A Scoping Review of Cognitive Impairment in Adults With Spinal Cord Injury: Mechanisms and Assessment Tools

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 ۲۰۱۳ to January ۲۰۲۴. 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 ۱۵ studies met the inclusion criteria, comprising ۱۰ cross-sectional studies, ۲ cohort studies, ۱ descriptive study, ۱ narrative review, and ۱ systematic review, involving ۷۷۱ adults with SCI. The reported prevalence of cognitive impairment ranged from ۳۰% to ۶۰%. 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 (NUCOG), edinburgh cognitive and behavioral ALS (ECAS) screen, and stroop test. Conclusion: Cognitive impairment following pure SCI is a multifactorial condition influenced by central nervous system (CNS) 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.

کلیدواژه ها:

Spinal cord injury (SCI) ، Adult ، Cognitive impairment ، Cognitive domains ، Evaluation ، Assessment ، Cognitive dysfunction ، Neuropsychological assessment ، Scoping review ، Rehabilitation