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Understanding the relationship between cognitive performance and function in daily life after traumatic brain injury

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  • Lindsay Wilson
  • Lindsay Horton
  • Kevin Kunzmann
  • Barbara J Sahakian
  • Virginia Fj Newcombe
  • Emmanuel A Stamatakis
  • Nicole von Steinbuechel
  • Katrin Cunitz
  • Amra Covic
  • Andrew Maas
  • Dominique Van Praag
  • David Menon
  • CENTER-TBI Participants and Investigators
  • Martin Ejler Fabricius (Medlem af forfattergruppering)
  • Daniel Kondziella (Medlem af forfattergruppering)
Vis graf over relationer

Objective Cognitive impairment is a key cause of disability after traumatic brain injury (TBI) but relationships with overall functioning in daily life are often modest. The aim is to examine cognition at different levels of function and identify domains associated with disability. Methods 1554 patients with mild-to-severe TBI were assessed at 6 months post injury on the Glasgow Outcome Scale - Extended (GOSE), the Short Form-12v2 and a battery of cognitive tests. Outcomes across GOSE categories were compared using analysis of covariance adjusting for age, sex and education. Results Overall effect sizes were small to medium, and greatest for tests involving processing speed (I • p 2 0.057-0.067) and learning and memory (I • p 2 0.048-0.052). Deficits in cognitive performance were particularly evident in patients who were dependent (GOSE 3 or 4) or who were unable to participate in one or more major life activities (GOSE 5). At higher levels of function (GOSE 6-8), cognitive performance was surprisingly similar across categories. There were decreases in performance even in patients reporting complete recovery without significant symptoms. Medium to large effect sizes were present for summary measures of cognition (I • p 2 0.111), mental health (I • p 2 0.131) and physical health (I • p 2 0.252). Conclusions This large-scale study provides novel insights into cognitive performance at different levels of disability and highlights the importance of processing speed in function in daily life. At upper levels of outcome, any influence of cognition on overall function is markedly attenuated and differences in mental health are salient.

OriginalsprogEngelsk
TidsskriftJournal of neurology, neurosurgery, and psychiatry
Vol/bind92
Udgave nummer4
Sider (fra-til)407-417
Antal sider11
ISSN0022-3050
DOI
StatusUdgivet - 1 apr. 2021

Bibliografisk note

© Author(s) (or their employer(s)) 2020. No commercial re-use. See rights and permissions. Published by BMJ.

ID: 61991017