Cognitive Impairment in Moderate Degree Diffuse Axonal Head Injuries: Analysis of 84 Cases Using MMSEFinancial Disclosure None.
Background Cognitive impairment is commonly seen in traumatic brain injury survivors. Posttraumatic cognitive sequelae may be more devastating than focal motor and focal sensory deficits, and are usually left unattended.
Aim and Objective Aim of this study was to assess cognitive impairment in patients who had sustained moderate degree diffuse axonal injuries and having good outcome (Glasgow Outcome Score of 5).
Methods and Materials Prospective observational study was done from 2011 to 2015 on the patients who had sustained moderated degree diffuse brain injuries. Eighty-four cases fulfilling the inclusion criteria were studied. Patients were assessed with Mini-Mental Status Examination at discharge, end of 1 month, and at 3 months.
Result Seventy-six were males and 8 were females. Age ranged from 16 to 49 years. Note that 4.76% (4) patients had hypotension at presentation, 32.14% (27) patients had associated injuries, and 19.04% (16) patients had hyponatremia at presentation. Diabetes mellitus was seen in 34.52% (29) patients, while hypertension was seen in 14.28% (12). At 3 months’ follow-up, 19.06% (16) patients had cognitive impairment. The present study revealed that hypotension and presence of associated injuries at presentation raises the odds of having cognitive impairment by 8 and 5 times, respectively.
Conclusion Routine assessment of cognitive impairment in head injury survivors is essential as it may help in identifying cognitive deficits. Early intervention of neurorehabilitation to such patients results in better neurocognitive outcome. Hypotension and associated injuries are associated with poor cognitive outcome.
Keywordshead injury - diffuse axonal injury - cognitive impairment - Mini-Mental Status Examination
11 August 2020 (online)
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- 1 Dewan MC, Rattani A, Gupta S. et al. Estimating the global incidence of traumatic brain injury. J Neurosurg 2018; 1: 1-18
- 2 Mesulam M-M. Principles of Behavioural and Cognitive Neurology. 2nd ed. Philadelphia: FA Davis; 2000
- 3 Chaudhury S, Pande V, Saini R. et al. Neuropsychiatric sequelae of head injury. Indian J Neurotrauma 2005; 2: 13-21
- 4 Adams JH, Doyle D, Ford I, Gennarelli TA, Graham DI, McLellan DR. Diffuse axonal injury in head injury: definition, diagnosis and grading. Histopathology 1989; 15 (01) 49-59
- 5 Folstein MF, Folstein SE, McHugh PR. “Mini-mental state”. A practical method for grading the cognitive state of patients for the clinician. J Psychiatr Res 1975; 12 (03) 189-198
- 6 Arciniegas DB, Held K, Wagner P. Cognitive impairment following traumatic brain injury. Curr Treat Options Neurol 2002; 4 (01) 43-57
- 7 Scheid R, Walther K, Guthke T, Preul C, von Cramon DY. Cognitive sequelae of diffuse axonal injury. Arch Neurol 2006; 63 (03) 418-424
- 8 Veeramuthu V, Narayanan V, Kuo TL. et al. Diffusion tensor imaging parameters in mild traumatic brain injury and its correlation with early neuropsychological impairment: a longitudinal study. J Neurotrauma 2015; 32 (19) 1497-1509
- 9 Skandsen T, Finnanger TG, Andersson S, Lydersen S, Brunner JF, Vik A. Cognitive impairment 3 months after moderate and severe traumatic brain injury: a prospective follow-up study. Arch Phys Med Rehabil 2010; 91 (12) 1904-1913
- 10 Finnanger TG, Skandsen T, Andersson S, Lydersen S, Vik A, Indredavik M. Differentiated patterns of cognitive impairment 12 months after severe and moderate traumatic brain injury. Brain Inj 2013; 27 (13-14) 1606-1616
- 11 Leary JB, Kim GY, Bradley CL. et al. The association of cognitive reserve in chronic-phase functional and neuropsychological outcomes following traumatic brain injury. J Head Trauma Rehabil 2018; 33 (01) E28-E35
- 12 Miotto EC, Cinalli FZ, Serrao VT, Benute GG, Lucia MC, Scaff M. Cognitive deficits in patients with mild to moderate traumatic brain injury. Arq Neuropsiquiatr 2010; 68 (06) 862-868
- 13 Tombaugh TN, McIntyre NJ. The mini-mental state examination: a comprehensive review. J Am Geriatr Soc 1992; 40 (09) 922-935
- 14 Lee CN, Koh YC, Moon CT, Park DS, Song SW. Serial mini-mental status examination to evaluate cognitive outcome in patients with traumatic brain injury. Korean J Neurotrauma 2015; 11 (01) 6-10
- 15 Sharbafshaaer M. Impacts of cognitive impairment for different levels and causes of traumatic brain injury, and education status in TBI patients. Dement Neuropsychol 2018; 12 (04) 415-420
- 16 de Freitas Cardoso MG, Faleiro RM, de Paula JJ. et al. Cognitive impairment following acute mild traumatic brain injury. Front Neurol 2019; 10: 198
- 17 Reynolds S, Paniak C, Toller-Lobe G, Nagy J. A longitudinal study of compensation-seeking and return to work in a treated mild traumatic brain injury sample. J Head Trauma Rehabil 2003; 18 (02) 139-147
- 18 Vanderploeg RD, Curtiss G, Duchnick JJ, Luis CA. Demographic, medical, and psychiatric factors in work and marital status after mild head injury. J Head Trauma Rehabil 2003; 18 (02) 148-163
- 19 Willemse-van Son AH, Ribbers GM, Hop WC, Stam HJ. Community integration following moderate to severe traumatic brain injury: a longitudinal investigation. J Rehabil Med 2009; 41 (07) 521-527
- 20 Schütz C, Stover JF, Thompson HJ. et al. Acute, transient hemorrhagic hypotension does not aggravate structural damage or neurologic motor deficits but delays the long-term cognitive recovery following mild to moderate traumatic brain injury. Crit Care Med 2006; 34 (02) 492-501
- 21 McDonald SJ, Sun M, Agoston DV, Shultz SR. The effect of concomitant peripheral injury on traumatic brain injury pathobiology and outcome. J Neuroinflammation 2016; 13 (01) 90
- 22 Roberts RO, Knopman DS, Przybelski SA. et al. Association of type 2 diabetes with brain atrophy and cognitive impairment. Neurology 2014; 82 (13) 1132-1141