ABSTRACT
Research Objectives To investigate the impact of COVID-19 on cognition and independence with functional tasks of patients admitted to an inpatient rehabilitation unit (IRU). Design Cross-sectional observational study with assessments at admission and discharge of 94 COVID-19 patients admitted to an urban inpatient rehabilitation unit (IRU) between March 2020 - August 2020. Setting This study took place in an urban acute care hospital 22-bed IRU. Participants 94 individuals admitted to the IRU with a diagnosis of COVID-19. 77 patients received an admission cognitive assessment, 45 also received discharge cognitive assessment. All received admission and discharge Quality Indicator for Self-Care (QI SC) Score. Interventions Not applicable. Main Outcome Measures Montreal Cognitive Assessment (MoCA) administered to identify cognitive impairment. The Uniform Data System (UDS) Quality Indicators (on Self-Care (QI-SC) scored for functional status. Results 75/77 (97%) patients received an admission cognitive assessment coded as independent with ADL and cognitive tasks prior to admittance. 62/77 (80.5%) patients demonstrated cognitive deficits on the MoCA at admission: 39/77 (50.6%) mildly impaired, 20/77 (26%) moderately impaired, and 3/77 (3.9%) severely impaired. 32/45 patients discharge scores improved and met the MoCA minimally clinically important difference (MCID);however, 35/45 continued to score in the impaired range. Patients who met the MoCA MCID demonstrated significantly greater QI-SC score gains than those that did not meet the MCID. 70/77 (91%) were discharged home with recommendation for continued therapy services. Conclusions Cognitive impairment is common amongst patients requiring prolonged hospitalization and acute inpatient rehabilitation for COVID-19. Most patients admitted to the IRU demonstrated intact independence and cognition prior to disease onset and hospitalization. Although most patients on the IRU showed improvements in cognition according to the MoCA;these patients were recommended for continued therapy and/or assistance for functional tasks post discharge. Since cognitive deficits were still present at discharge, the need for standardized assessment and follow-up is indicated, especially given the association with functional outcome. Author(s) Disclosures None.
ABSTRACT
Cognitive impairment is increasingly recognized as a sequela of COVID-19. It is unknown how cognition changes and relates to functional gain during inpatient rehabilitation. We administered the Montreal Cognitive Assessment (MoCA) at admission to 77 patients undergoing inpatient rehabilitation for COVID-19 in a large US academic medical center. Forty-five patients were administered the MoCA at discharge. Functional gain was assessed by change in the quality indicator for self-care (QI-SC). In the full sample, 80.5% of patients exhibited cognitive impairment on admission, which was associated with prior delirium. Among 45 patients with retest data, there were significant improvements in MoCA and QI-SC. QI-SC score gain was higher in patients who made clinically meaningful changes on the MoCA, an association that persisted after accounting for age and delirium history. Cognitive impairment is frequent among COVID-19 patients, but improves over time and is associated with functional gain during inpatient rehabilitation.