Self-Reported Cognitive Concerns in People With Lower Limb Loss

Abstract

Objective To investigate differences between self-reported cognitive concerns in people with lower limb loss (LLL) and normative data derived from the U.S. general population. A secondary aim was to determine if there were cognitive differences based on amputation etiology or age. Design Survey. Setting General community. Participants A volunteer sample of 1086 persons with LLL resulting from trauma or dysvascular complications who regularly use a prosthetic limb. Interventions Not applicable. Main Outcome Measure The Quality of Life in Neurological Disorders Applied Cognition General Concerns v1.0 Short Form (Neuro-QoL ACGC), an eight-item self-report measure of general cognitive concerns. Results People with LLL reported significantly more cognitive concerns than the Neuro-Qol normative sample. Mean Neuro-QoL ACGC scores were significantly lower than normative values (p<0.001) across subgroups defined by age (i.e., <40, 40–49, 50–59, 60–69, and 70+ years) and subgroups defined by etiology (i.e., traumatic and dysvascular LLL). However, there were no significant differences in cognitive concerns among age subgroups (p=0.84) or between the etiology subgroups (p=0.58). Conclusions When compared to the Neuro-QoL normative sample, individuals with LLL report greater concerns with cognitive health. Cognitive concerns were not differentially affected by age or cause of amputation. The presence of cognitive concerns in people with LLL suggests a need to assess perceived cognitive function in order to tailor education and training in prosthetic use and care.

Association of self-reported cognitive concerns with mobility in people with lower limb loss

“…A recent review examined cognitive functioning in people with LLL due primarily to dysvascular disease and noted that greater than 10% of people were diagnosed with dementia in LLL studies, compared to the 5–10% expected in the general population [36]. However, Neuro-QoL ACGC data from a large subset (n=1086) of the current sample demonstrated that the report of cognitive concerns was not differentially affected by amputation etiology [27]. In the current study, 60% of participants reported cognitive concerns, as measured by the Neuro-QoL ACGC, that were greater than the U.S general population (i.e., 0.5 SD or more below the mean T-score).…”

“…This self-report measure is part of a larger set of instruments developed to assess health-related quality of life in adults and children with neurologic disorders [24]. Neuro-QoL ACGC has been used previously to study perceived cognitive abilities in a variety of clinical populations, including people with multiple sclerosis [25], stroke [26], and people with LLL [27]. The Neuro-QoL ACGC 8-item short form consists of questions that ask respondents about the frequency of cognitive concerns (e.g., problems with memory, concentration, thinking clearly) they have experienced over the previous seven days.…”

Comprehensive Neuropsychological Assessment of Cognitive Functioning of Adults With Lower Limb Amputation in Rehabilitation

“…Sample means were compared against the means and standard deviations of published normative values for each assessment. Similar analyses have been used previously 20,24 , and allow for an inferential estimation of whether and how cognitive functioning in (this whole sample of)…”

“…Recent work with a large sample with LLA (N=1086) examined self-reported cognitive concerns (i.e. difficulties in functioning) 20 . Respondents reported significantly more cognitive concerns than a general population normative sample, regardless of age or aetiology.…”

Risk of depression following traumatic limb amputation—a general population-based cohort study

“…Physical function, cognitive function, stress resilience, and employment were related to depression occurrence and rehabilitation outcomes in TLA patients [2 –4,7,8,14], because physical and cognitive function are important for prosthesis use, mobility, and participation in activities [14 –16], and high stress resilience helps amputees to develop new coping strategies to address their new role in society and in their employment [17]. However, in earlier studies, these characteristics were measured after amputation, and most studies focused on people with dysvascular amputation.…”