EFFECT OF COGNITIVE IMPAIRMENT ON REHABILITATION OUTCOME

Previous studies examining the relationship between cognition and abil ity to benefit from inpatient rehabilitation have found cognitive dysf unction to be associated with a poor rehabilitation outcome. To examin e whether cognitive dysfunction precluded effective rehabilitation, 52 consecutive admissions to a geriatric rehabilitation unit were assign ed Mini Mental State Examination (MMSE) scores. Functional gains were assessed by the change in Functional Independence Measure (FIM) score from admission to discharge. Neither MMSE score alone nor in combinati on with age was significantly associated with change in FIM (r = 0.10; R = 0.25; P < 0.18). MMSE score alone and in combination with age was correlated with functional status on admission (r = 0.58; R = 0.58; P < 0.0001) and discharge (r = 0.49; R = 0.51; P < 0.0004). Patients ev idenced a similar increase in functional status regardless of cognitiv e ability, but cognitively impaired individuals entered the inpatient unit with a lower functional status, and their level of function at di scharge was also impaired relative to cognitively intact cohorts. Low MMSE scores were associated with a greater likelihood of nursing home placement, but a considerable percentage (38%) of individuals with sev ere cognitive impairment and the majority of individuals with mild to moderate cognitive impairment returned home following discharge. These findings suggest that geriatric patients with cognitive dysfunction s hould be considered for admission to rehabilitation programs if functi onal gains will affect quality of life or disposition.