Improving current understanding of cognitive impairment in patients with a spinal cord injury: A UK-based clinician survey.

Context: Emerging data suggests that patients with a spinal cord injury (SCI) have a higher risk of developing cognitive impairment. The true incidence of cognitive impairment in this group is unclear due to the difficulty in administering commonly used assessment tools, which are dependent on functional abilities e.g. drawing and writing.

Methods: A 16-question online survey, that aims to understand current practices on the assessment of cognition and the limitations of currently available tools, was sent via a Research Network Group to British Association of Spinal Cord Injury Specialists (BASCIS) registered clinicians at each of the 12 Spinal Injuries Centers in the UK and Ireland.

Results: 41 responses from 11 different SCI centers, with most from clinicians who have worked with SCI patients for over 10 years. 68% felt that there was a higher incidence of cognitive impairment in those with an SCI. However, 15% reported not using tools to screen for cognitive impairment, primarily due to lack of time, lack of guidelines, and physical disabilities affecting the ability to complete tests. When used, the most commonly utilized tools were those that rely on intact hand function.

Conclusions: Clinicians report a higher incidence of cognitive impairment in those with an SCI. However, currently used tools are not always appropriate, and patients with impaired hand function may be under-represented or undiagnosed. Further work is needed for a more standardized assessment tool to ensure that these patients receive appropriate diagnosis and management, particularly since cognitive impairment in this group can increase care needs and reduce engagement with rehabilitation.