COGNITIVE AND FUNCTIONAL ASSESSMENTS OF STROKE PATIENTS - AN ANALYSISOF THEIR RELATION

Objectives: To improve the assessment of stroke patients for the purpo se of designing rehabilitation treatments and predicting rehabilitatio n outcomes. Specific objectives included the evaluation of the power o f functional scales to properly assess both physical and cognitive dis abilities, and the evaluation of the relations between functional, neu rological, physical, and cognitive assessments. The hypothesis was tha t the relations between different assessment types (eg, functional, ne urological, etc) can be assessed by the relations between the results of these assessments when administered to stroke patients. Design: Six ty-six stroke patients were administered a series of tests including f unctional assessments (Functional Independence Measure, Barthel Index, Rankin Functional Scale), neurological assessments (Canadian Neurolog ical Scale, National Institute of Health Stroke Scale), physical asses sments (Stages of Motor Recovery, Clinical Outcome Variables Scale), a nd cognitive assessments (Stroke Unit Mental Status Examination, Mini Mental State, Raven Matrices, Boston Naming Test). Results: Analysis o f correlation coefficients revealed that the stronger relationships we re observed between functional assessments and physical assessments, a nd between functional assessments and neurological assessments. Cognit ive tests did not correlate highly with any of the functional tests us ed in this study, Three factors were extracted using factor analysis. They were interpreted as being a physical disability factor (50% of th e variance), a cognitive disability factor (23% of the variance), and a dementia factor (12% of variance). Functional scales obtained higher loads on the physical disability factor only. Conclusions: Considerin g that cognitive functions are frequently affected in stroke patients, cognitive impairment needs to be more seriously considered when descr ibing and/or predicting a patient's level of independence. In brain in jured patients, such as stroke patients, we suggest that the total sco re provided by standardized functional scales should be interpreted wi th care. We believe that rehabilitation outcome could be better predic ted if the results of functional assessment were coupled with in-depth cognitive assessment. (C) 1997 by the American Congress of Rehabilita tion Medicine and the American Academy of Physical Medicine and Rehabi litation.