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- Title
Profiles of Cognitive Functioning at 6 Months After Traumatic Brain Injury Among Patients in Level I Trauma Centers: A TRACK-TBI Study.
- Authors
Bryant, Andrew M.; Rose, Nathan B.; Temkin, Nancy R.; Barber, Jason K.; Manley, Geoffrey T.; McCrea, Michael A.; Nelson, Lindsay D.; Badjatia, Neeraj; Gopinath, Shankar; Keene, C. Dirk; Madden, Christopher; Ngwenya, Laura B.; Puccio, Ava; Robertson, Claudia; Schnyer, David; Taylor, Sabrina R.; Yue, John K.
- Abstract
This cohort study examines the prevalence and characteristics of cognitive impairment and decline at 6 months after traumatic brain injury (TBI) among patients seen at level I trauma centers. Key Points: Question: What is the prevalence of distinct cognitive dysfunction profiles 6 months after traumatic brain injury (TBI) in patients at level I trauma centers? Findings: In this cohort study of 1057 patients with TBI, diverse cognitive impairment profiles were observed, with processing speed as the most commonly impaired domain in moderate-severe TBI and impairment prevalence lower and more equally distributed across domains in mild TBI. In this cohort, 64% to 79% performed commensurate with estimated premorbid abilities in memory, processing speed, and executive functioning. Meaning: Although many persons with TBI performed within normal limits cognitively 6 months after injury, those with cognitive dysfunction manifested diverse profiles, which may inform personalized interventions. Importance: Cognitive dysfunction is common after traumatic brain injury (TBI), with a well-established dose-response relationship between TBI severity and likelihood or magnitude of persistent cognitive impairment. However, patterns of cognitive dysfunction in the long-term (eg, 6-month) recovery period are less well known. Objective: To characterize the prevalence of cognitive dysfunction within and across cognitive domains (processing speed, memory, and executive functioning) 6 months after injury in patients with TBI seen at level I trauma centers. Design, Setting, and Participants: This prospective longitudinal cohort study used data from Transforming Research and Clinical Knowledge in TBI (TRACK-TBI) and included patients aged 17 years or older presenting at 18 US level I trauma center emergency departments or inpatient units within 24 hours of head injury, control individuals with orthopedic injury recruited from the same centers, and uninjured friend and family controls. Participants were enrolled between March 2, 2014, and July 27, 2018. Data were analyzed from March 5, 2020, through October 3, 2023. Exposures: Traumatic brain injury (Glasgow Coma Scale score of 3-15) or orthopedic injury. Main Outcomes and Measures: Performance on standard neuropsychological tests, including premorbid cognitive ability (National Institutes of Health Toolbox Picture Vocabulary Test), verbal memory (Rey Auditory Verbal Learning Test), processing speed (Wechsler Adult Intelligence Scale [4th edition] Processing Speed Index), and executive functioning (Trail Making Test). Results: The sample included 1057 persons with TBI (mean [SD] age, 39.3 [16.4] years; 705 [67%] male) and 327 controls without TBI (mean [SD] age, 38.4 [15.1] years; 222 [68%] male). Most persons with TBI demonstrated performance within 1.5 SDs or better of the control group (49.3% [95% CI, 39.5%-59.2%] to 67.5% [95% CI, 63.7%-71.2%] showed no evidence of impairment). Similarly, 64.4% (95% CI, 54.5%-73.4%) to 78.8% (95% CI, 75.4%-81.9%) of participants demonstrated no evidence of cognitive decline (defined as performance within 1.5 SDs of estimated premorbid ability). For individuals with evidence of either cognitive impairment or decline, diverse profiles of impairment across memory, speed, and executive functioning domains were observed (ie, the prevalence was >0 in each of the 7 combinations of impairment across these 3 cognitive domains for most TBI subgroups). Conclusions and Relevance: In this cohort study of patients seen at level I trauma centers 6 months after TBI, many patients with TBI demonstrated no cognitive impairment. Impairment was more prevalent in persons with more severe TBI and manifested in variable ways across individuals. The findings may guide future research and treatment recommendations.
- Subjects
UNITED States; COGNITION disorders; MEMORY; EXECUTIVE function; CONFIDENCE intervals; COGNITIVE processing speed; TRAUMA centers; PATIENTS; NEUROPSYCHOLOGICAL tests; EMERGENCY medical services; GLASGOW Coma Scale; RESEARCH funding; DESCRIPTIVE statistics; BRAIN injuries; LONGITUDINAL method; DOSE-response relationship in biochemistry; SECONDARY analysis; DISEASE complications
- Publication
JAMA Network Open, 2023, Vol 6, Issue 12, pe2349118
- ISSN
2574-3805
- Publication type
Article
- DOI
10.1001/jamanetworkopen.2023.49118