Research Reports - Twelve-month recovery of medical decision-making capacity following traumatic brain injury.

Neurology. 2016 Sep 6;87(10):1052-9. doi: 10.1212/WNL.0000000000003079. Epub 2016
Aug 10.

Steward KA(1), Gerstenecker A(1), Triebel KL(1), Kennedy R(1), Novack TA(1),
Dreer LE(1), Marson DC(2).

OBJECTIVE: To investigate recovery of medical decision-making capacity (MDC) over
the first year following traumatic brain injury (TBI).
METHODS: A total of 177 participants (111 persons with TBI and 66 healthy
controls) were recruited from an inpatient/outpatient TBI rehabilitation unit and
outpatient neurology department. Participants with TBI were classified by injury
severity into subgroups: mild TBI (mTBI; n = 28), complicated mild TBI (cmTBI; n
= 23), and moderate/severe TBI (msevTBI; n = 60). Control and TBI groups were
compared at 1 month (t1), 6 months (t2), and 12 months (t3) postinjury using the
Capacity to Consent to Treatment Instrument (CCTI), which evaluates MDC using 5
consent standards: expressing choice, reasonable choice, appreciation, reasoning,
and understanding.
RESULTS: Relative to controls, no TBI group displayed impairment on CCTI
expressing choice or reasonable choice at any timepoint. Those with mTBI had
reduced appreciation and understanding at t1, which resolved by t2. The cmTBI and
msevTBI groups were impaired on all 3 complex consent standards at t1. While
patients with cmTBI improved to a level similar to controls by t3, those with
msevTBI remained impaired on reasoning and understanding. Across all TBI groups,
notable MDC improvement only occurred over the first 6 months postinjury.
CONCLUSIONS: Over 1 year, most individuals with mTBI or cmTBI regain MDC, while
many individuals with msevTBI have lingering deficits in reasoning and
comprehension of treatment information. Clinical recovery of MDC occurs primarily
during the first 6 months post-TBI regardless of injury severity. Clinicians can
therefore identify MDC outcomes in TBI at 6 months postinjury.

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