Early detection of cognitive impairments with the Montreal Cognitive Assessment in patients with uncomplicated and complicated mild traumatic brain injury.

OBJECTIVES: The Montreal Cognitive Assessement (MoCA) is a brief and standardized cognitive screening tool that has been used with several clinical populations. The aim of this study was to screen the early cognitive status of patients following mild traumatic brain injury (mTBI) with the MoCA. METHODS: The MoCA was administered within the first 2 weeks post-injury to 42 patients with uncomplicated mTBI, 92 patients with complicated mTBI and 50 healthy controls. RESULTS: Patients with complicated mTBI had a significantly lower performance (more impairments) on the total score of the MoCA than both the group with uncomplicated mTBI and the control group. Also, the group with uncomplicated mTBI had a significantly lower performance than controls. Moreover, age, education and TBI severity had a significant effect on the MoCA total score where younger, more educated and patients with less severe (higher GCS score) mTBI performed significantly better. CONCLUSIONS: The MoCA may be clinically useful to acutely screen cognition following mTBI.

Highlighting the differences in post-traumatic symptoms between patients with complicated and uncomplicated mild traumatic brain injury and injured controls.

OBJECTIVE: The goal of the current study is to explore the difference in acute post-concussive symptoms (PCS), headaches, sleep and mood complaints between groups of patients with complicated and uncomplicated mild traumatic brain injuries (mTBIs) and a comparable group of injured controls. Interactions among the following four factors were studied: presence of (1) PCS; (2) headaches; (3) sleep disorders; and (4) psychological status. METHODS: A total of 198 patients, followed at the outpatient mTBI clinic of the MUHC-MGH, completed questionnaires and a brief neurological assessment two weeks post-trauma. RESULTS: Whether they had a TBI or not, all patients presented PCS, headaches, sleep and mood complaints. No significant differences between groups in terms of reported symptoms were found. Variables such as depression and anxiety symptoms, as well as sleep difficulties and headaches were found to correlate with PCS. The high rate of PCS in trauma patients was observed independently of traumatic brain injury status. This study has also shown that patients with complicated mTBI were more likely to have vestibular impairment after their injury. CONCLUSION: The vestibular function should be assessed systematically after a complicated mTBI. Furthermore, the mTBI diagnosis should be based on operational criteria, and not on reported symptoms.

Prediction of behavioural and cognitive deficits in patients with traumatic brain injury at an acute rehabilitation setting.

OBJECTIVE: The goal of this study was to identify factors that would predict short-term neuropsychological outcome in patients with traumatic brain injury (TBI) hospitalized in an acute rehabilitation setting. METHODS: Data was collected in the context of an acute early rehabilitation setting of a trauma centre. A brief neuropsychological assessment was carried out for 348 patients within a month following their trauma. RESULTS: Length of post-traumatic amnesia (PTA) was the best predictor of behavioural, memory and executive function variables within a month post TBI. The odds of being agitated, labile, irritable and disinhibited at one month post trauma were almost six times higher for those with PTA that lasted more than 7 days compared to those with a PTA of less than 24 hours. Also, the odds of having a higher mental manipulation score (less significant executive function impairment) were almost two times lower for those with frontal lesions, and three to six times lower for those with PTA of more than 24 hours. In addition, TBI severity, education and age were considered good predictors of some aspects of neuropsychological outcome. CONCLUSION: This model may help clinicians and administrators recognize the probable post-traumatic deficits as quickly as possible and to plan interventions as well as post-acute discharge orientation accordingly and early on.

Olfactory function in acute traumatic brain injury.

OBJECTIVE: Traumatic brain injury (TBI) represents a significant public health problem and is associated with a high rate of mortality and morbidity. Although TBI is amongst the most common causes of olfactory dysfunction the relationship between injury severity and olfactory problems has not yet been investigated with validated and standardized methods in the first days following the TBI. METHODS: We measured olfactory function in 63 patients admitted with TBI within the first 12 days following the trauma by means of the Sniffin' Sticks identification test (quantitative assessment) and a parosmia questionnaire (qualitative assessment). TBI severity was determined by means of the Glasgow Coma Scale (GCS) and by duration of post-traumatic amnesia (PTA) as measured by the Galveston Orientation and Amnesia Test. RESULTS: Poor olfactory scores correlated with a longer amnesia period, but not with GCS scores. Further, we observed higher parosmia scores in assault victims than in victims of falls or motor vehicle collisions. CONCLUSIONS: We show that PTA is intimately related to olfactory problems following a TBI. Thus, a thorough evaluation of olfaction is essential in order to detect posttraumatic olfactory dysfunction and to take appropriate actions early on to help the individual deal with this impairment.

Olfactory and executive dysfunctions following orbito-basal lesions in traumatic brain injury.

OBJECTIVE: To study the acute relationship between olfactory function and traumatic brain injury (TBI), cognitive functions and outcome. METHODS: Sixty-two patients with TBI were evaluated within the first 2 weeks following TBI. The Sniffin'Sticks identification test was used to assess olfaction. A neuropsychological evaluation was carried out to assess attention, verbal fluency, naming, memory, problem-solving and mental flexibility. The extended Glasgow Outcome Scale (GOSE) and the Disability Rating Scale (DRS) were rated at discharge from acute care. RESULTS: Traumatic lesions located in the basal frontal area resulted in odour identification scores that were significantly lower than when lesions were elsewhere (p < 0.001). A significant positive correlation was shown between odour identification scores and mental flexibility scores (p = 0.004) and patients with hyposmia had worse performances on executive tests measuring problem-solving, verbal fluency and mental flexibility (p < 0.01). Moreover, the odour identification score and the DRS total score were related (p = 0.019). CONCLUSIONS: These findings add information regarding acute olfactory status following TBI and provide evidence on the importance of assessing olfaction very early post-TBI in order to plan intervention and determine what accident prevention advice will be required for home or work re-integration.

Prediction of the level of cognitive functional independence in acute care following traumatic brain injury.

PRIMARY OBJECTIVE: To determine a predictive model for cognitive functional outcome of patients with traumatic brain injury (TBI) at discharge from acute care. METHODS AND PROCEDURE: Three hundred and thirty-five patients were included in this analysis. Variables considered were age, education, initial score on the Glasgow Coma Scale (GCS), duration of post-traumatic amnesia (PTA), cerebral imaging results and the need for neurosurgical intervention. EXPERIMENTAL INTERVENTIONS: Functional Independence Measure (FIM). MAIN OUTCOMES AND RESULTS: Results of this analysis indicated better cognitive FIM at discharge from acute care settings for patients with TBI when PTA was less than 24 hours, when level of education was higher, when no parietal lesion was identified, when no neurosurgical intervention was required, for patients with TBI who were younger and who presented with a higher GCS score upon admission. CONCLUSIONS: This model will help to plan resource allocation for treatment and discharge planning within the first weeks following TBI.

Effect of an integrated reality orientation programme in acute care on post-traumatic amnesia in patients with traumatic brain injury.

PRIMARY OBJECTIVE: To assess the effect of an integrated reality orientation programme (North Star Project) in acute care on the duration of post-traumatic amnesia (PTA) of patients suffering from traumatic brain injury (TBI). It was hypothesized that those patients having participated in this programme would show a shorter PTA than those patients that did not. METHOD: Duration of PTA for 12 patients with TBI who were part of the North Star Project was compared with that of 26 patients matched for initial GCS and age for whom this approach was not available (control group). RESULTS: Length of PTA was shorter by 5 days for the North Star patients. This result was not statistically significant (p = 0.19) but is clinically relevant. No between-group difference was found for Glasgow Coma Scale. CONCLUSIONS: Consequences of shorter PTA would include increased and more appropriate patient interaction and earlier transfer to rehabilitation. The North Star project also allows the family to become more actively involved in the treatment of their loved one. Further study is required to evaluate this intervention strategy to improve orientation for the patient with TBI.