Cognitive Impairment 3 Months After Moderate and Severe Traumatic Brain Injury: A Prospective Follow-Up Study (original) (raw)
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Cognitive Impairment Following Acute Mild Traumatic Brain Injury
Frontiers in Neurology
Patients with mild traumatic brain injury (mTBI) may present cognitive deficits within the first 24 h after trauma, herein called "acute phase," which in turn may lead to long-term functional impairment and decrease in quality of life. Few studies investigated cognition in mTBI patients during the acute phase. The objectives of this study were to investigate the cognitive profile of patients with mTBI during the acute phase, compared to controls and normative data, and whether loss of consciousness (LOC), previous TBI and level of education influence cognition at this stage. Fifty-three patients with mTBI (aged 19-64 years) and 28 healthy controls participated in the study. All patients were evaluated at bedside within 24 h post-injury. Demographic and clinical data were registered. Cognitive function was assessed with the Mini-mental state examination (MMSE), the Frontal Assessment Battery (FAB), Digit Span (working memory), and the Visual Memory Test/Brief Cognitive Battery (for episodic memory). The clinical sample was composed mainly by men (58.5%). The mean age was 39 years-old and 64.3% of the patients had more than 8 years of education. The most common causes of mTBI were fall from own height (28.3%), aggression (24.5%), and fall from variable heights (24.5%). Compared to controls, mTBI patients exhibited significantly worse performance on MMSE, FAB, naming, incidental memory, immediate memory, learning, and delayed recall. Compared to normative data, 26.4% of patients had reduced global cognition as measured by the MMSE. Episodic memory impairment (13.2%) was more frequent than executive dysfunction (9.4%). No significant differences were found in cognitive performance when comparing patients with or without LOC or those with or without history of previous TBI. Patients with lower educational level had higher rates of cognitive Cardoso et al. Cognitive Impairment in Traumatic Brain Injury impairment (VMT naming−28.6 vs. 4.2%; VMT immediate memory−32 vs. 4.2%; VMT learning−39.3 vs. 4.2%, all p < 0.05). In sum, we found significant cognitive impairment in the acute phase of mTBI, which was not associated with LOC or history of TBI, but appeared more frequently in patients with lower educational level.
Neuropsychological Functioning in a National Cohort of Severe Traumatic Brain Injury
Journal of Head Trauma Rehabilitation, 2015
Objectives: To determine the rates of cognitive impairment 1 year after severe traumatic brain injury (TBI) and to examine the influence of demographic, injury severity, rehabilitation and sub-acute functional outcomes on cognitive outcomes 1 year after severe TBI. Setting: National multicenter cohort study over 2 years. Participants: Patients (N=105) aged ≥16 years with Glasgow Coma Scale (GCS) 3-8 and Galveston Orientation and Amnesia Test >75. Main Measures: Neuropsychological tests representing cognitive domains of Executive Functions, Processing Speed, and Memory. Injury severity included Rotterdam CT score, GCS, and post-traumatic amnesia (PTA), together with length of rehabilitation and Glasgow Outcome Scale-Extended (GOSE). Results: Totally, 67% of patients with severe TBI had cognitive impairment. Executive Functions, Processing Speed, and Memory were impaired in 41%, 58%, and 57% of patients, respectively. Using multiple regression, Processing Speed was significantly related to PTA, GOSE, and length of inpatient rehabilitation (R 2 =.30); Memory was significantly related to GOSE (R 2 =.15); and Executive functions to PTA (R 2 =.10). Rotterdam CT and GCS scores were not associated with cognitive functioning at one year post-injury. Conclusion: Findings highlight cognitive consequences of severe TBI with nearly two-thirds of patients showing cognitive impairments in at least one of three cognitive domains. Regarding injury severity predictors, only PTA was related to cognitive functioning.
Neurobehavioural deficits after severe traumatic brain injury (TBI)
Brain Injury, 2006
Objectives: Debilitating neurobehavioural sequalae often complicate traumatic brain injury (TBI). Cognitive deficits, particularly of attention, memory, information-processing speed and problems in self-perception, are very common following severe TBI. Method: The Neurobehavioural Rating Scale (NRS) is a multi-dimensional clinical-based assessment instrument designed and validated to measure neurobehavioural disturbances following TBI. This study examined 41 patients who were admitted to the intensive care unit of the Department of General Neurosurgery at Cologne University Hospital after severe TBI between January 1995 and July 2003. All 27 items of the NRS were assessed 6 and 12 months post-injury. Results: Subjects after severe TBI (GCS<9) showed relatively high overall scores on the NRS, reflecting a high degree of overall neurobehavioural dysfunction. NRS items did not change significantly between 6 and 12 months post-trauma for anxiety, expressive deficit, emotional withdrawal, depressive mood, hostility, suspiciousness, fatigability, hallucinatory behaviour, motor retardation, unusual thought content, liability of mood and comprehension deficit. There was a tendency of improvement for inattention, somatic concern, disorientation, guilt feelings, excitement, poor planning and articulation deficits. For conceptual disorganization, disinhibition, memory deficit, agitation, inaccurate self-appraisal, decreased initiative, blunted affect and tension even a tendency for further deterioration in the post-traumatic follow-up was detected. Changes between 6 and 12 months post-TBI were statistically significant for disorientation (improvement), inattention/ reduced alertness (improvement) and excitement (deterioration). Conclusion: The data shows that neurobehavioural deficits after TBI do not show a general tendency to disappear over time. Some aspects related to self-appraisal, conceptual disorganization and affect may even deteriorate, thereby presenting a challenging problem for both the patients and relatives. This is in contrast to the parallel improvement of post-traumatic sensomotoric deficits.
Dementia & Neuropsychologia, 2018
Traumatic brain injury (TBI) is one of main causes of death and disability among many young and old populations in different countries. Objective: The aim of this study were to consider and predict the cognitive impairments according to different levels and causes of TBI, and education status. Methods: The study was performed using the Mini-Mental State Examination (MMSE) to estimate cognitive impairment in patients at a trauma center in Zahedan city. Individuals were considered eligible if 18 years of age or older. This investigation assessed a subset of patients from a 6-month pilot study. Results: The study participants comprised 66% males and 34% females. Patient mean age was 32.5 years and SD was 12.924 years. One-way analysis of variance between groups indicated cognitive impairment related to different levels and causes of TBI, and education status in patients. There was a significant difference in the dimensions of cognitive impairments for different levels and causes of TBI, and education status. A regression test showed that levels of traumatic brain injury (β=.615, p=.001) and education status (β=.426, p=.001) predicted cognitive impairment. Conclusion: Different levels of TBI and education status were useful for predicting cognitive impairment in patients. Severe TBI and no education were associated with worse cognitive performance and higher disability. These data are essential in terms of helping patients understand their needs. Therefore, the factors identified can help plan effective rehabilitation programs. IMPACTOS DO COMPROMETIMENTO COGNITIVO PARA DIFERENTES NÍVEIS E CAUSAS DE TRAUMATISMO CRANIOENCEFÁLICO E GRAU DE INSTRUÇÃO EM PACIENTES LESADOS RESUMO. A lesão cerebral traumática (TCE) é uma das principais causas de morte e incapacidade em muitos jovens e idosos em diferentes países. Objetivo: O objetivo deste estudo foi considerar e prever os prejuízos cognitivos para os diferentes níveis e causas do TCE e status de educação. Métodos: O estudo foi feito usando o Mini-Exame do Estado Mental (MMSE) para estimar o comprometimento cognitivo em pacientes dirigido a um centro de trauma na cidade de Zahedan. Os indivíduos foram considerados elegíveis se tivessem 18 anos de idade ou mais. Esta investigação avaliou um subconjunto de pacientes de um estudo piloto de 6 meses. Resultados: Os participantes do estudo foram 66% do sexo masculino e 34% do sexo feminino. A média de idade dos pacientes foi de 32,5 anos e DP foi de 12,924 anos. A análise de variância unidirecional entre grupos indicou comprometimento cognitivo relacionado a diferentes níveis e causas de TCE e status de educação em pacientes. Houve uma diferença significativa nas dimensões de deficiências cognitivas para os diferentes níveis e causas de TCE e status de educação. O teste de regressão mostrou que níveis de lesão cerebral traumática (β=0,615, p=0,001) e o status de educação (β=0,426, p=0,001) predizem o comprometimento cognitivo. Conclusão: Os diferentes níveis de TCE e estados de educação foram uteis para prever o comprometimento cognitivo em pacientes. TCE grave e sem educação foram relacionadas a piora do desempenho cognitivo e maior incapacidade. Esses dados são essenciais para ajudar os pacientes a entender o que realmente precisam, portanto, os fatores identificados podem contribuir no planejamento de programas de reabilitação efetivos. Palavras-chave: comprometimento cognitivo, traumatismo cranioencefálico (TCE), grau de instrução, pacientes lesionados.
Behavioural Neurology
Aim. To assess the clinical course of disability, cognitive, and emotional impairments in patients with severe TBI (s-TBI) from 3 months to up to 7 years post trauma. Methods. A prospective cohort study of s-TBI in northern Sweden was conducted. Patients aged 18-65 years with acute Glasgow Coma Scale 3-8 were assessed with the Glasgow Outcome Scale Extended (GOSE), the Hospital Anxiety and Depression Scale (HADS), and the Barrow Neurological Institute Screen for Higher Cerebral Functions (BNIS) at 3 months, 1 year, and 7 years after the injury. Results. The scores on both GOSE and BNIS improved significantly from 3 months (GOSE mean: 4.4±2.3, BNIS mean: 31.5±7.0) to 1 year (GOSE mean: 5.5±2.7, p=0.003, BNIS mean: 33.2±6.3, p=0.04), but no significant improvement was found from 1 year to 7 years (GOSE mean: 4.7±2.8, p=0.13, BNIS mean: 33.5±3.9, p=0.424) after the injury. The BNIS subscale “speech/language” at 1 year was significantly associated with favourable outcomes on the GOSE at...
Cognitive functioning following traumatic brain injury: A five-year follow-up
NeuroRehabilitation, 2016
OBJECTIVE: To describe the long-term prevalence and severity of cognitive deficits following significant (i.e., ventilation required for >24 hours) traumatic brain injury. To assess a comprehensive range of cognitive functions using psychometric measures with established normative, reliability, and validity data. METHODS: A group of 71 adults was assessed at approximately five years (mean = 66 months) following injury. Assessment of cognitive functioning covered the domains of intelligence, attention, verbal and visual memory, visual-spatial construction, and executive functions. RESULTS: Impairment was evident across all domains but prevalence varied both within and between domains. Across aspects of intelligence clinical impairment ranged from 8-25%, attention 39-62%, verbal memory 16-46%, visual memory 23-51%, visual-spatial construction 38%, and executive functions (verbal fluency) 13%. In addition, 3-23% of performances across the measures were in the borderline range, suggesting a high prevalence of subclinical deficit. CONCLUSIONS: Although the prevalence of impairment may vary across cognitive domains, long-term follow-up documented deficits in all six domains. These findings provide further evidence that while improvement of cognitive functioning following significant traumatic brain injury may be possible, recovery of function is unlikely.
Cognitive Impairment After Traumatic Brain Injury
Acta Colombiana de Psicologia
Colombia lacks studies on the neuropsychological characteristics of people who suffer a traumatic brain injury (TBI), despite this being a public health problem and the leading cause of disability and death. Previous studies have shown that TBI generates further cognitive impairment in attention and memory, which, in turn, affect the daily lives of patients. The aim of this study was to describe the cognitive functions that may be affected as a result of TBI. A total of 30 patients, mean age 34 years and a history of TBI of at least 6 months duration participated in the study; 9 of them had mild head injury; 10 had a moderate condition and 11 had severe TBI; their average schooling was 9 years and they had no history of previous neurological and / or psychiatric problems. The brief neuropsychological assessment in Spanish (NEUROPSI) was carried out, along with the application of the Trail Making Test A and B (TMTA-TMTB), the Wisconsin Card Sorting Test (WCST), the Figura Compleja de...
Journal of Neurotrauma, 2021
This study investigates subacute cognitive effects of mild traumatic brain injury (MTBI) in the Trondheim Mild TBI Study, as measured, in part, by the neuropsychological test battery of the Collaborative European NeuroTrauma Effectiveness Research in TBI (CENTER-TBI) program, including computerized tests from the Cambridge Neuropsychological Test Automated Battery (CANTAB) and traditional paper-and-pencil tests. We investigated whether cognitive function was associated with injury severity: intracranial traumatic lesions on neuroimaging, witnessed loss of consciousness (LOC), or post-traumatic amnesia (PTA) >1 h. Further, we explored which of the tests in the CENTER-TBI battery might be associated with the largest subacute effects of MTBI (i.e., at 2 weeks postinjury). We recruited 177 patients with MTBI (16-59 years of age) from a regional trauma center and an outpatient clinic,79 trauma control participants, and 81 community control participants. The MTBI group differed from community controls only on one traditional test of processing speed (coding; p = 0.009, Cliff's delta [D] = 0.20). Patients with intracranial abnormalities performed worse than those without on a traditional test (phonemic verbal fluency; p = 0.043, D = 0.27), and patients with LOC performed differently on the Attention Switching Task from the CANTAB (p = 0.020, D =-0.20). Patients with PTA >1 h performed worse than those with <1 h on 10 measures, from traditional tests and the CANTAB (D = 0.33-0.20), likely attributable, at least in part, to pre-existing differences in intellectual functioning between groups. In general, those with MTBI had good neuropsychological outcome 2 weeks after injury and no particular CENTER-TBI computerized or traditional tests seemed to be more sensitive to subtle cognitive deficits.
A quantitative review of the effects of traumatic brain injury on cognitive functioning
International Review of Psychiatry, 2003
Changes in cognitive functioning often result from traumatic brain injury (TBI) and predict other important aspects of psychosocial recovery. Despite this pivotal role, no quantitative review of cognitive functioning across the spectrum of TBI severity has been reported. We therefore conducted a meta-analysis of 39 mostly cross-sectional studies of the cognitive effects of mild head injury (MHI) and moderate-severe TBI from the acute phase through long-term follow-up. The studies reported 48 comparisons of patients (n ¼ 1716) and control subjects (n ¼ 1164). Averaged across all follow-up periods, the effect of moderate-severe TBI (weighted mean Cohen's d ¼ À0.74) was more than three times the effect of MHI (weighted mean d ¼ À0.24) on overall cognitive functioning. Further, the natural logarithm of the follow-up interval correlated very strongly with estimates of d among patients with MHI, but less so among those with moderate-severe TBI. In short, findings from published research suggest that overall cognitive functioning recovers most rapidly during the first few weeks following MHI, and essentially returns to baseline within 1-3 months. Cognitive functioning also improves during the first two years after moderate-severe TBI, but remains markedly impaired even among patients tested > 2 years post-injury.