JNNP: Relationship between cognitive function and daily life function after brain trauma

Trauma brain injury (TBI) is the leading cause of disability, which is a huge burden on individuals and society.
more than half of patients with mild brain trauma report impaired function at 6 months, and more seriously, disabilities can last for years.
, the relationship between cognitive impairment and everyday function is not entirely clear.
dimensions of cognition were associated with the Glasgow Results Scale (GOSE), explaining the 31% difference in results.
, however, these studies were relatively small, with an average sample size of 135 (range 37-334).
, there is little information about cognitive performance at different levels of functional recovery.
reported that individuals with GOSE scores that recovered well performed poorly on cognitive tests.
possible explanations include unrecognized cognitive impairments found in objective tests, mismatches in standard data for testing, or the use of rough scales.
TBI center recruited 4,509 patients from 65 centers for core data collection.
they were evaluated by GOSE at a six-month time.
to record demographic and clinical data during acute periods, the Glasgow Coma Scale (GCS) is the preferred measure of assessment at the time of discharge from the emergency room and, if not, should be assessed as early as possible.
CT scan after an injury is used to diagnose imaging abnormalities.
follow-up with all patients at a 6-month point, which is the focus of this study.
GOSE is evaluated as a structured interview or a questionnaire completed by a patient or caregiver.
to create a GOS by focusing on scoring interviews and questionnaires and combining them as a preferred source (94 percent of assessments).
results of the GOSE are classified as: good recovery (8), moderate disability, severe disability (4).
SF-12v2 was completed by patients on 12 health-related quality of life assessments, providing an overall measure of overall functional outcomes, while a summary of psychological components assessed results related to mental health.
created a control group by spliting patients who reported full recovery (GOSE 8): GOSE 8a included patients with GCS=15 at the time of recruitment and no abnormalities in early CT, while GOSE 8b included remaining patients who recovered well.
investigates the distribution of individual test scores and applies a number 10 transformation to reduce the measurement variance from experiments a and B, select reaction time (RTI), pairing association learning (PAL), rapid visual processing (RVP), spatial working memory (SWM), and attention conversion task (AST) incubation period.
the GOSE classification using a single-factor co-variance analysis (ANCOVA) based on age, gender and education level.
conducted a six-month cognitive assessment of 1,554 of the 2,604 surviving patients and a GOS follow-up.
completion rates are influenced by the GOSE category: GOSE 3 patients had the lowest completion rates (8 to 21 percent in cognitive tests), followed by GOSE 4 patients (30 to 57 percent), while patients with higher GOSE results had significantly higher completion rates than those with higher RESULTS. Patients, generally around 70% (GOSE 5 59%-74%, GOSE 6 65%-81%, GOSE 7 62%-79%, GOSE 8 53%-69%).
current study provides two key information on this relationship: (1) identifying the cognitive areas most closely related to function in daily life;
in the current analysis, the overall relationship between processing speed and functional results is strongest.
addition to processing speed, learning memory and attention were associated with functional results, while measurements of the two executive functions showed the smallest differences in different types of results.
study allows for a more detailed examination of cognitive abilities at different levels of disability than before.
the most obvious evidence of cognitive impairment in the most disabled groups.
, as mentioned earlier, many patients with severe disabilities did not complete the tests, consistent with severe cognitive impairment in the group.
performance of patients with GOSE 5 also decreased significantly.
such persons may not participate in one or more major areas of activity, such as work or social and leisure activities.
diffuse whiteness is the key neuropathological basis for cognitive impairment and adverse daily life outcomes.
results, there were significant differences in psychological and physical health-related outcomes at a higher level of recovery than cognitive outcomes.
comparison with the SF-12v2 Physical Health Summary shows that the relative simplicity of GOSE explains the lack of cognitive differences in higher recovery levels: participants in GOSE 8a and GOSE 8b are close to health standards.
addition, there were significant differences in mental and physiological health outcomes of SF-12v2 in the GOSE 6-8b population, and there was no evidence to explain the similarity of cognitive performance between these groups.
between cognitive and mental health and functional outcomes after brain trauma.
cognitive impairment appears to be a key factor in low-level disabilities.
on the other hand, differences in mental health are prominent in higher levels of recovery.
the relationship between function and mental health in daily life is two-way, understanding mental health issues provides a clear focus for treatment, which can also improve functional outcomes.
study is the first cognitive study to be conducted in brain trauma and is sufficient to describe in detail the performance of different functional outcome levels.
there was little difference in cognitive performance among high-level outcomes.
this raises two key questions for future research.
first question relates to the drivers of outcomes and whether emotional and mental health factors play a key role in functional recovery.
second question concerns the nature and significance of cognitive impairment in these patients.
this large-scale study provides new insights into cognitive manifestations of varying degrees of disability and emphasizes the importance of processing speed in everyday life.
, the effect of cognition on overall function was significantly reduced and the difference in mental health was significant.
Wilson L, Horton L, Kunzmann K, et al Understanding the relationship between the cognitive performance and function in daily life after the brain brain injury Journal of Neurology, Neurosurgery Psython Published Online First: 02 December 2020. doi:10.1136/jnnp-2020-324492MedSci Original Source: MedSci Original Copyright Notice: All notes on this website "Source: Met Medical" or "Source: MedSci Original" text, images and audio and video materials, copyrighted by Met Medical, not authorized No media, website or individual may be reproduced, and authorization must be made with the "Source: Metz Medicine" in the authorizing the reprint.
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