[Predictors of the recovery of cognitive functions in patients with traumatic brain injury]

INTRODUCTION

After a traumatic brain injury (TBI), cognitive functionality may be severely altered. Some studies have aimed at identifying the best predictive variables for cognitive recovery, however, results still remain unclear.

AIMS

To assess the recovery of cognitive functionality in TBI patients after a rehabilitation programme, and to identify the variables that best predict the cognitive recovery.

PATIENTS AND METHODS

We conducted a retrospective pre-post study with 58 adult TBI patients that underwent an intensive rehabilitation programme. All of them were assessed using the cognitive functions sub-scale from the FIM+FAM scale, at admission and discharge. Both scores were compared using non-parametric test Wilcoxon. Cognitive functionality gain percentage was calculated and correlated with all the collected data. A multiple linear regression analysis was carried out to identify the best predictors of cognitive functionality gain percentage by introducing all clinical, demographic and cognitive information.

RESULTS

The group's cognitive functionality increased significantly from 33,6% to 85% (p < 0,01). Patients with higher cognitive functionality gain percentage were those with younger age, shorter time post-TBI, and higher scores on cognitive functions sub-scale, conditional attention and Luria's memory word tests. The best predictors for cognitive functionality gain percentage were time post-TBI and cognitive functions at admission (adjusted R(2) = 55,8%).

CONCLUSIONS

Patients who started rehabilitation sooner and had a higher cognitive functionality at admission, showed the greatest increase in cognitive functionality gain percentage. Other variables like age, or scores on cognitive tests must also be considered in future studies.

Skull fracture, with or without clinical signs, in mTBI is an independent risk marker for neurosurgically relevant intracranial lesion: a cohort study

PRIMARY OBJECTIVE

To explore the possibility of identifying skull fracture, with or without clinical signs, as a predictor of positive CT scans in mild traumatic brain injury (mTBI).

RESEARCH DESIGN

Prospective cohort study, matched 1:1 for five potential confounding variables (age, sex, symptoms, mechanism of injury and extracranial trauma severity).

METHODS AND PROCEDURES

The study was performed on patients with mTBI (Glasgow Coma Scale 15-14), with or without radiologically demonstrated skull fracture. The cohort with skull fracture included 155 patients selected from a sample of 5097 mTBI patients treated during 1998 at the Critical Care and Emergency Department of the Trauma Centre. The cohort without skull fracture was prospectively recruited from patients with mTBI treated in the same department from 2002-2005.

MAIN OUTCOMES AND RESULTS

The percentage of patients with intracranial lesion (IL) was significantly higher in mTBI patients with skull fracture than in those without. The risk of requiring neurosurgery was 5-fold higher when skull fracture was present. Of mTBI patients with skull fracture and IL, 63.2% showed no clinical signs of bone injury.

CONCLUSIONS

Skull fracture, with or without clinical signs, in mTBI patients is associated with an increased risk of neurosurgically-relevant intracranial lesion.

Cognitive deterioration due to GH deficiency in patients with traumatic brain injury: A preliminary report

PRIMARY OBJECTIVE

To determine whether cognitive and behavioural disorders observed in TBI patients are due to hormonal deficits or to the brain injury itself.

RESEARCH DESIGN

Transversal, between-group design.

METHODS AND PROCEDURES

Studied 22 severe TBI patients (GCS < 8): 11 had isolated GH deficiency and 11 did not. Prepared detailed clinical reports on patients and performed physical examinations, standard biochemical and full blood count analysis. Patients underwent neuropsychological assessment and hormonal evaluation 6 months after TBI diagnosis.

RESULTS

TBI patients with GH deficiency show greater deficits in attention, executive functioning, memory and emotion than those without GH deficiency.

CONCLUSIONS

Results show GH-related cognitive impairment in patients who develop GH deficiency after TBI and suggest that treatment of GH deficiency would improve cognition. The clinical importance of these findings should be established to better understand the nature, magnitude and meaning of GH-related cognitive impairment in patients who develop GH deficiency after TBI.

The locked-in syndrome: a challenge for therapy

The locked-in syndrome (LIS) is a severe condition originated by a ventral pons lesion causing quadriplegia and anarthria but with a preserved consciousness. LIS seems to be a well defined clinical picture, although different problems still persist, such as the diagnosis as it is usually mistaken for akinetic mutism and a vegetative state; the unclear prognosis, because of the patient's psychological state and the lack of information and data concerning the different types of available treatment and the need for results. Rehabilitation is a challenge for physicians, new methods and techniques of specialized treatments for these patients are opening a new future that will allow us to abandon the initial pessimism. A more efficient rehabilitation of these patients depends on the intensity of the rehabilitation, the multidisciplinary approach, and duration of the treatment.

Dissociating arabic numeral reading and basic calculation: a case study

This study is about JS, a patient who suffered from anomia, phonological dyslexia and severe writing problems following a left hemispheric stroke. He showed good arabic numeral comprehension as evidenced in number-comparison tasks, but impairment in transcoding arabic numerals into verbal numbers and verbal numbers into arabic numerals. Although JS had several operand reading errors, the four arithmetic operations were not affected. In calculations with arabic numerals, he produced the correct results both in oral and written responses. For instance, when presented with the multiplication "7 x 3", JS read the operation as "four times five", but provided the correct response orally "twenty one" and written "21". This behavior goes against those hypotheses which posit that multiplication facts are verbally-based, and those which establish the same route for verbal number production in calculation and arabic numeral reading.

Neurobehavioural and cognitive profile of traumatic brain injury patients at risk for depression and suicide

The possibility that patients who have suffered a traumatic brain injury will commit suicide is high, and in many cases clinicians tend to underestimate this possibility. In this study, 39 consecutive patients are studied through a Rorschach technique more than 1.5 years after their hospital discharge. The data show that 48.6% of the patients fulfil the criteria that classifies them as depressive, and, of these, 65% are at clinical risk to commit suicide (33.3% of the total of TBI patients); 25.6% have not met the criteria of depression or suicidal tendencies, and another 25.6% show very low suicide tendency scores. Only 15.6% of the total patients presented only depression without risk of suicide. The neurobehavioural and cognitive profile of the TBI suicide-prone patient shows an emotional person with cognitive difficulties in how they interpret reality, the person tries to understand what is happening around them, but is unable to cope. They show concrete thoughts, although they have difficulties solving problems and have few intellectual resources to cope with their surroundings. They do not know how to distance themselves from the emotional aspects of situations.

[Pre-postoperative neuropsychological evaluation in the surgical treatment of epilepsy]

INTRODUCTION

Epilepsy is one of the most common neurological disorders, affecting about one percent of the world population. Pharmacological treatment fails in one-third of these patients. Surgical intervention has become an accepted treatment option for those patients with seizure disorders that are refractory to conventional therapies. Cortical resection and callosotomy are the most widely accepted methods of surgical intervention. A prerequisite for success in this type of surgical intervention is the preoperative clinical assessment of the epilepsy surgery candidate.

DEVELOPMENT

This paper examines the current uses of neuropsychological assessment in an epilepsy surgery program. Several areas are addressed for discussion with respect to the contributions of neuropsychological assessment: the preoperative evaluation of the epilepsy surgery candidates, including the clinical examination of language and memory functions during the Wada test; the neuropsychological changes that result from surgery and the predictive role of neuropsychology in these areas, and prediction for seizure control following surgery.

CONCLUSION

Assessment of cognitive functions is an important component of the preoperative evaluation of the epilepsy surgery candidate, and is needed in order to obtain complete diagnostic information.

Executive functioning as outcome in patients after traumatic brain injury

The present study was designed to determine how traumatic brain injury affect executive functioning, to know whether different treatments in the acute phase improve this functioning, and to check whether the severity of the neurocognitive impairment is detected by the Glasgow Outcome Scale (GOS). Ability for problem solving and executive functioning within 2 years after Traumatic Brain Injury (TBI) was examined in 35 conscious survivors. Two groups were formed. One group consisted of 13 patients who needed neurosurgery. The other group was made up of 22 patients without neurosurgical treatment. All were treated in the Neurosurgical Intensive Care Unit and in the Rehabilitation Service. The following variables were registered: Secondary Lesions, Glasgow Coma Scale (GCS), CT, subacute CT, and Glasgow Outcome Scale. Neuropsychological tests administered were Wisconsin Card Sorting Test (WCST) and the Tower of Hanoi/Sevilla. Comparing both groups' test performance (man Whitney U) we found that a severe traumatic brain injury, whatever the treatment applied in the acute phase, impairs the executive functioning of the patients; this impairment is related to acute pathophysiological events. The neurosurgical intervention does not improve the executive functioning. The Glasgow Outcome Scale does not detect more than 25% of the patients with severe impairment. It is suggested that the Tower of Hanoi/Sevilla could be a good tool to evaluate the executive functioning routinely in TBI patients as outcome. It also suggested that mild TBI patients must be referred for a complete neuropsychological examination.

The attentional system in brain injury survivors

The present study was designed to check the model of attention proposed by Posner and Petersen (1990), in patients with traumatic brain injury. We analyzed a series of neuropsychological tests administered to these patients after they were discharged from the hospital. Scores obtained from this group were subjected to factor analysis. The results of this analysis could be characterized by four factors which accounted for 85.4% of the variance. According to our data, factor 1 (perceptual and motor speed) and factor 2 (vigilance and alertness) represent Posner's posterior attention system. Factor 3 (encoding) and factor 4 (shifting) represent Posner's anterior attention system (AAS), but we have to consider that the AAS is not only attention but is shared by other cognitive processes. The results also suggest that the attention system could be stable and could be defined independently from the type of patient and type of illness.

[Visual constructive deficits and coma depth]

The present study has the purpose of relating the capacities of visual retention with the Benton Visual Retention Test and the level of coma depth, which is measured with the GCS (Glasgow Coma Scale). 31 subject suffering cranioencephalic damage admitted to the intensive care unit (ICU) have been studied. GCS scores were obtained during their stay in the intensive care unit and the Benton Visual Retention Test was administered after hospital discharge. The procedure followed consists in comparing the performance of subjects with higher GCS scores to subjects with lower values when executing administration. A of form C of BVRT. We could conclude as follows: firstly that BVRT is a useful tool to detect the existence of brain damage; secondly, indexes of brain damage presence with BVRT are: a low figure in correct design, more errors, less errors in distortion and rotation; more errors in the left visual hemifield. Thirdly, the depth of coma is a good prognosis index on BVRT execution and in consequence of visuo-constructive abilities.

Mental performance in long-term heavy cannabis use: a preliminary report

Mental performance of 23 male chronic cannabis users was measured on the 1958 Wechsler Adult Intelligence Scale and compared with scores of a control group. Analysis showed significant differences on nine of the 14 scores especially those indicating capacity for compromise, the elaboration of adequate judgments, and the capacity of verbalization and communication.