Cognitive functioning in persons with lower limb amputations: a review

Abstract

Disability and RehabilitationResults. Thirty papers were found that met the inclusion criteria. The studies were characterised by heterogeneity of design, methodological quality, sample characteristics, assessment of cognitive functioning, and outcomes examined. The research published to date suggests that cognitive impairment is more prevalent among persons with lower limb amputations than in the general population, and is linked with a number of important outcomes in this patient group, including mobility, prosthesis use, and maintenance of independence following amputation.Conclusions. These findings highlight the importance of assessing the cognitive abilities of persons with lower limb amputations. An understanding of the cognitive profile of these patients could assist rehabilitation teams in determining their suitability for prosthetic or wheelchair rehabilitation, ascertaining appropriate and realistic goals for rehabilitation, and tailoring rehabilitation programmes to patients' strengths so that maximal mobility and independence is achieved. Individuals with lower limb amputations may be particularly susceptible to impairments in cognitive function for a number of reasons. Firstly, there has been a significant increase in the average age at which amputation occurs in recent years, due to improvements in the medical management of associated conditions such as diabetes and peripheral vascular disease [14]. Over half of all individuals referred to prosthetic centres in the U.K. every year are older than 65 years of age, and more than a quarter are aged over 75 years [15]. The rising age at which lower limb amputation is performed brings with it a 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31 32 33 34 35 36 37 38 39 40 41 42 43 44 45 46 47 48 49 50 51 52 53 54 55 56 57 58 59 [5,9,12,19]. These shared characteristics may leave individuals with dysvascular amputations susceptible to vascular cognitive impairment [20,21],which affects approximately five percent of all persons aged over 65 years [22] and is characterised by deficits in attentional and executive functioning (the ability to organise cognitive processes e.g. planning and sequencing of actions) in addition to slowing of motor performance and information processing, with episodic memory remaining relatively intact [8,20,23].Diabetes mellitus, which is present in almost half of all cases of lower limb amputation [24], is associated with increased incidence of dementia and accelerated decline in cognitive functioning [25][26][27].

Cognitive functioning among patients with diabetic foot

“…Limb loss has a considerable impact on physical, psychological, and social aspects of everyday life. A review study from 2012 reported a higher prevalence of cognitive impairment among people with lower limb amputation than in the general population (Coffey et al, 2012). People with diabetes who had an amputation because of peripheral vascular disease had lower cognitive functioning, especially in the areas of memory and executive function (Coffey et al, 2012).…”

“…A review study from 2012 reported a higher prevalence of cognitive impairment among people with lower limb amputation than in the general population (Coffey et al, 2012). People with diabetes who had an amputation because of peripheral vascular disease had lower cognitive functioning, especially in the areas of memory and executive function (Coffey et al, 2012). Cognitive functioning is a crucial predictor of the success rehabilitation programs after amputation (Sansam, Neumann, O'Connor, & Bhakta, 2009).…”

Self-Reported Cognitive Concerns in People With Lower Limb Loss

“…2 Although LLL has been traditionally viewed as a focused, musculoskeletal condition, research suggests that people with LLL experience greater cognitive impairment (CI) than the general population. 3, 4 In a review by Coffey and colleagues, CI in people with LLL was attributed to two primary factors: the typical age of people with LLL and the common presence of comorbid conditions, like diabetes or dysvascular disease. 3 In the United States (U.S.), an estimated 54% of people with LLL experience amputation due to vascular conditions and 42% of people with LLL are over age 65.…”

“…3, 4 In a review by Coffey and colleagues, CI in people with LLL was attributed to two primary factors: the typical age of people with LLL and the common presence of comorbid conditions, like diabetes or dysvascular disease. 3 In the United States (U.S.), an estimated 54% of people with LLL experience amputation due to vascular conditions and 42% of people with LLL are over age 65. 2 Older age, 5 diagnosis of diabetes, 6 and comorbid dysvascular conditions 7 have each been associated with a decline in cognitive function.…”

“…2 Older age, 5 diagnosis of diabetes, 6 and comorbid dysvascular conditions 7 have each been associated with a decline in cognitive function. Because previous research of cognitive function in people with LLL primarily involved older participants with LLL from dysvascular conditions, 3 little is known about cognitive functioning in people with LLL from non-dysvascular conditions or in younger people with LLL. It is sometimes assumed that these individuals do not experience CI, but its presence in these subpopulations could have significant impacts on rehabilitative care.…”