Association of Cognitive Impairment With Rate of Functional Gain Among Older Adults With Stroke

Document Type

Journal Article

Publication Date



Journal of the American Medical Directors Association




Stroke; cognition; mobility limitation; post-acute care; recovery of function; rehabilitation; self-care


OBJECTIVES: This study explored the association between cognitive impairment at admission with self-care and mobility gain rate (amount of change per week) during a post-acute care stay (admission to discharge) for older adults with stroke. DESIGN: Retrospective cohort study. SETTING AND PARTICIPANTS: Four inpatient rehabilitation and 6 skilled nursing facilities. A total of 100 adults with primary diagnosis of stroke; mean age 79 years (SD 7.7); 67% women. METHODS: Retrospective cohort study. We evaluated the extent to which cognitive impairment at admission explained variation in weekly gain rate separately for self-care and mobility. Additional covariates were occupational and physical therapy minutes per day, self-care and mobility function at admission, age, and number of comorbidities. RESULTS: Participants were classified as having severe (n = 16), moderate (n = 39), or mild (n = 45) cognitive impairment at admission. Occupational therapy minutes per day (β = 0.04; P < .01) and Functional Independence Measure (FIM) self-care function at admission (β = 0.48; P < .01) were both significantly associated with self-care gain rate (Adjusted R = 0.18); cognitive impairment group, age, and number of comorbidities were not significant. Only FIM mobility function at admission (β = 0.29; P < .001) was significantly associated with mobility gain rate (Adjusted R = 0.18); cognitive impairment group, physical therapy minutes, age, and number of comorbidities were not significant. CONCLUSIONS AND IMPLICATIONS: These results provide preliminary evidence that patients with stroke who have severe cognitive impairment may benefit from intensive therapy services as well as less severely impaired patients, particularly occupational therapy for improvement in self-care function.


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