Cognitive performance of people with traumatic spinal cord injury: a cross-sectional study comparing people with subacute and chronic injuries

Molina, Brooke S. G.; Segura, Andreu; Serrano, Juan Pedro; Alonso, Francisco; Molina, L Morales; Pérez-Borrego, Yolanda A.; Ugarte, Marta; Oliviero, Antonio

doi:10.1038/s41393-018-0076-0

Cited by 44 publications

(33 citation statements)

References 27 publications

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“…Routine cognitive assessments should be encouraged in this population considering that cognitive dysfunctions, which are present in the subacute setting, worsen over time (ie, in chronic stages), and have significant implications for individuals aging with SCI. The majority of neuropsychological tests assessed in this present study displayed good‐to‐excellent reliability when administered to individuals with chronic SCI.…”

Section: Discussionmentioning

confidence: 99%

Reliability of Cognitive Measures in Individuals With a Chronic Spinal Cord Injury

Nightingale

Lim

Sachdeva

et al. 2019

PM&R

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Background: Following spinal cord injury (SCI), up to 64% of individuals experience cognitive deficit. However, the reliability of commonly used neuropsychological tests is currently unknown in this population. Objectives: To evaluate the test-retest reliability of cognitive measures in individuals with SCI. Design: Cross-sectional study. Setting: Vancouver General Hospital. Participants: Individuals with a chronic (>2 years) SCI (n = 22). Methods: Across three visits (separated by~16 days), 22 participants with chronic SCI completed a neuropsychological battery evaluating memory (Rey Auditory-Verbal Learning Test [RAVLT]), attention/concentration/psychomotor speed (Digit Span Task, Stroop Test), and executive function (Trail Making Test A&B, Symbol Digit Modalities Test, Controlled Oral Word Association Test). Coefficients of variation (CV intra ) and intraclass correlation coefficients (ICCs) were calculated to determine the reliability of each test between visits. Linear regressions were performed to assess the associations between variability (CV intra ) and participant characteristics, such as age or highest education level attained. Repeated-measures, one-way analysis of variance (ANOVA) was conducted to determine any significant practice effects, and smallest real differences (SRDs) were calculated. Main Outcome Measurements: Repeated scores on aforementioned neuropsychological tests. Results: ICCs ranged from 0.77 to 0.93, with the exception of RAVLT recognition score (ICC = 0.27). Age showed a moderate association with CV intra in RAVLT interference recall scores (r = 0.43, P = .047), but was not a confounding factor for other measures. Education was not associated with CV intra . Significant practice effects were noted for most of the cognitive tests assessed. Conclusions: Other than the RAVLTrecognition score, these cognitive measures demonstrated good-to-excellent reliability. Although this is encouraging, test-retest variability should be considered when interpreting the efficacy of various cognitive training strategies to mitigate cognitive decline in this population. Thus, the SRD values presented herein will allow researchers and clinicians to identify "true" changes in cognitive function with repeated testing.

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Section: Discussionmentioning

confidence: 99%

Reliability of Cognitive Measures in Individuals With a Chronic Spinal Cord Injury

Nightingale

Lim

Sachdeva

et al. 2019

PM&R

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“…In the general population poor cognitive function is associated with unemployment and lower work performance, reduced health literacy [5], depression [6], and increased mortality [7]. Impaired cognition presents in the sub-acute phase post-SCI, which may impede functional rehabilitation, and worsens over time [8]. Reduced cognitive performance has been demonstrated in chronically-injured SCI individuals compared to age-matched non-injured controls [9].…”

Section: Introductionmentioning

confidence: 99%

Diverse cognitive impairment after spinal cord injury is associated with orthostatic hypotension symptom burden

Nightingale

Zheng

Sachdeva

et al. 2020

Physiology & Behavior

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“…Second, heterogeneity among participants has limited the predictive validity of the MCI diagnosis [11]. Individuals with SCI display different trajectories of MCI, varying from remission [21,24], stabilization [25], to worsening [13], possibly as a result of distinct underlying 'causes' that can be identified as differentiable etiological subtypes [26,27]. It has been suggested that the predictive validity of a MCI diagnosis improves by subtyping [28], but as far as known, there are no SCI studies that have applied subtyping to clarify such distinctions.…”

Section: Introductionmentioning

confidence: 99%

“…TBI significantly increases an individual's risk of MCI after SCI [11,13,[18][19][20][21][22][23][24][25][26]. Mild and mild-complicated forms of TBI interfere less with cognition than do severe forms of TBI; however, mild-complicated and moderate TBI appear undifferentiable in terms of their influence on cognition [35,55,56].…”

Section: Introductionmentioning

confidence: 99%

A prospective cohort study investigating contributors to mild cognitive impairment in adults with spinal cord injury: study protocol

et al. 2020

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Background Studies report rates of mild cognitive impairment (MCI) in spinal cord injury (SCI) range between 10 and 60%. This broad estimate of MCI in SCI is most likely a result of: (i) inconsistent operationalization of MCI; (ii) heterogeneity among individuals with SCI; (iii) failure to account for MCI subtypes, thereby adding to the heterogeneity of samples; and, (iv) poor control for traumatic brain injury (TBI) that obscures differentiation of MCI attributable to TBI versus other factors. There is a paucity of longitudinal studies following the course of MCI in SCI, and none that account for multiple predictors of MCI, including interactions among predictors. Methods An inception cohort longitudinal study will assess approximately 100 individuals aged 17–80 years with acute SCI, with measures taken at three timepoints (baseline, 3 months post-baseline, and 12 months post-injury). Data relevant to medical care received within the first 24–48 h of presentation to the emergency department will be analysed, as will measures of cognition, injury characteristics, medical history, personal factors, psychological status, psychosocial functioning, and quality of life. Latent class mixture modelling will determine trajectories for the primary outcome of interest, cognitive functioning and its subtypes, and secondary outcomes of interest such as depression. Multiple regression analyses will identify predictors of MCI and its subtypes. Discussion The prospective design will reveal change in cognitive functioning across time and unveil different outcome trajectories; thus addressing the lack of knowledge on trajectories of MCI and MCI subtypes in SCI. Through subtyping MCI, we hope to yield groups of cognitively impaired individuals with SCI that are potentially more homogenous and thereby stable and predictable. This is the first study to capture emergency department and acute care diagnostic evidence of mild TBI, which has been poorly controlled in previous studies. Our study will also be the first to distinguish the contribution of TBI from other factors to the development of MCI in individuals with SCI. Trial registration The study was prospectively registered with the Australian and New Zealand Clinical Trial Registry (ACTRN12619001702101) on 3rd December 2019.

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Cognitive performance of people with traumatic spinal cord injury: a cross-sectional study comparing people with subacute and chronic injuries

Cited by 44 publications

References 27 publications

Reliability of Cognitive Measures in Individuals With a Chronic Spinal Cord Injury

Reliability of Cognitive Measures in Individuals With a Chronic Spinal Cord Injury

Diverse cognitive impairment after spinal cord injury is associated with orthostatic hypotension symptom burden

A prospective cohort study investigating contributors to mild cognitive impairment in adults with spinal cord injury: study protocol

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