Department of Geriatric Research, Bethanien-Hospital/Geriatric Center at the University of Heidelberg, Heidelberg, Germany.
Network Aging Research, University of Heidelberg, Heidelberg, Germany.
J Alzheimers Dis. 2017;60(3):1171-1182. doi: 10.3233/JAD-170401.
Dementia is a frequent diagnosis in geriatric rehabilitation. Studies in patients with dementia on the development of their cognitive status during rehabilitation and its relation to functional outcomes have been scarce.
To describe the changes in cognitive status in patients with dementia during inpatient rehabilitation and to determine its association with patient characteristics and rehabilitation outcome.
Cohort study in a geriatric rehabilitation center with data collection at admission and discharge. Outcome measures were change in global and domain-related cognitive functioning and its association with activities of daily living (ADL) and discharge home.
154 patients (mean age 83.7 years) diagnosed with mild to moderate dementia were included. Cognitive performance significantly improved from admission to discharge for all cognitive variables tested (p < 0.001 to 0.03). Change in global cognitive functioning, executive functions, and episodic memory were positively associated with ADL recovery. Change in global cognitive functioning predicted ADL improvements (β= 0.32; p = 0.006). Only 7.8% of patients, characterized by worse ADL and motor abilities as well as higher frailty scores at admission, deteriorated in global cognitive scores. In comparison to patients with stable or improved cognition, these patients showed least improvements in ADL-scores (4.1 versus 12.5) and a trend for higher institutionalization (50% versus 26.5%).
The findings highlight the potential of patients with dementia to recover cognitive functioning during rehabilitation. Cognitive change represents an independent rehabilitation outcome and a prognostic factor for successful rehabilitation suggesting that specific interventions are indicated to maintain and enhance cognitive functioning in these highly vulnerable patients.
痴呆是老年康复中常见的诊断。关于痴呆患者在康复过程中认知状态的发展及其与功能结局的关系的研究很少。
描述痴呆患者在住院康复期间认知状态的变化，并确定其与患者特征和康复结局的关系。
在老年康复中心进行队列研究，在入院和出院时收集数据。结局指标为认知功能的整体和领域相关变化，及其与日常生活活动（ADL）和出院回家的关系。
共纳入 154 例（平均年龄 83.7 岁）轻度至中度痴呆患者。所有测试的认知变量（p<0.001 至 0.03）从入院到出院均显著改善。认知功能的整体变化、执行功能和情景记忆与 ADL 恢复呈正相关。认知功能的变化预测 ADL 的改善（β=0.32；p=0.006）。只有 7.8%的患者，其入院时的 ADL 和运动能力较差，以及脆弱性评分较高，其整体认知评分恶化。与认知稳定或改善的患者相比，这些患者的 ADL 评分改善最少（4.1 分与 12.5 分），并且有更高的机构化趋势（50%与 26.5%）。
研究结果强调了痴呆患者在康复过程中恢复认知功能的潜力。认知变化是独立的康复结局和成功康复的预后因素，表明需要对这些高度脆弱的患者进行特定的干预，以维持和增强其认知功能。
