A screening test is not enough to define the prognostic role of cognitive impairment after hip fracture: a short-term prospective study

Bardesono, Francesca; Trombetta, Silvia; Gullone, Laura; Bonardo, Alessandra; Gindri, Patrizia; Castiglioni, Carlotta; Milano, Edoardo; Massazza, Giuseppe; Monaco, Marco Di

doi:10.1007/s40520-022-02233-6

Cited by 2 publications

(3 citation statements)

References 35 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…The results confirm two recent reports and strongly suggest additional evaluations in the patients who seem undamaged on a screening test. 24 , 46 In particular, a MoCA test in the patients with a normal (or mildly altered) score on the SPMSQ emerges as a good tool to better the predictive capability of the cognitive assessment in the patients with subacute hip fracture. A seven-point difference in MoCA scores (corresponding to the difference between 25° and 75° percentiles in MoCA score distribution in the sample) was associated with an adjusted odds ratio of around 2 to achieve successful rehabilitation.…”

Section: Discussionmentioning

confidence: 99%

“…The result is similar to the one recently reported by Bardesono et al in 127 women with subacute hip-fracture. 24 Further studies are needed to assess the prognostic role of the MoCA score after screening cognition by other tests that may work better than the SPMSQ to predict activities of daily living.…”

Section: Discussionmentioning

confidence: 99%

“…A very recent study has investigated the prognostic role of 3 further tests in women with subacute hip fracture with no more than 4 errors on the SPMSQ: each of the three tests, Montreal Cognitive Assessment (MoCA), Frontal Assessment Battery (FAB) and Rey Auditory Verbal Learning Test (RAVLT) has proven to predict functional ability in activities of daily living in the women with no obvious cognitive impairment on the screening test. 24 Unfortunately, the independence of the three tests from each other and/or the best test of the 3 to predict function have not been investigated.…”

mentioning

confidence: 99%

See 2 more Smart Citations

Cognitive assessment to optimize prediction of functional outcome in subacute hip fracture: a short-term prospective study

DI MONACO,

SGARBANTI,

TROMBETTA

et al. 2024

Eur J Phys Rehabil Med

Self Cite

View full text Add to dashboard Cite

BACKGROUND Cognitive impairment is a long-known negative prognostic factor after hip fracture. Cognition is usually screened by a single easy-to-administer bedside tool, but recent studies have shown that screening tests may be not enough to rule out cognitive impairment with an unfavorable prognostic role. Unfortunately, data on outcome prediction by further cognitive assessments is sparse. AIM We focused on patients with subacute hip fracture defined cognitively intact or mildly impaired on the screening evaluation performed by the Short Portable Mental Status Questionnaire (SPMSQ). We hypothesized that each of 3 further cognitive tests could independently predict activities of daily living, with optimal prediction of function obtained by performing all three the tests. DESIGN Short-term prospective study. SETTING Rehabilitation ward. POPULATION Inpatients with subacute hip-fracture. METHODS Three cognitive tests were performed on admission to rehabilitation in the patients who made ≤4 errors on the SPMSQ: Montreal Cognitive Assessment (MoCA), Rey Auditory Verbal Learning Test (RAVLT, immediate and delayed recall) and Frontal Assessment Battery (FAB). We assessed activities of daily living by the Barthel index. Successful rehabilitation was defined with a Barthel Index Score ≥85. RESULTS Each of the three cognitive tests assessed before rehabilitation significantly predicted the Barthel index scores measured at the end of the rehabilitation course in our sample of 280 inpatients. However, only the MoCA score retained its significant predictive role when the scores from the three tests were included together as independent variables in a multiple regression model, with adjustments for a panel of potential confounders (P=0.007). The adjusted odds ratio to achieve successful rehabilitation for a seven-point change in MoCA score was 1.98 (CI 95% from 1.02 to 3.83; P=0.042). CONCLUSIONS Contrary to our hypothesis, MoCA but not RAVLT and FAB retained the prognostic role when the scores from the three tests were evaluated together as potential predictors of functional ability in activities of daily living. CLINICAL REHABILITATION IMPACT In the presence of a normal (or mildly altered) score on the SPMSQ in subacute hip fracture, MoCA scores improve prediction of activities of daily living and should be routinely performed.

show abstract

Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

mentioning

confidence: 99%

See 1 more Smart Citation