Cognitive Correlates of a Large Time Differential between Timed Up and Go and Gait Speed during In-Patient Stroke Rehabilitation.

Overview

Purpose: Cognitive impairment is highly prevalent after stroke but can be difficult to identify acutely. We aimed to study if a large difference between two common, routine physical therapy assessments (timed up-and-go [TUG] test and 10-metre walk test [10MWT]) could identify patients with subtle cognitive difficulties post-stroke. Method: An observational study was conducted in 141 individuals admitted to acute in-patient rehabilitation after stroke. We computed the per cent difference between TUG and 10MWT performance. Cognitive outcome measures were the trail making tests A and B (TMT-A and TMT-B) and the Functional Independence Measure (FIM)-cognition subscale. Linear and logistic regression analyses were conducted to evaluate if the difference between TUG and 10MWT was associated with cognitive functioning. Results: After adjusting for covariates, there was no significant linear association between TUG-10MWT discrepancy and cognition; however, stroke patients with the largest difference between TUG and 10MWT (highest quartile of scores) exhibited significantly worse attention on the TMT-A (adjusted odds ratio = 2.46, p = 0.04). Conclusions: A large difference between TUG and 10MWT may reflect deficits in complex sustained attention in individuals with stroke. Physical therapy staff may use this difference score to identify patients with potential cognitive deficits and refer them for comprehensive neuropsychological evaluation.