Cognitive and physical impairment in spinal cord injury: A scoping review and call for new understanding

The Journal of Spinal Cord Medicine, 2023 · DOI: 10.1080/10790268.2022.2134634 · Published: January 1, 2023

Spinal Cord Injury Participation Neurology

Simple Explanation

Spinal cord injury (SCI) can result in nerve damage, inflammation and nerve degeneration, leading to sensory loss and physical impairment. Cognitive frailty, involving both physical and cognitive decline, may be reversible if detected early. This review explores the relationship between cognitive and physical function post-SCI. The review suggests that impairments in mobility, which is one aspect of physical function, is associated with decreased cognitive function. Identifying those with mobility limitations due to SCI may help assess dementia risk in this population. This study proposes a conceptual framework to support research into understanding the relationship between physical and cognitive impairment in patients with SCI, adapting established systems-based ageing research to support unique patient profiles.

Study Duration

Not specified

Participants

56,464 (13,989 with SCI)

Evidence Level

Scoping Review

Key Findings

1
Neuroinflammation is a potential mechanism for cognitive impairment among patients with SCI. The review indicates that pro-inflammatory mediators and markers of glial activation are major factors contributing to further cognitive decline and dementia.
2
Reduced physical activity due to mobility impairment is associated with an increased risk of cognitive impairment, suggesting a link between physical frailty and cognitive decline in SCI patients.
3
The research indicates that there are potential shared mechanistic pathways underlying cognitive and physical impairment, including concomitant traumatic brain injury, neuroinflammation, glial activation, and demyelination/structural brain changes.

Research Summary

This scoping review examines current research on physical and cognitive impairment in SCI patients to identify research gaps and encourage new studies on cognitive frailty in this population. The review identifies potential mechanisms linking cognitive and physical decline post-SCI, including neuroinflammation and reduced physical activity, and highlights the need to consider concomitant traumatic brain injury in acute SCI management. The authors call for further research into the systemic impact of cognitive, mental health, and physical function on SCI patients to refine rehabilitation therapies and explore predisposing factors for cognitive and physical impairment.

Practical Implications

Enhanced SCI Care

Consider evaluating traumatic brain injury in patients presenting with SCI to optimize acute treatment and guide neurocognitive rehabilitation.

Targeted Rehabilitation

Rehabilitation programs should address impairments in learning, attention, memory, and abstract reasoning to facilitate the learning of new skills.

Preventive Strategies

Developing therapeutic methods for preventing cognitive decline by understanding the shared biological relationship between physical and cognitive impairment in SCI.

Study Limitations

1
The literature search was limited to articles written in English.
2
Inconsistent search terminology potentially yielded only approximately 50% of eligible studies.
3
Relatively small sample sizes in many of the included studies.

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