Volume 14, Issue 2 (Spring--In Press 2026)
PCP 2026, 14(2): 0-0 |
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Mahmoudi M, Loni E, AkbarFahimi N, Mahmoudi M. A Scoping Review of Cognitive Impairment in Adults with Spinal Cord Injury: Mechanisms and Assessment Tools. PCP 2026; 14 (2)
URL: http://jpcp.uswr.ac.ir/article-1-1045-en.html
URL: http://jpcp.uswr.ac.ir/article-1-1045-en.html
1- Department of Occupational Therapy, School of Rehabilitation, University of Social Welfare and Rehabilitation Sciences, Rofeideh Rehabilitation Hospital, Tehran, Iran.
2- Clinical Research Development Center, Rofeideh Rehabilitation Hospital, Department of Clinical Sciences, University of Social Welfare and Rehabilitation Sciences, Tehran, Iran.
3- Department of Occupational Therapy, School of Rehabilitation, University of Social Welfare and Rehabilitation Sciences, Rofeideh Rehabilitation Hospital, Tehran, Iran. ,fahimi1970@yahoo.com
4- Bachelor of Nursing, Young Researchers and Elite Club, Islamic Azad University, Semnan, Iran.
2- Clinical Research Development Center, Rofeideh Rehabilitation Hospital, Department of Clinical Sciences, University of Social Welfare and Rehabilitation Sciences, Tehran, Iran.
3- Department of Occupational Therapy, School of Rehabilitation, University of Social Welfare and Rehabilitation Sciences, Rofeideh Rehabilitation Hospital, Tehran, Iran. ,
4- Bachelor of Nursing, Young Researchers and Elite Club, Islamic Azad University, Semnan, Iran.
Abstract: (560 Views)
Background and Objective: Spinal cord injury (SCI) is a life-altering condition associated with a wide range of physical and psychological consequences. Among these, cognitive dysfunction remains an under-recognized complication. This scoping review aimed to explore the prevalence of cognitive impairment, the proposed underlying mechanisms, and to identify the assessment tools used to evaluate cognitive deficits in adults with SCI without concomitant traumatic brain injury.
Methods: A comprehensive search was conducted across multiple electronic databases, including Medline, OTseeker, CINAHL, PsycINFO, Cochrane Library, Scopus, ProQuest, ScienceDirect, MagIran, and Google Scholar, covering the period from January 2013 to January 2024. Peer-reviewed articles in English or Persian with full text available and using the main keywords ("pure spinal cord injury," "adult," "cognitive disorder," "cognitive domains," "assessment," "evaluation," "test") were included.
Results: A total of 15 studies met the inclusion criteria, comprising 10 cross-sectional studies, 2 cohort studies, 1 descriptive study, 1 narrative review, and 1 systematic review, involving 771 adults with SCI. The reported prevalence of cognitive impairment ranged from 30% to 60%. Proposed mechanisms contributing to cognitive dysfunction included reduced dopamine receptor expression, chronic neuroinflammatory changes in the thalamus, hippocampus, and cerebral cortex, cardiovascular dysregulation (such as impaired autonomic control, altered inhibitory processes, hypoxia, and anoxia), autonomic dysfunction, obstructive sleep apnea, substance and medication effects, and psychological factors (including emotional distress and anxiety). The most frequently affected cognitive domains were attention, concentration, working memory, visuospatial processing, and processing speed. Commonly used cognitive assessment tools included the Beck Depression Inventory, Wechsler Adult Intelligence Scale, Mini-Mental State Examination, Neuropsychiatry Unit Cognitive Assessment Tool, Edinburgh Cognitive and Behavioral ALS Screen, and Stroop Test.
Conclusion: Cognitive impairment following pure SCI is a multifactorial condition influenced by central nervous system alterations, cardiovascular dysfunction, and psychological factors. Although no standardized or specialized instrument currently exists for accurately screening cognitive deficits in this population, clinicians should remain vigilant in detecting these impairments to enable timely diagnosis and the development of tailored cognitive rehabilitation strategies.
Methods: A comprehensive search was conducted across multiple electronic databases, including Medline, OTseeker, CINAHL, PsycINFO, Cochrane Library, Scopus, ProQuest, ScienceDirect, MagIran, and Google Scholar, covering the period from January 2013 to January 2024. Peer-reviewed articles in English or Persian with full text available and using the main keywords ("pure spinal cord injury," "adult," "cognitive disorder," "cognitive domains," "assessment," "evaluation," "test") were included.
Results: A total of 15 studies met the inclusion criteria, comprising 10 cross-sectional studies, 2 cohort studies, 1 descriptive study, 1 narrative review, and 1 systematic review, involving 771 adults with SCI. The reported prevalence of cognitive impairment ranged from 30% to 60%. Proposed mechanisms contributing to cognitive dysfunction included reduced dopamine receptor expression, chronic neuroinflammatory changes in the thalamus, hippocampus, and cerebral cortex, cardiovascular dysregulation (such as impaired autonomic control, altered inhibitory processes, hypoxia, and anoxia), autonomic dysfunction, obstructive sleep apnea, substance and medication effects, and psychological factors (including emotional distress and anxiety). The most frequently affected cognitive domains were attention, concentration, working memory, visuospatial processing, and processing speed. Commonly used cognitive assessment tools included the Beck Depression Inventory, Wechsler Adult Intelligence Scale, Mini-Mental State Examination, Neuropsychiatry Unit Cognitive Assessment Tool, Edinburgh Cognitive and Behavioral ALS Screen, and Stroop Test.
Conclusion: Cognitive impairment following pure SCI is a multifactorial condition influenced by central nervous system alterations, cardiovascular dysfunction, and psychological factors. Although no standardized or specialized instrument currently exists for accurately screening cognitive deficits in this population, clinicians should remain vigilant in detecting these impairments to enable timely diagnosis and the development of tailored cognitive rehabilitation strategies.
Keywords: Spinal cord injury (SCI), Adult, Cognitive impairment, Cognitive domains, Evaluation, Assessment, Cognitive dysfunction, Neuropsychological assessment, Scoping review, Rehabilitation
Type of Study: Review paper |
Subject:
Rehabilitation
Received: 2025/08/23 | Accepted: 2025/11/2 | Published: 2026/04/27
Received: 2025/08/23 | Accepted: 2025/11/2 | Published: 2026/04/27
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