Spinal cord injury is associated with reduced cognitive capacity to self-regulate, organise and adapt to new situations

Abstract

Abstract Study design Cross-sectional observational cohort study Objectives To investigate differences in executive function (EF) in adults with spinal cord injury (SCI) compared with able-bodied (AB) controls across tasks imposing varying levels of executive demand, and to examine implications for targeted cognitive screening. Setting Two SCI units in New South Wales (SCI), Australia, and the community of New South Wales, Australia (able-bodied). Methods Executive function was assessed in 40 adults with acute SCI and 32 AB controls using the Neuropsychiatry Unit Cognitive Assessment Tool (NUCOG). Two multivariate analyses of covariance (MANCOVA) were conducted to compare group performance across tasks requiring higher-order EF processes and tasks characterised by minimal EF demand, controlling for age, sex, and years of education. Results A significant multivariate group difference was observed across EF tasks, with individuals with SCI demonstrating significantly lower performance on categorical fluency, abstraction, and Digit Span Reverse following correction for multiple comparisons. No significant group differences were observed across tasks characterised by minimal EF demand. Conclusion Adults with SCI exhibit selective impairments in higher-order executive functioning that emerge under increased cognitive demand, while performance on low-demand tasks remains relatively preserved. These findings highlight the importance of assessing EF components at the task level and support the need for targeted screening approaches sensitive to higher-order executive deficits to optimise rehabilitation outcomes.