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Life After Traumatic Brain Injury Cognitive, emotional and behavioural function after moderate and severe traumatic brain injury

Finnanger, Torun Gangaune
Doctoral thesis
Åpne
fulltext not available (Låst)
Permanent lenke
http://hdl.handle.net/11250/279050
Utgivelsesdato
2014
Metadata
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  • Regionalt kunnskapssenter for barn og unge - Psykisk helse og barnevern [176]
Sammendrag
Traumatic brain injury (TBI) may occur after motor vehicle accidents, falls, or blows

to the head. TBI may be classified as mild, moderate or severe depending on a

number of factors, but primarily by level of consciousness after the trauma.

Survivors after moderate and severe TBI comprise a heterogeneous group with great

variability in terms of reduced function. They often experience impairments across a

range of cognitive abilities, some of which may become chronic. In addition,

secondary symptoms of emotional and behavioural problems may develop over time

after the injury. Furthermore, all of these problems may affect the ability to resume

work and engage in social activities; they may also affect the relationship to family

and friends. There are few prospective studies examining cognitive, emotional, and

behavioural function over a significant period of time. In addition, prospective

studies on predictors of and associates to long-term cognitive, emotional, and

behavioural function are still warranted.

The main objective was to describe cognitive, emotional, and behavioural problems

at several time points after TBI with emphasis on the long-term perspective. In

addition, we wished to explore a broad array of demographic and injury-related

factors hypothesized to be associated with cognitive, emotional, and behavioural

outcomes after TBI.

The study includes patients admitted to St. Olav’s Hospital, Trondheim University

Hospital with moderate and severe TBI, from acute care to 5 years post-injury. It is

part of a larger project, “The Head Injury Project”, which studies several aspects of

the assessment, treatment, and clinical management of patients with TBI. The

participants in the present study were recruited from the database of the “Head Injury

Project”. Two overlapping but not identical populations (injured 2004-2007) and one

extended population (injured 2004-2008) were included. Injury severity and level of

consciousness were monitored and registered for all participants, and examination

with MRI was performed within 4 weeks post-injury. At 3 months (n=61) and 12

months (n=50) post-injury, participants aged 15-65 years at the time of injury were

assessed with neuropsychological tests and completed a questionnaire reporting

symptoms of depression. The extended population (n=67) completed questionnaires

concerning cognitive, emotional, and behavioural function 2-5 years post-injury. The

results were compared with those of a control group consisting of healthy people

matched by age, gender, and education.

Our study demonstrated that differentiating between individuals with moderate and

severe TBI revealed important differences regarding which cognitive functions were

affected and the degree of cognitive impairment at 3 and 12 months post-injury; it

also yielded a more nuanced description of cognitive deficits and their improvement

over time. Cognitive function was affected by both moderate and severe TBI at 3 and 12 months post-injury, and was associated with global outcome 12 months postinjury.

The groups differed regarding which cognitive functions improved from 3 to

12 months post-injury; only processing speed and visual memory improved for both

groups. At 12 months post-injury, individuals with severe TBI exhibited reduced

motor function, processing speed, verbal memory, and executive function. However,

only executive function was reduced among patients with moderate TBI compared

with healthy controls. Nevertheless, a larger proportion of individuals with moderate

TBI had low scores (-1.5 SD below normative average) on tests that assessed

executive function and processing speed at 12 months post-injury. Still, a significant

proportion of individuals with moderate TBI exhibited normal performance on most

neuropsychological tests at both 3 and 12 months post-injury – a finding that lends

strength to previously raised concerns that cognitive problems after moderate TBI

may be overestimated. Furthermore, executive function appears to be important for

patients’ ability to resume independent living, employment, and leisure activities

regardless of injury severity.

Persons with moderate and severe TBI reported more pronounced difficulties in

aspects of executive functions related to attentional control, working memory and

emotional regulation, as well as emotional and behavioural problems related to

symptoms of depression, anxiety, and aggression 2-5 years post injury compared to

healthy controls. Reported symptoms of depression during the first year after injury

and detection of traumatic diffuse axonal injury (DAI) on early MRI were important

predictors of later self-reported executive, emotional, and behavioural problems. Our

findings indicate interplay between demographic, neuropathological, and

psychological factors during the development of self-reported executive, emotional,

and behavioural problems for years after TBI. As such, outcomes after moderate and

severe TBI are best understood within the frame of a biopsychosocial model. Hence,

early radiological examination and repeated psychological evaluations screening for

cognitive and emotional problems may provide clues to which patients may be at

risk, and assist with the making of clinical decisions regarding long-term follow-up.
Utgiver
NTNU
Serie
Doctoral thesis at NTNU;2014:308

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