Psychological; D000328:Adult; D000671:Amputation, Surgical / Q000523:psychology / Q000534:rehabilitation; D000674:Amputees / Q000523:psychology* / Q000534:rehabilitation*; D001186:Artificial Limbs; D003071:Cognition / Q000502:physiology*; D015331:Cohort Studies; D003925:Diabetic Angiopathies / Q000000981:diagnostic imaging / Q000601:surgery; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D007398:Interpersonal Relations; D007407:Interviews as Topic; D016014:Linear Models; D035002:Lower Extremity / Q000601:surgery; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D053580:Muscle Strength / Q000502:physiology; D009483:Neuropsychological Tests; D058729:Peripheral Arterial Disease / Q000000981:diagnostic imaging / Q000601:surgery*; D011446:Prospective Studies; D017755:Prosthesis Fitting; D011859:Radiography; D013997:Time Factors; D014728:Veterans / Q000706:statistics & numerical data