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The role of clinical and demographic predictors for understanding the cognitive impairment in Spinal Cord Injury (SCI) patients

Spinal Cord (2024)Cite this article

Subjects

Abstract

Study design

Using a cross-sectional design, we extracted sociodemographic and clinical data from 488 Spinal Cord Injury (SCI) patients during their initial assessment before receiving intensive rehabilitation treatment.

Objectives

The primary objectives of this study were to ascertain the prevalence of cognitive impairment in the study sample and specify the key clinical and demographic predictors of cognitive functioning in SCI patients.

Setting

Lucy Montoro Rehabilitation Institute (LMRI), University of Sao Paulo, Sao Paulo, Brazil.

Methods

We utilized independent univariate and multivariate regression models with the Montreal Cognitive Assessment (MoCA) scale, adapted for individuals with visual impairment. Moreover, we consider scores from the execution tasks (visuospatial/executive) as the dependent variable.

Results

Our findings demonstrate that approximately 80% of the evaluated study sample exhibited cognitive impairment. Through the multivariate regression models, we show that several factors, including age, education, depression levels, and the use of analgesics and/or opioids, are significant predictors of total cognitive scores. These factors are independent of the clinical features associated with SCI, such as age, sex, education, and time since the injury.

Conclusions

The results indicate a high prevalence of significant cognitive impairment within the sample, with age, education, depression levels, and the use of analgesics and/or opioids emerging as the primary predictors of total cognitive scores, independent of the clinical features correlated to SCI. These findings hold significant implications for both clinical research and practice, offering valuable guidance for comprehensive management throughout hospitalization and rehabilitation.

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Fig. 1: Distribution of patients in the spectrum of total MoCA scores.

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Data availability

This work correspondence and requests for materials should be addressed to Marcel Simis.

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Acknowledgements

Authors are grateful to Margarida H. Miyazaki, executive director of IMREA; Fabio Pacheco Muniz de Souza e Castro, executive director of LMRI; Katia Lina Miyahara and Mariane Tateishi, Clinical Director of IMREA, for the tremendous support of the hospital. Besides, Vera Lucia Rodrigues Alves, Valéria Dini Leite, Daniel Rubio de Souza, and Artur César Aquino dos Santos for assistance with study monitoring.

Funding

This work was supported by Núcleo de Apoio a Pesquisa-Núcleo de Estudos Avançados em Reabilitação (NAP-NEAR). The researchers received support from the São Paulo Research Foundation (FAPESP- SPEC, grant #17/12943-8). Specifically, LMM was supported by a postdoctoral research grant #21/05897-5, São Paulo Research Foundation (FAPESP), SPB is supported by a postdoctoral research grant #20/08512-4, São Paulo Research Foundation (FAPESP).

Author information

Authors and Affiliations

  1. Instituto de Medicina Física e Reabilitação, Hospital das Clínicas HCFMUSP, Faculdade de Medicina, Universidade de São Paulo, São Paulo, SP, Brazil

    Ana Clara Portela Hara, Nicole C. Aching, Sara P. Barbosa, Daniel R. Souza, Linamara R. Battistella & Marcel Simis

  2. Mental Health Department, Santa Casa of Sao Paulo Medical Science School, São Paulo, SP, Brazil

    Lucas M. Marques

  3. Neuromodulation Center and Center for Clinical Research Learning, Spaulding Rehabilitation Hospital and Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA

    Felipe Fregni

  4. Departamento de Medicina Legal, Bioética, Medicina do Trabalho e Medicina Física e Reabilitação, Faculdade de Medicina da Universidade de São Paulo, São Paulo, Brazil

    Linamara R. Battistella & Marcel Simis

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  1. Ana Clara Portela Hara
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  2. Nicole C. Aching
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  7. Linamara R. Battistella
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Contributions

Simis, M. and Battistella, L.R. developed the study concept and design. Moreover, Portela-Hara, A.C. and Aching, NC, performed data collection. Marques, L.M. performed the data analysis. All authors participated in the interpretation of the results, the writing of the manuscript, and the approval of its final version.

Corresponding author

Correspondence to Marcel Simis.

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The authors declare no competing interests.

Ethical approval

This study was submitted and approved by the Ethics Committee for Analysis of Research Projects - CAPPesq of the Clinical Hospital of the Faculty of Medicine of USP (N°. Plataforma Brasil 15138519.0000.0068).

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Portela Hara, A.C., Aching, N.C., Marques, L.M. et al. The role of clinical and demographic predictors for understanding the cognitive impairment in Spinal Cord Injury (SCI) patients. Spinal Cord (2024). https://doi.org/10.1038/s41393-024-00986-7

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