Research Reports - Early CT frontal abnormalities predict long-term neurobehavioral problems after traumatic brain injury

J Neurotrauma. 2015 Aug 21. [Epub ahead of print]

Spikman JM(1,)(2), Timmerman ME(3), Coers A(2), van der Naalt J(2).

Behavioral problems are serious consequences of moderate to severe traumatic
brain injury (TBI) and have a negative impact on outcome. There may be two types:
neurobehavioral problems, manifesting as inadequate social behavior resulting
from prefrontal system damage, and affective behavioral problems, resulting from
emotional distress as a reaction to the brain injury. In the present study we
investigated whether these two types of behavioral problems, as indicated by
proxies, could be distinguished in a group of chronic TBI patients and whether
early indicators of prefrontal damage on imaging could predict long-term
neurobehavioral problems. Computed tomography (CT) imaging data on admission were
used to identify frontal lesions. Three hundred twenty-three moderate to severe
TBI survivors received 2 to 16 years post-trauma an aftercare survey with seven
questions asking for changes in behavior and affect, presented both to patients
and their proxies. One hundred eighty-six patients (59%) answered the behavioral
questions; 42% had frontal lesions on CT. Ordinal common factor analysis on proxy
scores yielded two factors, with behavior and affective items clearly separated
and the anger item mediocre related to both factors. Three scales were created:
Behavior, Affective and Anger. Frontal patients scored significantly higher on
the Behavior and Anger scales. Logistic regression analysis showed a fourfold
increase of long-term neurobehavioral problems in patients with frontal lesions.
Long-term neurobehavioral problems were significantly correlated to one-year
outcome and return to work in the long term. We conclude that in patients with
moderate to severe TBI neurobehavioral and affective problems can be
distinguished. Early CT frontal abnormalities predict long-term neurobehavioral
problems, but not affective problems. 

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