The subcortical basis of outcome and cognitive impairment in TBI

ObjectiveTo understand how, biologically, the acute event of traumatic brain injury gives rise to a long-term disease, we address the relationship between evolving cortical and subcortical brain damage and measures of functional outcome and cognitive functioning at 6 months after injury.MethodsFor this longitudinal analysis, clinical and MRI data were collected in a tertiary neurointensive care setting in a continuous sample of 157 patients surviving moderate to severe traumatic brain injury between 2000 and 2018. For each patient, we collected T1- and T2-weighted MRI data acutely and at the 6-month follow-up, as well as acute measures of injury severity (Glasgow Coma Scale), follow-up measures of functional impairment (Glasgow Outcome Scale–extended), and, in a subset of patients, neuropsychological measures of attention, executive functions, and episodic memory.ResultsIn the final cohort of 113 subcortical and 92 cortical datasets that survived (blind) quality control, extensive atrophy was observed over the first 6 months after injury across the brain. However, only atrophy within subcortical regions, particularly in the left thalamus, was associated with functional outcome and neuropsychological measures of attention, executive functions, and episodic memory. Furthermore, when brought together in an analytical model, longitudinal brain measurements could distinguish good from bad outcome with 90% accuracy, whereas acute brain and clinical measurements alone could achieve only 20% accuracy.ConclusionDespite great injury heterogeneity, secondary thalamic pathology is a measurable minimum common denominator mechanism directly relating biology to clinical measures of outcome and cognitive functioning, potentially linking the acute event and the longer-term disease of traumatic brain injury.

Download Full-text

The thalamic basis of outcome and cognitive impairment in traumatic brain injury

10.1101/669390 ◽

2019 ◽

Cited By ~ 2

Author(s):

Evan S. Lutkenhoff ◽

Matthew J. Wright ◽

Vikesh Shrestha ◽

Courtney Real ◽

David L. McArthur ◽

...

Keyword(s):

Traumatic Brain Injury ◽

Brain Injury ◽

Episodic Memory ◽

Executive Functions ◽

Cognitive Functioning ◽

Functional Outcome ◽

Post Injury ◽

Neuropsychological Measures ◽

Acute Event

AbstractObjectiveTo understand how, biologically, the acute event of traumatic brain injury gives rise to a long-term disease, we address the relationship between evolving cortical and subcortical brain damage and measures of functional outcome and cognitive functioning at six months post-injury.MethodsLongitudinal analysis of clinical and MRI data collected, in a tertiary neurointensive care setting, in a continuous sample of 157 patients surviving moderate to severe traumatic brain injury between 2000 and 2018. For each patient we collected T1- and T2-weighted MRI data, acutely and at a six-months follow-up, as well as acute measures of injury severity (Glasgow Coma Scale) and follow-up measures of functional impairment (Glasgow Outcome Scale extended), and, in a subset of patients, neuropsychological measures of attention, executive functions, and episodic memory.ResultsIn the final cohort of 113 subcortical and 92 cortical datasets that survived (blind) quality control, extensive atrophy was observed over the first six months post-injury across the brain. Nonetheless, only atrophy within subcortical regions, particularly in left thalamus, were associated with functional outcome and neuropsychological measures of attention, executive functions, and episodic memory. Furthermore, when brought together in an analytical model, longitudinal brain measurements could distinguish good versus bad outcome with 90% accuracy, whereas acute brain and clinical measurements alone could only achieve 20% accuracy.InterpretationDespite great injury heterogeneity, secondary thalamic pathology is a measurable minimum common denominator mechanism directly relating biology to clinical measures of outcome and cognitive functioning, potentially linking the acute “event” and the long(er)-term “disease” of TBI.

Download Full-text

Long-Term Effects of Decompressive Craniectomy on Functional Outcomes after Traumatic Brain Injury: A Multicenter Study

The American Surgeon ◽

10.1177/000313481808400844 ◽

2018 ◽

Vol 84 (8) ◽

pp. 1314-1318 ◽

Cited By ~ 1

Author(s):

Eliza Moskowitz ◽

Claudia I. Melendez ◽

Julie Dunn ◽

Abid D. Khan ◽

Richard Gonzalez ◽

...

Keyword(s):

Traumatic Brain Injury ◽

Brain Injury ◽

Confidence Interval ◽

Functional Outcome ◽

Decompressive Craniectomy ◽

Functional Outcomes ◽

Structured Interview ◽

Good Functional Outcome

Decompressive craniectomy (DC) is a surgical modality sometimes used in the management of elevated intracranial pressure. Questions remain as to its long-term benefits in traumatic brain injury patients. The extended Glasgow Outcome Scale (eGOS) is a scoring system based on a structured interview that allows for consistent and reproducible measurement of long-term functional outcomes. The purpose of this study was to determine the eGOS score of post-craniectomy patients after discharge and stratify survivors based on outcome. A multicenter review of patients who underwent DC was performed. Survivors underwent a phone survey at which time the eGOS was calculated. Patients with an eGOS ≥ 5 were considered to have a good functional outcome. Fifty-four patients underwent DC. Age (OR 1.038; confidence interval 1.003–1.074) and Glasgow Coma Scale (OR 0677; confidence interval 0.527–0.870) were predictors of mortality. Patients who were available for follow-up (n = 13) had poor functional outcomes at discharge (eGOS = 3); however, this improved at the time of follow-up survey (eGOS = 5; P = 0.005). DC is a controversial operation with high mortality and uncertain benefit. Among our cohort, the eGOS score was significantly higher at follow-up survey than it was at discharge. Although the mortality was high, if patients survived to discharge, most had a good functional outcome at follow-up survey.

Download Full-text

Cognitive functioning following traumatic brain injury: A five-year follow-up

Neurorehabilitation ◽

10.3233/nre-151297 ◽

2016 ◽

Vol 38 (1) ◽

pp. 71-78 ◽

Cited By ~ 15

Author(s):

Nigel V. Marsh ◽

Maria R. Ludbrook ◽

Lauren C. Gaffaney

Keyword(s):

Traumatic Brain Injury ◽

Brain Injury ◽

Cognitive Functioning

Download Full-text

Cognitive recovery and predictors of functional outcome 1 year after traumatic brain injury

Journal of the International Neuropsychological Society ◽

10.1017/s1355617709990452 ◽

2009 ◽

Vol 15 (5) ◽

pp. 740-750 ◽

Cited By ~ 76

Author(s):

SOLRUN SIGURDARDOTTIR ◽

NADA ANDELIC ◽

CECILIE ROE ◽

ANNE-KRISTINE SCHANKE

Keyword(s):

Traumatic Brain Injury ◽

Brain Injury ◽

Functional Outcome ◽

Injury Severity ◽

Cognitive Measures ◽

Related Factors ◽

Predictive Values ◽

Neuropsychological Measures ◽

Cognitive Components ◽

One Year

AbstractOutcome studies on traumatic brain injury (TBI) have shown that functional status can be predicted by demographic, injury severity, and trauma-related factors. Concurrent cognitive functions as one of the determinants of functional outcome is less documented. This study evaluated the effects of concurrent neuropsychological measures on functional outcome 1 year after injury. Neuropsychological data, employment status, self-reported fatigue, and the Glasgow Outcome Scale-Extended (GOSE) were collected from 115 persons with TBI (ranging from mild to severe) at 3 and 12 months postinjury. Principal components analysis was conducted with the neuropsychological measures and three components emerged. Multiple regression analysis, controlling for demographic and injury severity related factors, was used to test the effects of cognitive components at 12 months on functional outcome (GOSE). One year after injury, 64% were categorized as “good recovery” and 36% as “moderate disability” according to GOSE. Good functional recovery depended on shorter duration of posttraumatic amnesia, less fatigue, absence of intracranial pathology, higher education, and better performance on cognitive measures. The predictive values of Verbal/Reasoning and Visual/Perception components are supported; each added significantly and improved prediction of functional outcome. The Memory/Speed component showed a near-significant relationship to outcome. (JINS, 2009, 15, 740–750)

Download Full-text

Comparison of executive functions and functional outcome between older patients with traumatic brain injury and normal older controls

Applied Neuropsychology Adult ◽

10.1080/23279095.2020.1862118 ◽

2020 ◽

pp. 1-13

Author(s):

Elaine de Guise ◽

Catherine Degré ◽

Océane Beaujean ◽

Jessica Julien ◽

Maude Lague-Beauvais ◽

...

Keyword(s):

Traumatic Brain Injury ◽

Brain Injury ◽

Executive Functions ◽

Functional Outcome ◽

Older Patients

Download Full-text

Self-awareness, depression and neurocognitive functions in patients with moderate and severe traumatic brain injury

Journal of Applied Cognitive Neuroscience ◽

10.17981/jacn.1.1.2020.12 ◽

2020 ◽

Vol 1 (1) ◽

pp. 69-80

Author(s):

Lisandro Heber Vales ◽

Silveira Brussain ◽

Fabian Roman

Keyword(s):

Traumatic Brain Injury ◽

Depressive Symptoms ◽

Brain Injury ◽

Episodic Memory ◽

Executive Functions ◽

Rating Scale ◽

Verbal Learning ◽

Self Awareness ◽

Neurocognitive Functions ◽

Severe Tbi

Introduction: Traumatic Brain Injury (TBI) is the most common cause of disability in youngpatients. In the self-awareness deficits that can arise after TBI, patients experience difficulties in understanding the disabilities resulting from their injury. This is an important problem that affects the rehabilitation processes. Materials and methods: Self-awareness, neurocognitive functions and depressive symptoms were observed in 31 outpatients with a diagnosis of moderate or severe TBI, aged between 16 and 45 years. Instruments: Patient Competency Rating Scale (PCRS), Neurocognitive Assessment and Hamilton Depression Rating Scale (HDRS). Results: Correlations were found between self-awareness and its dimensions with visuospatial skills, executive functions (double task and cognitive inhibition), episodic memory (Rey Auditory-Verbal Learning Test and Montevideo short story) and depressive symptoms. Conclusions: Patients who have suffered a moderate or severe TBI may have impaired self-awareness. Self-awareness is the ability to objectively perceive (perceive our own self), while maintaining a sense of subjectivity, It is a complex function that needs to use executive functions and episodic memory. The relationship found between interpersonal self-awareness and depressive symptoms does not seem to be conclusive, since this association is probably more complex, and involves other variables not considered in this study.

Download Full-text

Functional Outcome 6 Months after Severe Traumatic Brain Injury Following Admission to Intensive Care Unit: A Follow-Up Study in Two Neuro-Center Hospitals

IIUM Medical Journal Malaysia ◽

10.31436/imjm.v16i1.1149 ◽

2017 ◽

Vol 16 (1) ◽

Author(s):

Norain Abdul Rashid ◽

Mohd Basri Mat Nor ◽

Mohamed Saufi Awang ◽

Salizar Mohamed Ludin

Keyword(s):

Traumatic Brain Injury ◽

Brain Injury ◽

Functional Outcome ◽

Sofa Score ◽

Small Sample ◽

Post Injury ◽

Saps Ii ◽

Saps Ii Score ◽

Severe Tbi

Introduction: Traumatic brain injury (TBI) is a major medical and socioeconomic problem. Patients with severe TBI shows physical and functional improvement but remain with cognitive and psycho-social problem throughout recovery. Despite all the issues, the impact of TBI on long-term survivors in Malaysia is unknown. The aim of this study is to measure the functional level of ICU survivors with severe TBI within 6 months post injury. Materials and method: A cohort study was employed for this study. 33 participants from Hospital Tengku Ampuan Afzan (HTAA) Kuantan, Pahang and Hospital Sultanah Nur Zahirah (HSNZ) Kuala Terengganu with severe TBI were included in this study. The functional assessment of Glasgow Outcome Scale Extended (GOSE) was measured in all samples within in a 6 month period. Results: The participants mean age was 31.79 with ranged from 16 to 73 years old. The result of this study showed that within 3 months after discharged from the hospital, all the participants still had poor recovery n=33 (100.0%). Meanwhile, at 6 months after discharge from the hospital, n= 16 (48.5%) participants were scored good recovery. In this case, the SOFA and SAPS II score contributed significantly to the prediction (SOFA score p=0.045, SAPS II score p= 0.028) of functional outcome. Conclusion: The functional outcome of severe TBI improved in six months post injury. The SOFA score and SAPS II score become significant predictors for functional outcome in this study. However, there were some limitations to this study, which are small sample size and short follow-up duration. This study emphasized the importance of SOFA and SAPS II score in predicting functional outcome; thus early care plan should be done if severe TBI have higher SOFA or SAPS II score.

Download Full-text

Development of Rehabilitation of Eclectic Cognitive Functioning Post-Traumatic Brain Injury to Retrain and Restore Attention, Concentration, Memory and Executive Functions (RETRACE)

BMJ Innovations ◽

10.1136/bmjinnov-2018-000292 ◽

2020 ◽

Vol 6 (3) ◽

pp. 99-112

Author(s):

Sakshi Chopra ◽

Sumit Sinha ◽

Senthil S Kumaran ◽

Harsimarpreet Kaur ◽

Ravindra Mohan Pandey ◽

...

Keyword(s):

Traumatic Brain Injury ◽

Brain Injury ◽

Executive Functions ◽

Cognitive Functioning ◽

Randomised Trial ◽

Significant Proportion ◽

Healthy Controls ◽

Cognitive Domains ◽

Significant Difference ◽

Post Traumatic

BackgroundTraumatic brain injury (TBI) incapacitates nearly 3.5 million Indians and can result in a host of physical, cognitive, social, emotional and behavioural problems. Neuropsychological rehabilitation (NR) aids in amelioration of these deficits. As people with low literacy levels represent a significant proportion of the world, specific cognitive rehabilitation modules for such populations are indispensable. A standardised, economical NR intervention may assist in faster recovery.MethodsThe study was initiated after obtaining institute ethics approval and the Clinical Trials Registry – India clearance. A 6-week indigenised literacy-free NR intervention Rehabilitation of Eclectic Cognitive Functioning post Traumatic Brain Injury to Retrain and Restore Attention, Concentration, Memory and Executive Functions (RETRACE) was developed. This intervention targeted areas of memory, attention and concentration, executive functioning, and response inhibition. It was standardised on 50 healthy controls and 18 patients. Prior to recruitment, a written informed consent was obtained from each patient, their primary caregiver and the healthy controls.ResultsIndividuals were divided into four groups based on their education levels: illiterates; 1–9 years, 10–14 years; and >15 years. All the outcomes for each of the four cognitive domains in the intervention did not have any significant difference for errors committed among the healthy controls with respect to different levels of education. The performance of patients with the healthy controls on all the four cognitive domains revealed a significant difference in each.ConclusionsRETRACE covers major areas of cognitive impairment that affects an individual’s social, vocational and personal quality of life after brain injury. This intervention is feasible to administer and may help alleviating cognitive complaints after brain injury in low literate or mixed cultural populations. RETRACE is simple to score and can be done easily at the patient’s home under the supervision of the patient’s caregiver. Further study of its efficacy in a randomised trial is already underway.

Download Full-text