Cognitive Profiles Among Individuals With Spinal Cord Injuries: Predictors and Relations With Psychological Well-being

Abstract

Objectives: To examine predictors of profiles of cognitive functioning among individuals receiving acute inpatient spinal cord injury (SCI) rehabilitation, as well as associations between their cognitive functioning and psychological well-being (life satisfaction and depression) 6 months after the baseline assessment. Design: Prospective observational study design, with 2 assessments approximately 6 months apart. Setting: A rehabilitation unit at a level 1 trauma hospital during acute SCI hospitalization and outpatient setting after discharge. Participants: Individuals (NZ89) with SCI. Intervention: None. Main Outcome Measures: Cognitive functioning (assessed by the Repeatable Battery for the Assessment of Neuropsychological Status), life satisfaction (measured by the Life Satisfaction Index A), and depressive symptoms (measured by the Patient Health Questionnaire-9). Results: Latent profile analysis identified 3 classes of individuals with similar patterns of cognitive functioning: class1 (average levels of cognitive performance across all assessed domains; nZ48), class 2 (average cognitive performance, except in recall and memory; nZ23), and class 3 (low cognitive functioning across multiple domains of cognition; nZ18). Fewer years of education, history of smoking, history of substance use other than alcohol, and greater postconcussion symptoms were associated with higher odds of classification in class 3 (P<.05). Six months post baseline, individuals in class 3 reported significantly lower levels of life satisfaction than individuals in class 1 (c 2 (1)Z5.86; PZ.045) and marginally higher depressive symptoms than individuals in class 2 (c 2 (1)Z5.48; PZ.057). Conclusions: The impact of impaired cognition during acute rehabilitation may persist after discharge and influence the psychological well-being of individuals with SCI. Identifying individuals with cognitive dysfunction and attending to modifiable risk factors and may help ameliorate maladjustment after SCI.

Elevated Serum Neuropeptide FF Levels Are Associated with Cognitive Decline in Patients with Spinal Cord Injury

“…Long-standing neuroinflammation due to pathological mechanisms activated by SCI are understood to be central to SCI-associated cognitive decline [ 11 ]. Cognitive dysfunction due to SCI can persist in the long term after discharge from hospital and adversely affect quality of life [ 12 ]. Differences between individuals in terms of post-SCI cognitive deficits are documented and attributed to multiple clinical factors including older age, history of smoking, lower educational attainment, premorbid cognitive ability, and more severe postconcussion symptoms [ 8 , 12 ].…”

“…Cognitive dysfunction due to SCI can persist in the long term after discharge from hospital and adversely affect quality of life [ 12 ]. Differences between individuals in terms of post-SCI cognitive deficits are documented and attributed to multiple clinical factors including older age, history of smoking, lower educational attainment, premorbid cognitive ability, and more severe postconcussion symptoms [ 8 , 12 ]. Such deficits are associated with SCI irrespective of the level of injury [ 9 ] and support the concept that neurological injury sustained during SCI causes remote pathological neurodegenerative changes in brain regions, as evidenced by longitudinal, long-term MRI changes noted in remote cerebral cortex and motor cortex regions [ 13 – 16 ].…”

The Relationship between Cognitive Performance and Quality of Life in Elite Athletes after Spinal Cord Injury

“…Thirdly, the form of the study had to be tailored to the participant with the least functional abilities, thus with the complete exclusion of the use of upper limbs, which significantly limited the possibility of using tests assessing cognitive performance. This limiting factor has also been pointed out by Pasipanoydia et al (2021), highlighting the need for development and validation of neuropsychological test batteries for screening and assessment among patients with limited motor abilities [ 15 ]. Factors that were not considered may also contribute to CD, such as alcoholism, substance abuse, previous learning problems, or emotional problems.…”

“…Molina et al (2021) demonstrated the occurrence of cognitive impairment in individuals after SCI already in the subacute phase, which worsened over time [14]. This may not only affect the disruption of the first, most intensive and most important stage of rehabilitation, but may also affect the individual's quality of life and their eventual integration into society [14,15]. This is supported by the findings of Craig et al (2017), who found that the development of negative mood states was a significant problem in individuals with cognitive impairment after their transition to the community, at a time when personal resources were severely limited [4].…”

Differences in Functional Improvement Based on History of Substance Abuse and Pain Severity following Spinal Cord Injury

“…There is particular concern for these individuals in post-acute rehabilitation following a newly acquired spinal cord injury (SCI) given the higher prevalence and odds of substance use and disorders in this population compared to those without SCI 2 , 3 . Though minimally explored, substance abuse following SCI may be associated with a decline in psychological adjustment and well-being, increased pressure injuries, and decreased quality of life 4 – 8 . In other words, evidence suggests that a history or current diagnosis of substance abuse may be a characteristic of patients at risk for poor rehabilitation outcomes following SCI.…”