Research Reports - Neuropsychological outcome and its correlates in the first year after adult mild traumatic brain injury

Brain Inj. 2015 Sep 18:1-13. [Epub ahead of print]

Barker-Collo S(1), Jones K(2), Theadom A(2), Starkey N(3), Dowell A(4), McPherson
K(5), Ameratunga S(6), Dudley M(7), Te Ao B(2), Feigin V(2); BIONIC Research
Group.

OBJECTIVE: The relationship between moderate/severe traumatic brain injury (TBI)
and cognitive deficits is well known. The nature, duration and predictors of
cognitive difficulties post-mild TBI remain unclear. This study examined
cognitive, mood and post-concussion outcomes of mild TBI over 1-year post-injury.
METHOD: Adults (>15 years) with mild TBI (n = 260) completed neuropsychological
(CNS-Vital Signs, Behavioural Dyscontrol Scale), mood (Hospital Anxiety
Depression Scale) and behavioural assessments (Cognitive Failures Questionnaire,
Rivermead Post-Concussion Questionnaire) at baseline, 1-, 6- and 12-months
post-injury.
RESULTS: Over the 12-months post-injury self-reported cognition (p = 0.027),
post-concussion symptoms (p < 0.001), depression (p < 0.001), anxiety (p < 0.001)
and dyscontrol (p = 0.025) improved significantly. Assessments of memory,
processing speed, executive function, psychomotor speed/reaction time, complex
attention and flexibility also improved significantly. At baseline >20% of
individuals produced very low scores on executive ability, complex attention and
cognitive flexibility. At 1- and 6-month follow-ups >20% of participants were
very low for complex attention, with 16.3% remaining so at 12-months. Executive
abilities and speed were related to post-concussion symptoms, mood and
self-reported cognition at 12-months.
CONCLUSIONS: Whilst significant improvements were noted across measures over
time, a significant proportion of individuals still perform poorly on
neuropsychological measures 12-months after mild TBI; and these were linked to
post-concussion symptoms, mood and self-reported cognitive outcomes. This implies
a longer trajectory for recovery than has previously been suggested, which has
implications for provision of assessment and rehabilitation services for more
extended periods. 

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