[Cognitive prerequisites of geriatric rehabilitation]

Rehabilitation aims at the restoration of maximal independence and autonomy after functional loss due to illness or accident. In old age losses of independence in daily life and autonomy are accounted for up to 60% by personal deficits in cognitive abilities. Functional losses in cognitive abilities represent a higher risk of having an accident or becoming ill. Cognitive performance proves to be predictive for success of rehabilitation, independent of functional state. Using the example of a fracture of the femur it can be shown that sensory and cognitive deficits increase the risk of accidents and that executive abilities co-influence long-term results. Strokes are more frequent if cognitive deficits have existed before and the resulting damages are stronger. Long-term results generally depend on complex abilities like everyday competence, reasoning and memory. Experiences with patients with dementia undergoing a memory training show that learning strategies are rarely generalized. Therefore in rehabilitation specific disorders, as for example cortical or subcortical patterns, have to be treated by different rehabilitation methods in the sense of differential rehabilitation. For this an early neuro-psychological assessment of the geriatric rehabilitation patient is needed. The cognitive-psychological findings only scarcely and insufficiently enter diagnostics and therapy. The diverse cognitive disorders have to be taken in account more frequently in education and differential rehabilitation methods have to be developed for geriatric patients with cognitive deficits.