How does cognitive impairment impact on functional improvement following the rehabilitation of elderly patients?

It has been suggested that patients with cognitive impairment do not benefit from rehabilitation or that rehabilitation gains are reduced. Most studies focus on absolute gain rather than gains in individual functional areas. The Barthel activities of daily living (ADL) score is a tool, which is used widely and comprises 10 functional domains. This study aimed to assess the response to rehabilitation based on improvement or deterioration on the Barthel ADL score for patients with different cognitive abilities

This independence measure was assessed at specific time periods in an observational study of 241 patients undergoing in-patient rehabilitation. Therapy was delivered formally by physiotherapists and occupational therapists and also informally by nursing staff. Patients were divided into four groups according to cognition. Group 1 (MMSE, mini-mental state examination 27-30), normal cognition, Group 2 (MMSE 21-26) mild impairment, Group 3 (MMSE 11-20) moderate impairmentand Group 4 (MMSE 0-10) severe impairment.

Statistically significant improvement was made in most of the functional domains by patients with normal cognition and mild cognitive impairment (p < 0.0025). The exception to this for both groups was in the areas of feeding and bowels because of the fact that most patients were independent with these aspects on admission. Group 3 patients made improvements in the domains of grooming, dressing, toileting, transferring and mobility. Group 4 patients did not demonstrate statistically significant improvement in any domain although there were trends for improvement in mobility and transferring.

This study demonstrated that cognitive impairment did have an impact on the ADL that patients improved in following rehabilitation. However, even patients with moderate cognitive impairment made significant gains with many ADL.