Annals of Rehabilitation Medicine

"Cognitive function"

Original Articles

Pain & Musculoskeletal rehabilitation

Association of Nutritional Risk With Gait Function and Activities of Daily Living in Older Adult Patients With Hip Fractures: Yasunobu Ishikawa, Takuji Adachi, Yasushi Uchiyama; Ann Rehabil Med 2024;48(2):115-123. Published online April 22, 2024; DOI: https://doi.org/10.5535/arm.230015

Objective
To investigate the association of nutritional risk with gait function and activities of daily living (ADLs) in older adult patients with hip fractures.
Methods
The retrospective data of older adult patients diagnosed with hip fractures who visited the recovery-phase rehabilitation ward between January 2019 and December 2022 were reviewed. Nutritional risk was evaluated using the Geriatric Nutritional Risk Index; gait function and ADLs were assessed using the modified Harris Hip Score subitem and Functional Independence Measure, respectively. Multivariate linear regression and path analysis with structural equation modeling were used to examine the factors associated with ADLs and the associations among the study variables.
Results
This study included 206 participants (172 females and 34 males; mean age, 85.0±7.3 years). In the multivariate analysis, gait function (β=0.488, p<0.001), cognitive function (β=0.430, p<0.001), and surgery (β=-0.143, p<0.001) were identified as independent factors. Pathway analysis revealed that nutritional risk was not directly correlated with ADLs but was directly associated with gait and cognitive functions. Gait and cognitive functions, in turn, were directly related to ADLs.
Conclusion
Nutritional risk was found to be associated with ADLs through an intermediary of gait and cognitive functions.

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Pediatric rehabilitation

Establishing Reference Values for a New Computerized Cognitive Function Test Program for Children: Hyunji Lee, Hajeong Kim, Suan Lee, Goo Joo Lee; Ann Rehabil Med 2024;48(2):135-145. Published online April 22, 2024; DOI: https://doi.org/10.5535/arm.230014

Objective
To establish reference values for the computerized cognitive test and evaluate cognitive function improvements across different age groups, we introduce the computerized Cognitive Function Test program (eCFT), specifically designed for children. We aimed to establish eCFT reference values and assess cognitive function improvements across different age groups.
Methods
We included children aged 3–6 years with confirmed normal cognition based on the Korean Developmental Screening Test for Infants and Children and Kaufman Assessment Battery for Children-II. The eCFT consists of 8 subtests for visual perception, attention, memory, and executive function.
Results
A total of 66 participants (36 males and 30 females) with an average age of 4.4 years participated. The age 6 group consistently outperformed both age group 3 and 4 in terms of correct responses. With regard to the completed stage, the “selective auditory stimulus” test findings were 2.0 and 3.9 for the age 3 and age 6 groups, respectively (p<0.05). The “trail-making” test findings were 1.7, 2.1, 2.6, and 2.8, respectively (between ages 3 and 6, p<0.01; between ages 4 and 6, p<0.05); moreover, the age 5 group surpassed the age 3 group (2.6 and 1.7, respectively, p<0.05).
Conclusion
The eCFT is an easily accessible tool to evaluate cognitive function in young children. We introduce reference values with a cutoff range for preschool-aged children, enabling early intervention for those with cognitive impairment. Given its accessibility and relatively short evaluation time, the eCFT has potential for clinical use.

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Improvement of the Working Memory by Transcranial Direct Current Stimulation in Healthy Older Adults.: Seo, Min Ho , Park, Sung Hee , Seo, Jeong Hwan , Kim, Yun Hee , Ko, Myoung Hwan; J Korean Acad Rehabil Med 2011;35(2):201-206.

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Objective
To investigate the short term effects of prefrontal transcranial direct current stimulation (tDCS) in healthy older adults aged more than 65 years by means of verbal and visuospatial working memory tasks. Method Twenty four healthy older adults (14 males and 10 females, age range: 65-78 years old) were enrolled in this study. A double-blind study was conducted. The subjects underwent sham or anodal tDCS over the left prefrontal cortex (F3 in the international 10-20 EEG system). DC was delivered for 30 minutes at 2 mA with 25 cm² saline- soaked sponge electrodes. A cathode electrode was applied to the left arm. Before and after tDCS, the subjects performed 2-back verbal working memory and visuospatial memory tasks. The rates of improvement of the accuracy and the reaction time were analyzed. Results On the 2-back verbal working memory tasks, the verbal working memory accuracy was improved in the real group compared with that of the sham group. On visuospatial working memory task, the working memory accuracy and reaction time were not improved in either the real group or the sham group. Conclusion The results showed beneficial effects of noninvasive anodal tDCS on the cognitive function in healthy older adults. We suggest that tDCS induces functional changes on the left prefrontal cortex, and it improves the age-related cognitive impairment in the healthy elderly population.

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Relationship of Language, Intelligent and Social Quotients in Children with Speech and Language Disorder.: Cho, Sung Rae , Park, Eun Sook , Park, Chang il , Kwak, Eun Hee , Kim, Mi Kyung , Min, Kyoung Hoon , Bae, Byung Woo , Park, Jin Hee; J Korean Acad Rehabil Med 2008;32(2):129-134.

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Objective: To investigate the relationship of language, intelligent and social quotients in children with speech and language disorder and to evaluate the clinical usefulness of language quotient for predicting the extents of cognitive and social functions.

Method: Total 139 children who visited the department of rehabilitation medicine for the evaluation of suspected speech-language delay. All children were evaluated for receptive and expressive language quotients, articulation accuracy, verbal, performance and full-scale intelligent quotients and social maturation assessment.

Results: Approximately 70% of the children who had chief complaints of speech or language disorder were diagnosed as 'receptive and expressive language developmental delay'. Intelligent and social quotients of the children with receptive and expressive language developmental delay were significantly lower than those of the other groups (p＜0.05). Both receptive and expressive language quotients, but not dysarticulation, were significantly correlated with intelligent and social quotients (p＜0.05). Multiple regression analysis demonstrated that the language quotients could predict intelligent and social quotients as simple equations (p＜0.01).

Conclusion: Primary result of receptive and expressive language quotients from screening test of language evaluation might be able to predict cognitive function and social maturity, which also showed high-degree positive correlation with intelligent and social quotients. This result could provide a useful guideline for further developmental studies in children with speech and language disorder who received primary speech evaluation. (J Korean Acad Rehab Med 2008; 32: 129-134)

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Cognition Associated with Dystrophin Deletion in Duchenne Muscular Dystrophy.: Cho, Soo Kyoung , Moon, Jae Ho , Lee, Sang Chul , Yoo, Tae Won , Ha, Young Ran , Park, Young Bum , Choi, Won Ah; J Korean Acad Rehabil Med 2006;30(3):225-229.

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Objective
To find correlations between the deletion of dystrophin gene and cognitive status in Duchenne muscular dystrophy (DMD). Method: Cognitive abilities of 49 DMD children with dystrophin deletion were tested. Korean Wechsler Intelligence Scale for children was used to evaluate the cognitive status in DMD. Gene deletion was classified into two groups according to the location of the rearrangement (proximal region: central and 3' region of the gene). Results: Molecular study by multiplex PCR (Polymerase Chain Reaction) of dystrophin exons was performed to identify 49 deletions in the 110 DMD patients. 13 out of 49 DMD were mentally impaired. In patients with distal dele-tions, total IQ (Intelligence Quotient) score was lower than the those with proximal deletions; which was not statistically significant. And the difference of the verbal and performance intelligence scale was not statistically significant. But comparisons of molecular and neuropsychological features showed that deletions localized in the central and 3' regions of the gene were preferentially associated with the mental impairement. Conclusion: We concluded that deletions in the distal portions of the gene were more related to the mental retardation, although deletions with variable locations might lead to cognitive impairments. (J Korean Acad Rehab Med 2006; 30: 225-229)

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The Efficacy of Donepezil on Cognitive Dysfunction in Subacute Post-stroke Patients.: Kim, Deog Young , Park, Chang il , Ohn, Suk Hoon , Yang, Eun Joo , Ahn, So Young , Na, Sang Il; J Korean Acad Rehabil Med 2006;30(2):111-115.

Abstract
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Objective
To evaluate the efficacy of donepezil on cognitive dysfunction in subacute post-stroke patients. Method: Sixty subacute stroke subjects were enrolled and randomly assigned into an experimental or control group. There was no significant difference between the two groups in age, sex and post-onset duration. Donepezil 5 mg was administered daily for 6 weeks to patients in the experimental group. Mini-Mental Status Examination (MMSE), Wechsler Memory Test (WMT) and Colored Progressive Matrices (CPM) were performed before and 6 weeks after administration of the study drug in both groups. Results: There was no difference between the two groupsin the MMSE, WMT, CPM scores at baseline. Six weeks later, the total score, memory input, recall and judgement as measured by the MMSE and the score on the WMT were significantly more improved in the experimental group when compared to the control group (p＜0.05). However, there was no significant difference between the two groups on the CPM score. Conclusion: These results suggested that donepezil may be helpful for improving cognitive function, especially memory in post-stroke patients. (J Korean Acad Rehab Med 2006; 30: 111-115)

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Effectiveness of Cognitive Training based on Virtual Reality for the Elderly.: Kim, Min Young , Lee, Ki Suk , Choi, Jin Sung , Kim, Hyun Bin , Park, Chang Il; J Korean Acad Rehabil Med 2005;29(4):424-433.

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Objective
Virtual reality (VR) has been thought to have great usability to enhance cognitive functions. This study was designed to evaluate the efficacy of a VR program which was developed to improve cognition of the elderly. Method: After developing a VR program, we set special input units and a large projection type monitor for the elderly. The VR program simulated 17 different house-hold tasks. Thirty elderly persons including 9 mild-dementia and 21 none-dementia were involved and were randomly divided into two groups. Fifteen were belonged to the training group and the other 15 belonged to the control group. The training group subjects underwent this VR program for 4 weeks by 3 times a week. Cognitive function change was assess by neuropsychological test scores before and after training period. Results: In the training group, scores in attention and immediate and delayed auditory memory tests were improved after training. However the control group didn't show any changes. And most subjects of the training group enjoyed this program. Conclusion: VR based cognitive training is a useful method to enhance cognitive functions for the elderly. (J Korean Acad Rehab Med 2005; 29: 424-433)

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Effect of Donepezil on Cognitive Function in Patients with Brain Injury.: Kim, Yun Hee , Shin, Seung Hun , Park, Sung Hee , Ko, Myoung Hwan; J Korean Acad Rehabil Med 2002;26(4):374-378.

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Objective: To evaluate the effect of donepezil on cognitive function in patients with brain injury who had cognitive impairment.

Method: Twenty one subjects with brain injury (18 males, 3 females) were enrolled and classified into two groups, experimentaland control group. There was no significant difference between two groups in age, postonset duration, and level of education. For the experimental group, one tablelet of Aricept^Ⱂ(5 mg of donepezil per tablet) was administered daily for 6 weeks. The baseline and follow up cognitive assessments were performed before and 6 weeks after. Mini- mental Status Examination (MMSE), Computerized Neuropsychologic Test (CNT), Judgement of Line Orientation (JLO), and visuospatial Wechsler memory test were used for the assessment of cognitive function.

Results: In baseline study, two groups showed no difference in their cognitive function. After 6 weeks, the experimental group showed significantly higher performance in forward digit span, verbal learning test, backward visual span, visual learning test, non-verbal Wechsler memory test, and judgement of line orientaion than control group (p＜0.05).

Conclusion: These results suggested that the administration of Aricept^Ⱂ was beneficial in improving the cognitive function, especially verbal and visual memory and visuospatial perception in patients with brain injury. (J Korean Acad Rehab Med 2002; 26: 374-378)

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Brief Cognitive and Visuospatial Assessment for Patient with Stroke and Correlation of Cognitive Function and Functional Outcome.: Wee, Jeong Sun , Han, Jae Young , Lee, Sam Gyu , Rowe, Sung Man; J Korean Acad Rehabil Med 2002;26(3):237-242.

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Objective: To know the usefulness of the Modified Mini- Mental State Exam (3MS) as a screening test of cognitive function after stroke and the relationship between the 3MS with clock drawing task (CDT) and the 3MS with visual scan task (VST) in view of visual neglect and functional outcome.

Method: We studied 17 patients with unilateral hemisphere stroke [7 right hemisphere stroke (RHS), 10 left hemisphere stroke (LHS)] who have a mean age of 59.4 years and a mean hospital stay of 34.3 days on final examination. None of them had the previous history of mental illness or the previous stroke attack. We performed the MMSE, 3MS, VST and CDT at the first week of onset of stroke and at discharge.

Results: 1) 3MS was a valuable screening test of cognitive function like MMSE (p＜0.05) in both RHS and LHS groups. 2) VST was a valuable screening method of unilateral neglect in patients with normal 3MS (p＜0.05). 3) CDT was also valuable screening method of unilateral neglect in patients with normal 3MS (p＜0.05). 4) 3MS with CDT showed no significant correlation with FIM score (p＞0.05).

Conclusion: We think that 3MS is a valuable screening test of cognitive function after stroke. VST and CDTs are valuable screening tools in estimating unilateral neglect after stroke. But 3MS with CDT is not well correlated with functional outcome. (J Korean Acad Rehab Med 2002; 26: 237-242)

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Cognitive Assessment for Patient with Brain Injury by Computerized Neuropsychological Test.: Kim, Yun Hee , Shin, Seoung Hun , Park, Se Hoon , Ko, Myoung Hwan; J Korean Acad Rehabil Med 2001;25(2):209-216.

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Objective: This research aimed to define the usefulness of the computerized neuropsychological test (CNT) for evaluation of cognitive deficit in the patients with brain injury.

Method: Twenty five subjects with brain injury (16 males, 9 females) were enrolled. Their mean age was 39.2 years. All patient were assessed their cognitive function using CNT. The CNT consisted of digit span, verbal learning test, visual span test, visual learning test, auditory continuous performance test, auditory controlled continuous performance test, visual continuous performance test, visual controlled continuous performance test, word-color test, hypothesis formation test and trail making test. Scores of each subtest on CNT analysed according to the brain lesion and involved hemisphere of the patients.

Results: In patients with left hemisphere lesion, scores in digit span and verbal-learning test were lower than that of right side lesion (p＜0.05). In contrast, patients with right hemisphere lesion showed significantly lower scores in visual span and visual-learning test (p＜0.05). The patients with frontal lobe lesion marked lower scores in verbal-learning and word-color test than the patients without frontal lesion (p＜0.01). Whereas the patients with parietal lobe lesion showed significantly lower scores in visual learning test (p＜0.05) than the patients without parietal lesion.

Conclusion: The cognitive deficit following the brain lesion could be characterized using CNT. CNT is considered to be used as a useful tool in the patients with brain injury for the assessment of their cognitive function.

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Case Reports

Effect of Methylphenidate on Cognitive Function of Brain Injured Patient: Report of 5 cases.: Kang, Kyong Ju , Yoon, Seo Ra , Cho, Kil Ho , Han, Seung Sang , Rowe, Sung Man; J Korean Acad Rehabil Med 1998;22(1):230-235.

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Outcome following brain injury is influenced by several factors, including on early medical and rehabilitative intervention, an integrated interdisciplinary team approach to treatment, and the patient's motivation and ablility to cooperate in rehabilitation efforts. Methylphenidate(MP) is a central stimulant that blocks the reuptake of serotonin and norepinephrine, and also it has a dopaminergic activity by releasing the dopamine from dopamine stored vesicles. Dopamine plays an important role in cognitive and affective brain functions. Methylphenidate has been used in an attention deficit disorder with hyperactivity in the pediatric clinic and for various types of depression and narcolepsy. Clinical research has not irreputably proved or disproved the effectiveness of MP for the improvement of cognitive function in brain injured patients.

This report presents five cases who were treated by MP for the improvement of cognitive function in brain injured patients. Among five cases, 3 cases suffered from hemorrhagic strokes and 2 cases from tranmatic brain injuries.

Three cases were in drowsy stateand 2 cases were semicomatous. After MP(10 mg) was ingested per oral route before breakfast, we evaluated patients' cognitive function by the Functional Independence Measure(FIM), Rappaport Disability Rating Scale(DRS), Mimi-mental State Examination(MMSE), Galveston Orientation and Amnesia Test(GOAT) and the clinical state as well as side effects. Based on the results from the study we suggest cautionally that MP would be useful for the treatment of brain injured pateints who had decreased cognitive function to induce an early participation of rehabilitation programs. Further prospective study is required with a large control group and affected group, to confirm our preliminary results.

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Encephalopathy Induced by Ammonia Inhalation: Case Reports.: Kim, Sang Kyu , Lee, Chung Ki , Kim, Hyun Jin; J Korean Acad Rehabil Med 1997;21(1):216-222.

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Ammonia is a colorless alkaline gas with a sharp pungent odor. It is widely used in industry and there are several case reports on deleterious pulmonary damage. Ammonia is also highly neurotoxic that interferes energy metabolism in the brain even with a small amount and causes encephalopat hy in patients with severe liver disease.

We experienced two patients with toxic encephalopathy and followed- up for 18 months. We assumed that ammonia was supposed to play a major role in the dysfunction of their brains. In our cases, the possible mechanisms of brain damage are as followings: ⸁ ammonia has direct toxic effect on brain by altering the energy metabolism, ⸂ inhalation of ammonia results in severe pulmonary damage and it may aggravate brain injury, and ⸃ besides ammonia itself, relatively hypoxic environment that they were exposed can take part in the brain injury.