scholarly journals Understanding the relationship between cognitive performance and function in daily life after traumatic brain injury

2020 ◽  
pp. jnnp-2020-324492
Author(s):  
Lindsay Wilson ◽  
Lindsay Horton ◽  
Kevin Kunzmann ◽  
Barbara J Sahakian ◽  
Virginia FJ Newcombe ◽  
...  
Keyword(s):  
Mental Health ◽  
Traumatic Brain Injury ◽  
Brain Injury ◽  
Cognitive Performance ◽  
Processing Speed ◽  
Daily Life ◽  
Short Form ◽  
Analysis Of Covariance ◽  
Effect Sizes ◽  
Different Levels

ObjectiveCognitive impairment is a key cause of disability after traumatic brain injury (TBI) but relationships with overall functioning in daily life are often modest. The aim is to examine cognition at different levels of function and identify domains associated with disability.Methods1554 patients with mild-to-severe TBI were assessed at 6 months post injury on the Glasgow Outcome Scale—Extended (GOSE), the Short Form-12v2 and a battery of cognitive tests. Outcomes across GOSE categories were compared using analysis of covariance adjusting for age, sex and education.ResultsOverall effect sizes were small to medium, and greatest for tests involving processing speed (ηp2 0.057–0.067) and learning and memory (ηp2 0.048–0.052). Deficits in cognitive performance were particularly evident in patients who were dependent (GOSE 3 or 4) or who were unable to participate in one or more major life activities (GOSE 5). At higher levels of function (GOSE 6–8), cognitive performance was surprisingly similar across categories. There were decreases in performance even in patients reporting complete recovery without significant symptoms. Medium to large effect sizes were present for summary measures of cognition (ηp2 0.111), mental health (ηp2 0.131) and physical health (ηp2 0.252).ConclusionsThis large-scale study provides novel insights into cognitive performance at different levels of disability and highlights the importance of processing speed in function in daily life. At upper levels of outcome, any influence of cognition on overall function is markedly attenuated and differences in mental health are salient.

scholarly journals Age, Sex and Cerebral Microbleed Effects On White Matter Degradation After Traumatic Brain Injury

2020 ◽  
Vol 4 (Supplement_1) ◽  
pp. 886-887
Author(s):  
Andrei Irimia ◽  
Ammar Dharani ◽  
Van Ngo ◽  
David Robles ◽  
Kenneth Rostowsky
Keyword(s):  
Traumatic Brain Injury ◽  
Brain Injury ◽  
White Matter ◽  
Diffusion Tensor ◽  
Diffuse Axonal Injury ◽  
Principal Component ◽  
Older Age ◽  
Analysis Of Covariance ◽  
Future Research ◽  
Cerebral Microbleed

Abstract Mild traumatic brain injury (mTBI) affects white matter (WM) integrity and accelerates neurodegeneration. This study assesses the effects of age, sex, and cerebral microbleed (CMB) load as predictors of WM integrity in 70 subjects aged 18-77 imaged acutely and ~6 months after mTBI using diffusion tensor imaging (DTI). Two-tensor unscented Kalman tractography was used to segment and cluster 73 WM structures and to map changes in their mean fractional anisotropy (FA), a surrogate measure of WM integrity. Dimensionality reduction of mean FA feature vectors was implemented using principal component (PC) analysis, and two prominent PCs were used as responses in a multivariate analysis of covariance. Acutely and chronically, older age was significantly associated with lower FA (F2,65 = 8.7, p < .001, η2 = 0.2; F2,65 = 12.3, p < .001, η2 = 0.3, respectively), notably in the corpus callosum and in dorsolateral temporal structures, confirming older adults’ WM vulnerability to mTBI. Chronically, sex was associated with mean FA (F2,65 = 5.0, p = 0.01, η2 = 0.1), indicating males’ greater susceptibility to WM degradation. Acutely, a significant association was observed between CMB load and mean FA (F2,65 = 5.1, p = 0.009, η2 = 0.1), suggesting that CMBs reflect the acute severity of diffuse axonal injury. Together, these findings indicate that older age, male sex, and CMB load are risk factors for WM degeneration. Future research should examine how sex- and age-mediated WM degradation lead to cognitive decline and connectome degeneration after mTBI.

Severity of Ongoing Post-Concussive Symptoms as a Predictor of Cognitive Performance Following a Pediatric Mild Traumatic Brain Injury

2020 ◽  
pp. 1-11
Author(s):  
Veronik Sicard ◽  
Danielle C. Hergert ◽  
Sharvani Pabbathi Reddy ◽  
Cidney R. Robertson-Benta ◽  
Andrew B. Dodd ◽  
...  
Keyword(s):  
Traumatic Brain Injury ◽  
Brain Injury ◽  
Cognitive Performance ◽  
Mild Traumatic Brain Injury ◽  
Parental Education ◽  
Visual Learning ◽  
Learning Task ◽  
Risk Scores ◽  
Group Differences ◽  
Post Injury

Abstract Objective: This study aimed to examine the predictors of cognitive performance in patients with pediatric mild traumatic brain injury (pmTBI) and to determine whether group differences in cognitive performance on a computerized test battery could be observed between pmTBI patients and healthy controls (HC) in the sub-acute (SA) and the early chronic (EC) phases of injury. Method: 203 pmTBI patients recruited from emergency settings and 159 age- and sex-matched HC aged 8–18 rated their ongoing post-concussive symptoms (PCS) on the Post-Concussion Symptom Inventory and completed the Cogstate brief battery in the SA (1–11 days) phase of injury. A subset (156 pmTBI patients; 144 HC) completed testing in the EC (∼4 months) phase. Results: Within the SA phase, a group difference was only observed for the visual learning task (One-Card Learning), with pmTBI patients being less accurate relative to HC. Follow-up analyses indicated higher ongoing PCS and higher 5P clinical risk scores were significant predictors of lower One-Card Learning accuracy within SA phase, while premorbid variables (estimates of intellectual functioning, parental education, and presence of learning disabilities or attention-deficit/hyperactivity disorder) were not. Conclusions: The absence of group differences at EC phase is supportive of cognitive recovery by 4 months post-injury. While the severity of ongoing PCS and the 5P score were better overall predictors of cognitive performance on the Cogstate at SA relative to premorbid variables, the full regression model explained only 4.1% of the variance, highlighting the need for future work on predictors of cognitive outcomes.

Mental health consequences of traumatic brain injury

2021 ◽  
Author(s):  
Jonathon R. Howlett ◽  
Lindsay D. Nelson ◽  
Murray B. Stein
Keyword(s):  
Mental Health ◽  
Traumatic Brain Injury ◽  
Brain Injury ◽  
Health Consequences

scholarly journals Exploring the intersection of traumatic brain injury and mental health in survivors of intimate partner violence

2021 ◽  
Vol 2 (2) ◽  
Author(s):  
Danielle Toccalino ◽  
Amy Moore ◽  
Sophia Chuon Gutierrez ◽  
Angela Colantonio ◽  
Christine M. Wickens ◽  
...  
Keyword(s):  
Mental Health ◽  
Traumatic Brain Injury ◽  
Intimate Partner Violence ◽  
Brain Injury ◽  
Partner Violence ◽  
The United States ◽  
Intimate Partner ◽  
Future Research ◽  
Heterosexual Relationships ◽  
Economic Implications

Introduction: One in four Canadian women experience intimate partner violence (IPV) in their lifetime. The COVID-19 pandemic has significantly increased rates of IPV globally and the level of violence encountered, exposing IPV survivors to greater risk of physical injury, including traumatic brain injury (TBI). Up to 75% of survivors are suspected of sustaining a TBI and 50-75% experience mental health or substance use challenges (MHSU) as a result of IPV, resulting in extensive personal, social, and economic implications. Objective: The objective of this scoping review was to synthesize what is currently known in the literature about MHSU and TBI among survivors of IPV and identify gaps. Methods: MEDLINE, EMBASE, PsycINFO, CINAHL, Cochrane, Scopus, and Web of Science were searched for relevant articles using a search strategy including text words and subject headings related to TBI, IPV, and MHSU. Two reviewers independently assessed articles for inclusion. Results: The search identified 399 unique articles, 34 of which were included in this study. Of these, 11 articles reported on MHSU in IPV-related TBI and 9 articles reported on both TBI and MHSU in IPV but did not discuss the groups together. The remainder were reviews or theses that noted MHSU in IPV-related TBI. Included articles predominantly focused on cis-gendered women in heterosexual relationships and were conducted in the United States. Only three articles focused on the experiences of Black or Indigenous women and none of the included studies discussed implications of co-occurring TBI and MHSU on survivor’s healthcare-related needs or access to care. Conclusions: Despite the high rates of co-occurring TBI and MHSU among survivors of IPV, there is little research on this intersection and no investigation of the impacts on the health system. Future research should focus on identifying the healthcare-related needs of survivors and identifying and mitigating barriers to access.

scholarly journals Behavioral Pain Indicators in Patients with Traumatic Brain Injury Admitted to an Intensive Care Unit

2018 ◽  
Vol 7 (4) ◽  
pp. 197-203 ◽  
Author(s):  
Roghieh Nazari ◽  
Saeed Pahlevan Sharif ◽  
Kelly A Allen ◽  
Hamid Sharif Nia ◽  
Bit-Lian Yee ◽  
...  
Keyword(s):  
Intensive Care Unit ◽  
Traumatic Brain Injury ◽  
Intensive Care ◽  
Brain Injury ◽  
Injury Severity ◽  
Repeated Measure ◽  
Neck Stiffness ◽  
Significant Difference ◽  
Eye Opening ◽  
Different Levels

Introduction: A consistent approach to pain assessment for patients admitted to intensive care unit (ICU) is a major difficulty for health practitioners due to some patients’ inability, to express their pain verbally. This study aimed to assess pain behaviors (PBs) in traumatic brain injury (TBI) patients at different levels of consciousness. Methods: This study used a repeated-measure, within-subject design with 35 patients admitted to an ICU. The data were collected through observations of nociceptive and non-nociceptive procedures, which were recorded through a 47-item behavior-rating checklist. The analyses were performed by SPSS ver.13 software. Results: The most frequently observed PBs during nociceptive procedures were facial expression levator contractions (65.7%), sudden eye openings (34.3%), frowning (31.4%), lip changes (31.4%), clear movement of extremities (57.1%), neck stiffness (42.9%), sighing (31.4%), and moaning (31.4%). The number of PBs exhibited by participants during nociceptive procedures was significantly higher than those observed before and 15 minutes after the procedures. Also, the number of exhibited PBs in patients during nociceptive procedures was significantly greater than that of exhibited PBs during the non-nociceptive procedure. The results showed a significant difference between different levels of consciousness and also between the numbers of exhibited PBs in participants with different levels of traumatic brain injury severity. Conclusion: The present study showed that most of the behaviors that have been observed during painful stimulation in patients with traumatic brain injury included facial expressions, sudden eye opening, frowning, lip changes, clear movements of extremities, neck stiffness, and sighing or moaning.

scholarly journals Effect Sizes for Symptomatic and Cognitive Improvements in Traumatic Brain Injury Following Hyperbaric Oxygen Therapy

2021 ◽  
Author(s):  
Adam Thomas Biggs ◽  
Hugh M. Dainer ◽  
Lanny F Littlejohn
Keyword(s):  
Traumatic Brain Injury ◽  
Brain Injury ◽  
Hyperbaric Oxygen ◽  
Hyperbaric Oxygen Therapy ◽  
Oxygen Therapy ◽  
Brain Injuries ◽  
Statistical Significance ◽  
Traumatic Brain Injuries ◽  
Therapeutic Benefit ◽  
Effect Sizes

Hyperbaric oxygen therapy has been proposed as a method to treat traumatic brain injuries. The combination of pressure and increased oxygen concentration produces a higher content of dissolved oxygen in the bloodstream, which could generate a therapeutic benefit for brain injuries. This dissolved oxygen penetrates deeper into damaged brain tissue than otherwise possible and promotes healing. The result includes improved cognitive functioning and an alleviation of symptoms. However, randomized controlled trials have failed to produce consistent conclusions across multiple studies. There are numerous explanations that might account for the mixed evidence, although one possibility is that prior evidence focuses primarily on statistical significance. The current analyses explored existing evidence by calculating an effect size from each active treatment group and each control group among previous studies. An effect size measure offers several advantages when comparing across studies as it can be used to directly contrast evidence from different scales, and it provides a proximal measure of clinical significance. When exploring the therapeutic benefit through effect sizes, there was a robust and consistent benefit to individuals who underwent hyperbaric oxygen therapy. Placebo effects from the control condition could account for approximately one-third of the observed benefits, but there appeared to be a clinically significant benefit to using hyperbaric oxygen therapy as a treatment intervention for traumatic brain injuries. This evidence highlights the need for design improvements when exploring interventions for traumatic brain injury as well as the importance of focusing on clinical significance in addition to statistical significance.

Epidemiology of traumatic brain injury

2021 ◽  
Vol 3 (89) ◽  
pp. 65-67
Author(s):  
V.V. Unzhakov ◽  
Keyword(s):  
Traumatic Brain Injury ◽  
Economic Development ◽  
Brain Injury ◽  
Therapeutic Effect ◽  
Social Problems ◽  
Results Of Treatment ◽  
Different Levels

The article presents medical and social problems of traumatic brain injury in countries with different levels of economic development. These problems show the need for studies of clinical and typical pathological processes in patients with traumatic brain injury. There is no doubt about the importance of studying the reasons leading to the decompensation of these processes, predicting their course and outcome, as well as a therapeutic effect on these processes to improve the results of treatment of victims

The Power of Perception: Beliefs About Memory Ability Uniquely Contribute to Memory Performance and Quality of Life in Adults Aging with Traumatic Brain Injury

2021 ◽  
Author(s):  
Umesh M. Venkatesan ◽  
Amanda Rabinowitz ◽  
Frank Hillary
Keyword(s):  
Quality Of Life ◽  
Older Adults ◽  
Traumatic Brain Injury ◽  
Psychological Distress ◽  
Brain Injury ◽  
Cognitive Performance ◽  
Memory Performance ◽  
Self Perceptions ◽  
Health Related

Objective. Personal beliefs about memory ability, which comprise memory self-efficacy (MSE), can influence memory performance in healthy older adults. Self-efficacy theory also predicts that MSE biases self-perceptions of functioning more globally, potentially impacting daily activity beyond cognitive performance. People with traumatic brain injury (PwTBI) frequently report debilitating memory problems long after acute recovery, but little is known about how MSE affects health outcomes in this population. We examined demographic and clinical correlates of MSE, as well as its relationship to memory test performance and health-related quality of life (QOL), in older adults with chronic moderate-to-severe TBI (msTBI). Method. One hundred fourteen adults, aged 50+ and at least one year post-msTBI, underwent neuropsychological testing to assess their memory functioning. Participants also self-reported levels of psychological distress, MSE (Cognitive Confidence subscale of the Metacognitions Questionnaire), and health-related QOL (Quality of Life after Brain Injury questionnaire). Results. Demographic and injury-related predictors showed weak correlations with MSE. Although the relationship between MSE and general psychological distress was robust, only the former significantly predicted memory performance. Bivariate analyses revealed significant relationships between MSE and five out of the six QOL domains assessed. Multivariate linear regression revealed a significant impact of MSE on overall QOL independent of demographic and clinical variables. Conclusions. Our findings support a unique role for MSE in both objective cognitive performance and subjective health of PwTBI. Increased focus on self-perceptions of ability and their impact on measured outcomes is an important step towards personalized rehabilitation for adults with chronic msTBI.

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