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Am J Phys Med Rehabil. 2015 Sep;94(9):707-17. doi: 10.1097/PHM.0000000000000235.

Relationship between cognition and functional outcomes after dysvascular lower extremity amputation: a prospective study.

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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).



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.


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.


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.


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.

[Indexed for MEDLINE]

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