title: The effect of cognitive impairment on prosthesis use in older adults who underwent amputation due to vascular-related etiology: A systematic review of the literature.
abstract: BACKGROUND
  Older adults with amputations secondary to vascular etiologies may additionally present with cognitive impairment. Cognition plays an important role in the adoption of a prosthetic limb, although the degree and type of impact are debated. Previous literature reviews have not been directed at the specific population of older adults who underwent vascular-related lower limb amputation.
  
  
  OBJECTIVE
  First, to assess extant literature for relationships between cognitive function and prosthesis-related outcomes in older adults who underwent lower limb amputation for vascular-related etiologies. Second, to perform a critical analysis of prosthesis-related outcomes and cognitive assessments performed in the studies.
  
  
  METHODS
  Systematic literature review.
  
  
  METHODS
  A systematic review of the literature was performed in databases using keyword combinations. A total of nine articles were selected to be included in this review.
  
  
  RESULTS
  Seven of the nine included studies found a relationship between decreased cognitive function and reduced performance on a prosthesis-related outcome. There were eight different prosthesis-related outcome measures, with only one study utilizing a comprehensive outcome measure.
  
  
  CONCLUSIONS
  Cognitive impairment can negatively impact successful prosthesis use in older adults with lower limb amputation secondary to vascular complications. Future studies should utilize comprehensive outcome measures that represent the multifaceted constructs of cognition and prosthesis use. Clinical relevance Cognitive assessment of older adults who have undergone lower limb amputation secondary to diabetes related complications or vascular disease can be used to inform clinical decision-making. Clinicians should consider selecting prosthesis-related outcome measures that capture the full breadth of prosthesis use when evaluating patients with cognitive impairment.
authors.affiliation: 1 Department of Rehabilitation Sciences, University of Hartford, West Hartford, CT, USA.|2 Department of Psychology, University of Hartford, West Hartford, CT, USA.
authors.forename: Daniel Joseph
authors.initials: DJ
authors.lastname: Lee
authors.affiliation: 1 Department of Rehabilitation Sciences, University of Hartford, West Hartford, CT, USA.|2 Department of Psychology, University of Hartford, West Hartford, CT, USA.
authors.forename: Matthew C
authors.initials: MC
authors.lastname: Costello
mesh_terms: D000368:Aged; D000671:Amputation, Surgical / Q000379:methods; D000674:Amputees / Q000523:psychology* / Q000534:rehabilitation*; D001186:Artificial Limbs / Q000523:psychology / Q000706:statistics & numerical data*; D060825:Cognitive Dysfunction / Q000150:complications / Q000175:diagnosis*; D005260:Female; D015577:Geriatric Assessment; D006801:Humans; D035002:Lower Extremity / Q000601:surgery; D008297:Male; D008875:Middle Aged; D016491:Peripheral Vascular Diseases / Q000150:complications / Q000175:diagnosis / Q000601:surgery*; D011379:Prognosis; D018570:Risk Assessment; D016896:Treatment Outcome
keywords: Prosthesis users; cognition; dysvascular; older adults; outcome measures