Nineteen hospitalized participants (11 women and 8 men) without known brain injury and loss of consciousness related to their illness were recruited from an acute inpatient rehabilitation hospital. This discrepancy may, in turn, reflect general trends in health care, with broad consequences for medical care in general. We undertook this investigation because we had informally observed at our institution that general clinical staff were only minimally noting such potentially pervasive cognitive deficits among patients who appeared to us, as neuropsychological investigators, to be considerably cognitively impaired. Surprisingly few studies have specifically examined whether hospitalized patients without known brain injury can perform normally on common bedside tests of cognitive function. We tested this hypothesis by comparing the neuropsychological test performances of a sample of 19 patients hospitalized for inpatient rehabilitation for disorders other than known cerebral disease with those of a comparison group of 18 community-dwelling persons of comparable age and education. We conducted a pilot study to examine the feasibility for the hypothesis that patients in acute rehabilitation who are hospitalized for disorders not known to involve cerebral injury can have significant cognitive impairment. Finally, not only are medical disorders themselves associated with cognitive decline, but also the number of such disorders may predict the extent of cognitive impairment. Results of a number of studies indicate that patients with comorbid cognitive impairment, with various medical illnesses, who were discharged to home without supervision, had an increased risk of further injury, illness, decreased functional outcome, and increased use of assisted living facilities in the future. Recognizing cognitive status is important because it may affect rehabilitation outcome and the transfer of rehabilitation skills to the home after discharge. Furthermore, although certain types of noncerebral surgery for disabling illnesses, including carotid endarterectomy, cardiac bypass surgery, hip arthroplasty, artery bypass graft, and thoracic surgery, have been reported to be associated with cognitive deficits, treating physicians nonetheless may underdiagnose cognitive deficits in hospitalized patients without brain injury because such associations are not commonly recognized. Many hospitalized patients receive analgesic medications that can alter arousal and cognitive function. Our observations suggest that this assumption is probably incorrect for several reasons. However, the same consideration may not be extended to patients without known brain injury when cognitive function is assumed to be intact. Treatment approaches used in acute inpatient rehabilitation programs are guided, in part, by whether a patient is known to have cognitive impairment secondary to brain injury.
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