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The influence of cognitive impairment on health-related quality of life in neurological disease

Published online by Cambridge University Press:  24 June 2014

Alex J. Mitchell*
Affiliation:
Department of Liaison Psychiatry, Leicester General Hospital, Leicester, UK
Steven Kemp
Affiliation:
St James' University Hospital, Leeds, UK
Julián Benito-León
Affiliation:
Department of Neurology, University Hospital ‘12 de Octubre’, Madrid, Spain; Centro de Investigación Biomédica en Red sobre Enfermedades Neurodegenerativas (CIBERNED), Madrid, Spain
Markus Reuber
Affiliation:
University of Sheffield, Sheffield, UK
*
Alex J. Mitchell, Department of Liaison Psychiatry, Leicester General Hospital, Leicester LE5 4PW, UK. Tel/Fax: +0116 2951951; E-mail: ajm80@le.ac.uk

Abstract

Mitchell AJ, Kemp S, Benito-León J, Reuber M. The influence of cognitive impairment on health-related quality of life in neurological disease.

Background:

Cognitive impairment is the most consistent neurological complication of acquired and degenerative brain disorders. Historically, most focus was on dementia but now has been broadened to include the important construct of mild cognitive impairment.

Methods:

Systematic search and review of articles linked quality of life (QoL) and cognitive complications of neurological disorders. We excluded QoL in dementia.

Results:

Our search identified 249 publications. Most research examined patients with brain tumours, stroke, epilepsy, head injury, Huntington's disease, motor neuron disease, multiple sclerosis and Parkinson's disease. Results suggested that the majority of patients with epilepsy, motor neuron disease, multiple sclerosis, Parkinson's disease, stroke and head injury have subtle cognitive deficits early in their disease course. These cognitive complaints are often overlooked by clinicians. In many cases, the cognitive impairment is progressive but it can also be relapsing-remitting and in some cases reversible. Despite the importance of severe cognitive impairment in the form of dementia, there is now increasing recognition of a broad spectrum of impairment, including those with subclinical or mild cognitive impairment. Even mild cognitive difficulties can have functional and psychiatric consequences–especially when they are persistent and untreated. Specific cognitive deficits such an inattention, dysexecutive function and processing speed may affect a number of quality of life (QoL) domains. For example, cognitive impairment influences return to work, interpersonal relationships and leisure activities. In addition, fear of future cognitive decline may also impact upon QoL.

Conclusions:

We recommend further development of simple tools to screen for cognitive impairments in each neurological condition. We also recommend that a thorough cognitive assessment should be a part of routine clinical practice in those caring for individuals with neurological disorders.

Type
Review article
Copyright
Copyright © 2010 John Wiley & Sons A/S

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